HCUP Facts and Figures
STATISTICS ON HOSPITAL-BASED CARE IN THE UNITED STATES, 2005
TABLE OF CONTENTS
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HIGHLIGHTS
HCUP Facts and Figures: Statistics on Hospital-based Care in the United States in 2005 presents information derived from the 2005 HCUP Nationwide Inpatient Sample (NIS) with trend information as far back as 1993. This report includes information from the most recent database containing discharge records for all patients treated in a sample of approximately 1,000 hospitals in 2005. These discharges are weighted to represent all inpatient stays in community hospitals across the nation. Community hospitals include all non-federal, short-term acute care hospitals and exclude psychiatric and substance abuse facilities.
Overall hospital statistics
- From 1997 to 2005, the number of community hospitals declined from 5,060 hospitals to 4,936 hospitals. Despite this decline, the volume of hospital stays grew by 4.5 million. Hospitals were able to accommodate this increase in discharges primarily because of a 4 percent reduction in the average length of stay.
- The average cost per hospital inpatient stay in 2005 was $7,900, up an average of 5.7 percent annually since 1997.
- After adjusting for inflation, the aggregate costs for all stays in community hospitals increased at a 5.1-percent average annual rate from 1997 to 2005. Population growth accounted for 1.1 percentage points of this growth, increases in the number of admissions per capita accounted for 0.4 percentage point, and 3.5 percentage points were attributable in part to increased service intensity resulting from new technology.
- Medicare and Medicaid together assumed primary financial responsibility for over half (57 percent) of all hospital stays in 2005. Medicaid paid for 1 out of 5 hospital stays.
- Six out of ten hospital stays had procedures associated with them, a proportion that has changed little since 1997.
Childbirth and newborns
- Among the most frequent reasons for hospitalizations were childbirth and newborns, which together accounted for nearly 1 out of 4 (23 percent) of all hospitalizations in 2005.
- C-section deliveries comprised 31 percent of all maternal discharges in 2005, up from a 21-percent rate that persisted from 1994 to 1998. The number of C-sections (first time and repeat) grew significantly (67 percent) between 1996 and 2005. The number of vaginal births after C-section fell 61 percent over the same period.
- The number of stays for prolonged pregnancy more than doubled from 104,000 in 1997 to 234,000 in 2005.
- In general, longer lengths of stay were associated with higher average charges. The two conditions with the longest hospital stays for all patients regardless of age were related to infants (infant respiratory distress syndrome; premature birth and low birth weight), with average stays 11 days longer than for the next longest stay diagnosis. Infant respiratory distress syndrome was also the condition with the highest average charge per stay ($114,200) overall.
Children
- For 1–17 year olds, hospitalizations with a principal diagnosis of asthma remained statistically unchanged (159,000 in 1997 and 139,000 in 2005).
- Mood disorders (depression and bipolar disorders) were the fifth most common reason for stays in acute care hospitals among children and adolescents.
Young adults and middle age
- Childbirth-related conditions were the most common reasons for hospitalizations among 18–44 year olds; however, mood disorders ranked third, accounting for 364,000 hospital stays in 2005—virtually unchanged since 1997.
- Cardiovascular conditions were the most common reasons for hospitalization among 45–64 year olds.
Elderly
- While people ages 65 and over represented 12 percent of the population in 2005, they comprised 34 percent of the hospitalizations.
- In 2005, there were 574 hospitalizations for every 1,000 adults ages 85 and older.
Specific diagnoses and procedures
- The number of hospital stays during which pressure sores were noted continued to increase in 2005. During the 12 year period since 1993, there was a 76 percent increase in pressure sore hospitalizations.
- Three out of four admissions for alcohol-related conditions in the 18–84 age group were for men. Uninsured patients accounted for 21 percent of all alcohol-related hospital stays, although only 5 percent of all stays were uninsured.
- Hospital stays for influenza varied widely by year. 1999, 2003 and 2005 were peak years for influenza hospitalizations.
- Of the top 20 costliest inpatient diagnoses, those for adult respiratory failure and/or arrest showed the most dramatic increase in inflation-adjusted cost from 2004 to 2005, growing at 12 times the rate for all diagnoses.
- The number of hospital stays for septicemia, or sepsis, increased 30 percent from 1997 to 2005. The inflation-adjusted cost of hospitalizations for septicemia increased at twice the rate for all diagnoses over this period.
- Conditions treated with expensive technology or requiring intensive care—including spinal cord injuries, heart valve disorders, and leukemia—had mean charges significantly higher than expected based on their average length of stay.
- Aggregate inpatient hospital costs adjusted for inflation increased 2.4 percent between 2004 and 2005. However, costs for half of the top 20 most costly conditions (mood disorders, newborn infants, stroke, heart attack, coronary artery disease, irregular heart beat, non-specific chest pain, congestive heart failure, diabetes with complications, and rehabilitation care) did not increase.
- Blood transfusions were the most common procedure performed during a hospitalization in 2005, occurring in 6 percent of all discharges.
Cardiovascular conditions and procedures
- Circulatory conditions accounted for 16 percent of all hospital stays in 2005. These stays were for diagnoses that included coronary artery disease, congestive heart failure, heart attack, and irregular heart beat.
- Six of the 20 most costly conditions associated with hospitalization were related to the heart. These six conditions (coronary artery disease, heart attack, congestive heart failure, irregular heart beat, stroke, and non-specific chest pain) together accounted for 17 percent of all community hospital costs in 2005.
- From 1997 to 2000, combined inflation-adjusted hospitalization costs for the most expensive cardiovascular conditions (coronary artery disease, heart attack, congestive heart failure, irregular heart beat, stroke, and non-specific chest pain) grew at progressively faster rates. Growth peaked in 2000 and then gradually slowed. In 2005, the combined inflation-adjusted costs for these conditions ($52 billion) were not statistically different from the costs in 2001 through 2004.
- The number of hospitalizations for congestive heart failure, non-specific chest pain, and irregular heart beat increased by 24 percent from 1997 to 2005. However, the volume of discharges with diagnoses of coronary artery disease and heart attack dropped by 17 percent over this period.
- Discharges for circulatory disease overall were essentially equally split between males and females, but differed for specific conditions. Four heart-related diagnoses—coronary artery disease, congestive heart failure, non-specific chest pain, and irregular heart beat—were among the ten most common principal diagnoses for both males and females. Heart attacks ranked as the fifth most common diagnosis among males, but only the twentieth most common among females.
- Diagnostic cardiac catheterization and arteriography (procedure to explore the functioning of the heart) was the second most frequently performed procedure overall for 2005.
- From 1993 to 2005, the volume of percutaneous transluminal coronary angioplasties (PTCA) nearly doubled. From 1993 to 1997, the number of coronary artery bypass grafts (CABG) increased, but from 1997 to 2005 the number of procedures fell by a third.
- Heart-related procedures—diagnostic cardiac catheterization and arteriography, PTCAs, and echocardiograms—were performed 50 percent more often on males than females.
- Two heart-related procedures—PTCA and cardiac catheterization and arteriography—were among the five most common procedures for individuals ages 45 and above.
Bariatric surgery
- From 1995 to 2004, the total number of bariatric surgeries increased 15-fold. These surgeries escalated rapidly beginning in 1998.
- However, in 2005, the number of bariatric surgeries performed did not continue to grow, after increasing from 8,000 in 1995 to 123,000 in 2004. An increase in surgeries performed in outpatient settings, increased insurer selectivity of approved providers, and removal of this procedure from insurance coverage were among the potential reasons for this change in trend.
Injuries
- Discharges with a diagnosis of poisoning by nonpsychiatric medications and drugs rose by 32 percent from 1997 through 2005, reflecting in part the increased use of pharmaceuticals.
- Hip fractures were the most common injury-related reason for hospitalization. They accounted for 317,000 hospital stays, involved a mean length of stay of 6.3 days, and resulted in an average hospital cost per stay of $12,300.
Musculoskeletal conditions and orthopedic procedures
- While the number of stays with any orthopedic procedure remained relatively constant between 1993 and 2000, the number of stays rose by 24 percent from 2000 to 2005.
- Of the most frequently performed orthopedic procedures, spinal fusion grew the most rapidly—nearly 140 percent over the 12-year period from 1993 to 2005. Arthroplasty of the knee and hip replacement were the second and third fastest growing reasons for hospitalizations related to orthopedic treatments, respectively. Knee arthroplasties grew 89 percent, and hip replacements grew 46 percent during this period.
Diabetes
- Diabetes-related hospitalizations occurred at a higher rate in lower income communities. There were almost 80 percent more diabetes admissions per 100,000 population among people residing in the lowest income communities (with incomes of $1–36,999) than in the highest income communities (with incomes of $61,000 and above).
FOREWORD
The mission of the Agency for Healthcare Research and Quality (AHRQ) is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. To help fulfill this mission, AHRQ develops a number of databases, including the powerful Healthcare Cost and Utilization Project (HCUP). HCUP is a Federal-State-Industry partnership designed to build a standardized, multi-State health data system. HCUP features databases, software tools, and statistical reports to inform policymakers, health system leaders, researchers, and the public.
For data to be useful, they must be disseminated in a timely, accessible manner. To meet this objective, AHRQ launched HCUPnet, an interactive, Internet-based tool for identifying, tracking, analyzing, and comparing statistics on hospital utilization, outcomes, and charges (http://hcupnet.ahrq.gov/). The HCUPnet user-friendly interface guides users in tailoring specific queries about hospital care online; with a click of a button, users receive answers within seconds.
To make HCUP data even more accessible, AHRQ disseminates HCUP Fact Books and online Statistical Briefs to present statistics about hospital care in easy-to-use and accessible formats
(http://www.hcup-us.ahrq.gov/reports.jsp). Fact Books provide information on broad aspects of hospital care. The most recent editions cover topics of mental health and substance abuse disorders, procedures performed in hospitals, ambulatory surgeries, and safety-net hospitals. Statistical Briefs provide information on more focused health care topics. The most recent editions address issues of methicillin-resistant Staphylococcus aureus (MRSA) infections, musculoskeletal procedures, emergency department admissions for children and adolescents, childbirth-related hospitalizations among adolescent girls, and prostate cancer.
The most recent addition to HCUP information sources is HCUP Facts and Figures, designed to showcase the wealth of statistics available from HCUP. This edition of HCUP Facts and Figures presents an overview of the information accessible through HCUP and illustrates the types of analyses that HCUP can address. This report also provides updates on many topics presented in previously published Fact Books and Statistical Briefs. New to this report are downloadable tables and graphs to make this information even more readily available.
We invite you to tell us how you are using HCUP Facts and Figures and other HCUP data and tools, and to share suggestions on how HCUP products might be enhanced to further meet your needs. Please e-mail us at hcup@ahrq.gov or send a letter to the address below.
Irene Fraser, Ph.D.
Director
Center for Delivery, Organization, and Markets
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
HCUP AND ITS DATA PARTNERS
HCUP is a family of powerful health care databases, software tools, and products for advancing research. Sponsored by the Agency for Healthcare Research and Quality (AHRQ), HCUP includes the largest all-payer encounter-level collection of longitudinal hospital inpatient, ambulatory surgery, and emergency department data in the United States. The HCUP Federal-State-Industry Partnership brings together the data collection efforts
of many organizations—State data organizations, hospital associations, private data organizations, and the Federal government—to create this national information resource. The HCUP Partnership has grown from 8 states in 1988 to 38 in 2007.
HCUP would not be possible without the current contributions of the following data collection Partners from across the United States:
Arizona Department of Health Services
Arkansas Department of Health & Human Services
California Office of Statewide Health Planning & Development
Colorado Health & Hospital Association
Connecticut Integrated Health Information (Chime, Inc.)
Florida Agency for Health Care Administration
Georgia GHA: An Association of Hospitals & Health Systems
Hawaii Health Information Corporation
Illinois Health Care Cost Containment Council and Department of Public Health
Indiana Hospital&Health Association
Iowa Hospital Association
Kansas Hospital Association
Kentucky Department for Public Health
Maryland Health Services Cost Review Commission
Massachusetts Division of Health Care Finance and Policy
Michigan Health & Hospital Association
Minnesota Hospital Association
Missouri Hospital Industry Data Institute
Nebraska Hospital Association
Nevada Division of Health Care Financing and Policy, Department of Human Resources
New Hampshire Department of Health & Human Services
New Jersey Department of Health & Senior Services
New York State Department of Health
North Carolina Department of Health and Human Services
Ohio Hospital Association
Oklahoma State Department of Health
Oregon Association of Hospitals and Health Systems
Rhode Island Department of Health
South Carolina State Budget & Control Board
South Dakota Association of Healthcare Organizations
Tennessee Hospital Association
Texas Department of State Health Services
Utah Department of Health
Vermont Association of Hospitals and Health Systems
Virginia Health Information
Washington State Department of Health
West Virginia Health Care Authority
Wisconsin Department of Health & Family Services
INTRODUCTION
Accurate and reliable hospital information is of vital importance—for a researcher investigating treatment outcomes, for a newly-diagnosed patient seeking information on the frequency with which procedures are performed, or for hospital executives researching medical trends to support purchasing decisions. The Healthcare Cost and Utilization Project (HCUP) can provide comprehensive information to help fulfill these and other needs.
Sponsored by the Agency for Healthcare Research and Quality (AHRQ), HCUP is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership, creating a national information resource
of patient-level discharge health care data.
HCUP is only possible through the collective efforts of State and private data organizations, hospital associations, and the Federal government to create the single largest all-payer discharge record resource from all hospitals in the U.S.—representing more than 4,900 community, non-Federal, short-term (acute care) general and specialty hospitals. Data on conditions treated in the hospital, as well as information on medical and surgical procedures are included. HCUP data are ideal for analyzing treatment use and diagnostic trends, examining patient characteristics, conducting cost and charge studies, and investigating quality of care.
The most popular HCUP database is the Nationwide Inpatient Sample (NIS), the largest all-payer database in the U.S. The NIS contains all discharge records from approximately 1,000 hospitals in HCUP-participating states. This broad-based collection of data provides information on patient and hospital demographics, diagnoses, procedures, charges, estimated costs, payers, source of admission and discharge destinations.
HCUP Facts and Figures highlights the rich potential of HCUP by providing targeted analysis of important trends organized around high-interest topics—hospital and discharge characteristics, diagnoses, procedures, costs and charges, and the uninsured. This report was designed to illustrate the range of information available from the HCUP NIS and its capacity to track the evolution of hospital use over time.
Many of the statistics presented in this report are available online through HCUPnet (http://hcupnet.ahrq.gov/). Graphical presentations, statistical tables, and bulleted notes highlight key facts and emerging trends for each topic. Downloadable tables, charts, and links to Definitions are available online by clicking on links throughout the report. In addition, a separate file containing downloadable tables and charts is available at http://www.hcup-us.ahrq.gov/reports.jsp.
HCUP has been a leader in hospital data and products and continues to be on the forefront of health care research in the 21st century. For more information, please visit the HCUP website at http://www.hcup-us.ahrq.gov.
OVERVIEW STATISTICS FOR HOSPITALS AND INPATIENT HOSPITAL STAYS
(text version)
Number of U.S. Registered Hospitals and Characteristics of Community Hospitals, 1997, 2004, and 2005
| Hospital Categories and Characteristics |
1997 |
2004 |
2005 |
| Number of U.S. registered hospitals† |
6,100 |
5,759 |
5,756 |
| Number of U.S. community hospitals |
5,060 |
4,919 |
4,936 |
| Number of non-government not-for-profit hospitals |
3,000 |
2,967 |
2,958 |
| Number of investor-owned (for-profit) community hospitals |
797 |
865 |
868 |
| Number of State and local government community hospitals |
1,260 |
1,117 |
1,110 |
| Community hospitals as a share of registered hospitals |
83% |
85% |
86% |
| |
| Community hospitals‡ |
|
|
|
| Discharges: |
|
|
|
| Total discharges in millions |
34.7 |
38.7 |
39.2 |
| Discharges per 1,000 population* |
127.8 |
131.7 |
132.1 |
| Total days of care in millions |
168.1 |
179.1 |
181.5 |
| Average length of stay in days |
4.8 |
4.6 |
4.6 |
| |
| Percent of discharges from: |
|
|
|
| Metropolitan hospitals |
84% |
87% |
87% |
| Teaching hospitals |
47% |
45% |
42% |
| Hospital ownership: |
|
|
|
| Non-Federal government hospitals |
14% |
14% |
14% |
| Private not-for-profit hospitals |
73% |
73% |
72% |
| Private for-profit hospitals |
13% |
13% |
13% |
| |
| Population in millions†† |
271.4 |
293.7 |
296.4 |
† Statistics from the American Hospital Association's Annual Survey of Hospitals.
‡ Statistics from the Healthcare Cost and Utilization Project (HCUP).
* Calculated using population from the U.S. Bureau of the Census.
†† Statistics from the U.S. Bureau of the Census (http://www.census.gov/popest/national/asrh/2005_nat_res.html).
Hospital costs rose rapidly and most hospital characteristics changed slowly over time.
- Of the 5,756 registered hospitals in the U.S. in 2005, 86 percent were community hospitals, a proportion that has changed little over time.
- However, the actual number of community hospitals declined from 5,060 in 1997 to 4,936 in 2005.
- Despite the decline in the number of community hospitals, discharges from those hospitals grew from 34.7 million in 1997 to 39.2 million in 2005, an average annual increase of 1.5 percent per year.
- The percent of community hospital discharges has changed little in terms of location, teaching status, and type of ownership.
(text version)
Charges and Costs for Community Hospital Stays, 1997, 2004, and 2005
| Hospital Categories and Characteristics |
1997 |
2004 |
2005 |
| Charges and Costs* |
| Average charges per stay |
$11,300 |
$20,400 |
$22,300 |
| Costs |
| Total aggregate costs in billions |
$177.1 |
$294.6 |
$310.9 |
| Average costs per stay |
$5,100 |
$7,600 |
$7,900 |
| Inflation-adjusted costs in 2005 dollars** |
| Total aggregate costs in billions |
$209.2 |
$303.5 |
$310.9 |
| Average costs per stay |
$6,000 |
$7,900 |
$7,900 |
* Charges represent amounts billed by hospitals. These amounts are seldom paid in full by insurers. Costs are calculated from charges using reported cost-to-charge ratios calculated from information on Medicare Cost Reports, reported by hospitals to the Centers for Medicare and Medicaid Services (CMS).
**Adjusted for inflation using the GDP deflator (http://www.bea.gov/national/nipaweb/TableView.asp#Mid, Table 1.1.4. Price Indexes for Gross Domestic Product).
- The average charge on the typical bill from a U.S. community hospital rose from $11,300 in 1997 to $22,300 in 2005, an increase of 8.9 percent per year in actual dollars. Few patients or insurers paid those amounts because of discounts negotiated by insurers with hospitals.
- The aggregate cost for stays in community hospitals rose significantly between 1997 and 2005, from $177.1 billion to $310.9 billion, reflecting an average annual increase of 7.3 percent. On a per-stay basis, cost increases averaged 5.7 percent annually, resulting in an average cost per stay of $7,900 in 2005.
- After adjusting for inflation, the total cost for hospital stays nationwide rose 5.1 percent per year over the 8 years.
- Of this increase, population growth accounted for 1.1 percentage points, increases in the number of admissions per population accounted for 0.4 percentage point (a possible effect of the gradual aging of the population), and the remainder—3.5 percentage points—was attributable, in part, to costs associated with increased service intensity from the expanded use of new technology.
EXHIBIT 1.2 Inpatient Hospital Stays and Average Length of Stay
(text version)
The average length of stay in U.S. community hospitals has stabilized since 2000, while the number of hospital stays continued to rise.
- The average length of stay (ALOS) in 2005 was 4.6 days—almost 20 percent shorter than in 1993, when the ALOS was 5.7 days. The ALOS declined throughout most of the 1990s and has stabilized in the current decade.
- The number of discharges has increased over the past 12 years, from 34.3 million discharges in 1993 to 39.2 million in 2005.
- From 1993 to 1998, the number of discharges grew very slowly, increasing by only 0.6 million.
- Growth in the number of discharges (an average of 0.3 percent annually) did not keep pace with the growth in population (1.2 percent annually).
- It is likely that the rapid growth in managed care plans slowed growth in hospital utilization.
- From 1998 through 2005, the number of discharges rose by 4.3 million.
- Growth in the number of discharges (an average of 1.7 percent annually) exceeded population growth
(1.1 percent annually).
- From 1998 to 2001, low unemployment and the need for employers to attract and retain workers through generous health benefits produced a loosening of care management by insurance plans.1
- Since 2001, growth in the number of discharges has slowed to rates that are only slightly faster than population growth (1.1 to 1.3 percent annually).
1Forrest S, Goetghebeur M, Hay J. Forces Influencing Inpatient Hospital Costs in the United States.
Available at http://www.bcbs.com/betterknowledge/cost/underlying-drivers.html.
EXHIBIT 1.3 Reasons for Hospital Stays
(text version)
Circulatory conditions were the most frequent causes of hospital stays.
- Circulatory conditions accounted for 16 percent of all hospital stays in 2005. These stays were for diagnoses such as coronary atherosclerosis (coronary artery disease), congestive heart failure, heart attack, and irregular heart beat.
- Pregnancy and childbirth (12 percent) and newborns (11 percent) ranked second and third among reasons for hospitalizations. Stays related to giving birth or being born accounted for 23 percent of discharges—nearly one in four hospital stays.
- Together with respiratory conditions (10 percent of all discharges) and digestive conditions (9 percent of all discharges), the top five conditions accounted for 58 percent of all discharges.
Circulatory conditions represented a higher percentage of stays for males (20 percent) than females (13 percent).
- Males accounted for 16.1 million stays in 2005, or 41 percent of all hospitalizations.
- Of these stays, 20 percent were for circulatory conditions, 14 percent were for newborns, 12 percent were for respiratory conditions, and 9 percent involved conditions of the digestive system.
- These four conditions together amounted to 55 percent of all hospitalizations for males in 2005.
- Females accounted for 23.0 million stays, or 59 percent of all hospital stays in 2005.
- Twenty percent of the stays for females were related to pregnancy and childbirth and 9 percent were for female newborns.
- Compared to the stays for males, stays for circulatory conditions (13 percent of all stays) were a smaller percentage of all female stays.
- Other major reasons for female hospitalizations included respiratory conditions (9 percent) and digestive system conditions (8 percent).
- These five conditions together accounted for almost 60 percent of all female hospitalizations in 2005.
(text version)
EXHIBIT 1.4 Admission Source
(text version)
Admission source in HCUP indicates routine admission and other specific settings from which the patient might enter the hospital.
- About half (51 percent) of all admissions to hospitals in 2005 were routine admissions referred by health professionals.
- Emergency departments accounted for the second largest source of admissions (43 percent).
- Two other settings accounted for a small proportion of admissions: Other short-term hospitals (3 percent) and long-term care facilities (1 percent).
- The remainder of admissions came from court/law enforcement sources or other unknown sources.
Exhibit 1.5 Discharge Status
(text version)
Discharge status indicates where the patient went after discharge from the hospital or the circumstance surrounding the discharge.
- The most common patient discharge status was routine (74 percent in 2005), with the patient being sent home
without closely supervised health care.
- Discharge to a long-term care facility was the second most common type of discharge, accounting for 12 percent of discharges.
- Discharge to the home with home health care supervision accounted for 9 percent of discharges.
- Remaining discharge circumstances (to another short-term hospital, in-hospital death, or when the patient leaves against medical advice) each accounted for 2 percent or less of discharges.
Exhibit 1.6 Patient Age
(text version)
Older people account for a large share of hospitalizations.
- While those aged 65 and over represented 12 percent of the population in 2005, they comprised 34 percent of the hospitalizations
- The younger patient age groups had a lower proportion of hospitalizations relative to their representation in the population.
- Patients 18–64 years of age, at 63 percent of the population, accounted for 48 percent of hospitalizations.
- Those under age 18, at 25 percent of the population, accounted for 18 percent of hospitalizations.
(text version)
Discharges for an age group divided by the number of people in that age group (discharges per 1,000 population) shows that increased age is often associated with a greater chance of hospitalization.
- While there were only 42 hospital stays for every 1,000 children ages 1 to 4 in 2005, there were 574 stays for every 1,000 adults ages 85 and over.
- The one exception to the pattern of increasing hospitalizations with increasing age was for neonates less than 1 year of age. This group experienced 1,212 hospitalizations per 1,000 neonates, because nearly all births occur in the hospital and some infants require additional hospitalization in the first year of life.
(text version)
The expected primary payer bears the major financial responsibility for the hospital stay. However, other payers, including the patients themselves, may also bear part of the cost of hospitalization.
- Medicare and Medicaid together assumed primary financial responsibility for over half of all hospital stays in 2005.
- Medicare was the expected primary payer for 37 percent of all inpatient hospital discharges (14.6 million hospital stays). Medicare patients are 65 and older or disabled.
- Medicaid was the expected primary payer for 1 out of every 5 hospital stays (7.6 million discharges) in 2005. These may include stays for patients covered by the State Children’s Health Insurance Program (SCHIP), depending on the state in which the hospital was located.
- Private insurance was the expected primary payer for 35 percent of all discharges (13.7 million hospital stays). These stays were primarily for employed persons and their families who receive health insurance coverage through their employers.
- Approximately 5 percent of all stays (2.1 million discharges) were listed as uninsured.
- Other payers accounted for 3 percent of all stays in 2005.
HOSPITAL INPATIENT STAYS BY DIAGNOSIS
(text version)
Number of Discharges, Percent Distribution, and Rank of Most Frequent Principal Diagnoses for Inpatient Hospital Stays, 1997, 2004, 2005
| PRINCIPAL DIAGNOSIS |
NUMBER OF DISCHARGES IN THOUSANDS |
PERCENT OF DISCHARGES |
RANK |
| 1997
| 2004
| 2005
| 1997
| 2004
| 2005
| 1997
| 2004
| 2005
|
| All discharges |
34,679 |
38,662 |
39,164 |
100.0 |
100.0 |
100.0 |
|
|
|
| Pregnancy, childbirth, and infants |
8,237 |
9,175 |
9,145 |
23.8 |
23.7 |
23.4 |
1 |
1 |
1 |
| Pneumonia (except that caused by tuberculosis or sexually transmitted disease) |
1,232 |
1,213 |
1,355 |
3.6 |
3.1 |
3.5 |
3 |
2 |
2 |
| Coronary atherosclerosis (coronary artery disease) |
1,407 |
1,192 |
1,110 |
4.1 |
3.1 |
2.8 |
2 |
3 |
3 |
| Congestive heart failure, nonhypertensive |
991 |
1,104 |
1,090 |
2.9 |
2.9 |
2.8 |
4 |
4 |
4 |
| Non-specific chest pain |
538 |
846 |
825 |
1.6 |
2.2 |
2.1 |
10 |
5 |
5 |
| Osteoarthritis (degenerative joint disease) |
418 |
659 |
738 |
1.2 |
1.7 |
1.9 |
17 |
9 |
6 |
| Mood disorders (depression and bipolar disorder) |
641 |
792 |
713 |
1.8 |
2.0 |
1.8 |
6 |
6 |
7 |
| Cardiac dysrhythmias (irregular heart beat) |
572 |
694 |
697 |
1.7 |
1.8 |
1.8 |
8 |
8 |
8 |
| Acute myocardial infarction (heart attack) |
732 |
695 |
662 |
2.1 |
1.8 |
1.7 |
5 |
7 |
9 |
| Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones in spinal column) |
536 |
616 |
647 |
1.5 |
1.6 |
1.7 |
11 |
10 |
10 |
| Chronic obstructive pulmonary disease and bronchiectasis (chronic obstructive lung disease) |
551 |
556 |
630 |
1.6 |
1.4 |
1.6 |
9 |
12 |
11 |
| Complication of medical device, implant or graft |
491 |
601 |
616 |
1.4 |
1.6 |
1.6 |
12 |
11 |
12 |
| Skin and subcutaneous tissue infections |
330 |
505 |
582 |
1.0 |
1.3 |
1.5 |
24 |
16 |
13 |
| Fluid and electrolyte disorders (primarily dehydration or fluid overload) |
468 |
555 |
574 |
1.4 |
1.4 |
1.5 |
13 |
13 |
14 |
| Septicemia (blood infection, except in labor) |
413 |
452 |
538 |
1.2 |
1.2 |
1.4 |
18 |
21 |
15 |
| All maternal discharges |
4,338 |
4,763 |
4,716 |
100.0 |
100.0 |
100.0 |
|
|
|
| Trauma to external female genitals (vulva) and area between anus and vagina (perineum), related to childbirth |
713 |
785 |
784 |
16.4 |
16.5 |
16.6 |
1 |
1 |
1 |
| Previous C-section |
271 |
456 |
481 |
6.3 |
9.6 |
10.2 |
4 |
2 |
2 |
| Normal pregnancy and/or delivery |
544 |
338 |
325 |
12.5 |
7.1 |
6.9 |
2 |
3 |
3 |
| Early or threatened labor |
261 |
255 |
236 |
6.0 |
5.4 |
5.0 |
5 |
4 |
4 |
| Fetal distress and abnormal forces of labor |
420 |
247 |
234 |
9.7 |
5.2 |
5.0 |
3 |
5 |
5 |
| Prolonged pregnancy |
104 |
218 |
234 |
2.4 |
4.6 |
5.0 |
11 |
8 |
6 |
| Hypertension complicating pregnancy, childbirth and the puerperium (high blood pressure during pregnancy) |
185 |
224 |
220 |
4.3 |
4.7 |
4.7 |
8 |
7 |
7 |
| Umbilical cord complication |
259 |
235 |
217 |
6.0 |
4.9 |
4.6 |
6 |
6 |
8 |
| Polyhydramnios and other problems of amniotic cavity (excess amniotic fluid and other problems of amniotic cavity) |
202 |
192 |
191 |
4.7 |
4.0 |
4.1 |
7 |
9 |
9 |
| All infant discharges |
3,899 |
4,411 |
4,429 |
100.0 |
100.0 |
100.0 |
|
|
|
| Liveborn (newborn infant) |
3,777 |
4,249 |
4,228 |
96.9 |
96.3 |
95.5 |
1 |
1 |
1 |
| Other perinatal conditions (other conditions occurring around the time of birth) |
56 |
72 |
94 |
1.4 |
1.6 |
2.1 |
2 |
2 |
2 |
| Hemolytic jaundice and perinatal jaundice (infant jaundice following birth) |
33 |
47 |
57 |
0.8 |
1.1 |
1.3 |
3 |
3 |
3 |
| Short gestation, low birth weight, and fetal growth retardation (premature birth and low birth weight) |
22 |
25 |
31 |
0.6 |
0.6 |
0.7 |
4 |
4 |
4 |
| Infant respiratory distress syndrome |
8 |
16 |
16 |
0.2 |
0.4 |
0.4 |
5 |
5 |
5 |
| Birth trauma |
1 |
1 |
1 |
0.0 |
0.0 |
0.0 |
7 |
6 |
6 |
| Intrauterine hypoxia and birth asphyxia (lack of oxygen to baby in uterus or during birth) |
1 |
1 |
1 |
0.0 |
0.0 |
0.0 |
6 |
7 |
7 |
| Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 1997, 2004 and 2005. |
The top 15 most frequently occurring principal diagnoses accounted for half of all discharges in 2005. While 12 of the 15 most frequent principal diagnoses in 2005 were among the most frequent diagnoses in 1997, there were notable changes within the rankings.
Among all discharges:
- Conditions related to pregnancy, childbirth, and infants were by far the most frequent reason for hospitalizations, at 23 percent of discharges in 2005, and were unchanged in rank across the years.
- Pneumonia was the second most common principal diagnosis, at 3.5 percent of discharges in 2005.
- Circulatory diseases accounted for 5 of the top 10 most frequent principal diagnoses in 2005, as they did in 1997
and 2004.
- The volume of stays for congestive heart failure, non-specific chest pain, and irregular heart beat increased over this period.
- However, the volume of stays for coronary artery disease (coronary atherosclerosis) and for heart attack (acute myocardial infarction) dropped noticeably between 1997 and 2005.
- Heart attack stays dropped in rank from fifth in 1997 to ninth in 2005.
- Diagnosis of degenerative joint disease (osteoarthritis) grew by over 75 percent in volume between 1997 and 2005, and thus moved from seventeenth to sixth among the most common principal diagnoses.
- Skin and subcutaneous tissue infections moved from the twenty-fourth most frequent diagnosis in 1997 to the thirteenth in 2005. Hospitalizations for these infections grew from 330,000 to 582,000, a 76 percent increase over that time period.
Among maternal and infant discharges:
- Stays for normal pregnancy and/or delivery and for fetal distress and abnormal forces of labor both declined by more than 40 percent from 1997 to 2005, and, in turn, fell in rank.
- The volume of prolonged pregnancies doubled from 1997 through 2005 and moved up in the ranking of all causes for maternal discharges from 11th to 6th.
- High blood pressure during pregnancy, umbilical cord complication, and excess amniotic fluid and other problems of the amniotic cavity accounted for about 14 percent of principal diagnoses of all maternal discharges in 1997, 2004, and 2005.
- About 95 percent of all infant discharges in 2005 had a principal diagnosis of "newborn infant," while conditions such as infant jaundice, premature birth and low birth weight, and respiratory distress syndrome accounted for the remaining 5 percent of these discharges.
(text version)
Number of Discharges and Percent Distribution of the Most Frequent Principal Diagnoses by Age, 1997, 2004, 2005
| AGE GROUP AND PRINCIPAL DIAGNOSIS |
NUMBER OF DISCHARGES IN THOUSANDS |
PERCENT OF DISCHARGES |
PERCENT OF AGE-SPECIFIC TOTAL DISCHARGES |
| 1997
| 2004
| 2005
| 1997
| 2004
| 2005
| 1997
| 2004
| 2005
|
| All ages* |
34,679 |
38,662 |
39,164 |
|
|
|
|
|
|
| ‹ 1 year |
4,426 |
4,898 |
4,978 |
12.8 |
12.7 |
12.7 |
100.0 |
100.0 |
100.0 |
| Liveborn (newborn infant) |
3,776 |
4,244 |
4,223 |
10.9 |
11.0 |
10.8 |
85.3 |
86.7 |
84.8 |
| Acute bronchitis |
108 |
112 |
107 |
0.3 |
0.3 |
0.3 |
2.4 |
2.3 |
2.2 |
| Hemolytic jaundice and perinatal jaundice (infant jaundice following birth) |
33 |
47 |
56 |
0.1 |
0.1 |
0.1 |
0.7 |
1.0 |
1.1 |
| Pneumonia (except that caused by tuberculosis or sexually transmitted disease) |
55 |
39 |
43 |
0.2 |
0.1 |
0.1 |
1.3 |
0.8 |
0.9 |
| Short gestation, low birth weight, and fetal growth retardation (premature birth and low birth weight) |
22 |
25 |
31 |
0.1 |
0.1 |
0.1 |
0.5 |
0.5 |
0.6 |
| 1-17 years |
1,821 |
1,784 |
2,059 |
5.3 |
4.6 |
5.3 |
100.0 |
100.0 |
100.0 |
| Pneumonia (except that caused by tuberculosis or sexually transmitted disease) |
135 |
108 |
142 |
0.4 |
0.3 |
0.4 |
7.4 |
6.0 |
6.9 |
| Asthma |
159 |
133 |
139 |
0.5 |
0.3 |
0.4 |
8.7 |
7.4 |
6.8 |
| Fluid and electrolyte disorders (primarily dehydration or fluid overload) |
64 |
79 |
98 |
0.2 |
0.2 |
0.3 |
3.5 |
4.4 |
4.8 |
| Appendicitis and other appendiceal conditions |
65 |
82 |
90 |
0.2 |
0.2 |
0.2 |
3.6 |
4.6 |
4.3 |
| Mood disorders (depression and bipolar disorder) |
64 |
84 |
73 |
0.2 |
0.2 |
0.2 |
3.5 |
4.7 |
3.6 |
| 18-44 years |
9,444 |
10,323 |
10,041 |
27.2 |
26.7 |
25.6 |
100.0 |
100.0 |
100.0 |
| Trauma to external female genitals (vulva) and area between anus and vagina (perineum), related to childbirth |
676 |
754 |
753 |
1.9 |
2.0 |
1.9 |
7.2 |
7.3 |
7.5 |
| Previous C-section |
270 |
453 |
478 |
0.8 |
1.2 |
1.2 |
2.9 |
4.4 |
4.8 |
| Mood disorders (depression and bipolar disorder) |
335 |
416 |
364 |
1.0 |
1.1 |
0.9 |
3.5 |
4.0 |
3.6 |
| Normal pregnancy and/or delivery |
511 |
323 |
312 |
1.5 |
0.8 |
0.8 |
5.4 |
3.1 |
3.1 |
| Fetal distress and abnormal forces of labor |
399 |
238 |
224 |
1.2 |
0.6 |
0.6 |
4.2 |
2.3 |
2.2 |
| 45-64 years |
6,496 |
8,546 |
8,660 |
18.7 |
22.1 |
22.1 |
100.0 |
100.0 |
100.0 |
| Coronary atherosclerosis (coronary artery disease) |
526 |
492 |
461 |
1.5 |
1.3 |
1.2 |
8.1 |
5.8 |
5.3 |
| Non-specific chest pain |
242 |
396 |
388 |
0.7 |
1.0 |
1.0 |
3.7 |
4.6 |
4.5 |
| Osteoarthritis (degenerative joint disease) |
105 |
235 |
272 |
0.3 |
0.6 |
0.7 |
1.6 |
2.7 |
3.1 |
| Pneumonia (except that caused by tuberculosis or sexually transmitted disease) |
199 |
246 |
271 |
0.6 |
0.6 |
0.7 |
3.1 |
2.9 |
3.1 |
| Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones in spinal column) |
190 |
249 |
266 |
0.5 |
0.6 |
0.7 |
2.9 |
2.9 |
3.1 |
| 65+ years |
12,482 |
13,059 |
13,374 |
36.0 |
33.8 |
34.2 |
100.0 |
100.0 |
100.0 |
| Congestive heart failure, nonhypertensive |
783 |
820 |
815 |
2.3 |
2.1 |
2.1 |
6.3 |
6.3 |
6.1 |
| Pneumonia (except that caused by tuberculosis or sexually transmitted disease) |
711 |
713 |
781 |
2.0 |
1.8 |
2.0 |
5.7 |
5.5 |
5.8 |
| Coronary atherosclerosis (coronary artery disease) |
810 |
641 |
596 |
2.3 |
1.7 |
1.5 |
6.5 |
4.9 |
4.5 |
| Cardiac dysrhythmias (irregular heart beat) |
402 |
477 |
469 |
1.2 |
1.2 |
1.2 |
3.2 |
3.7 |
3.5 |
| Osteoarthritis (degenerative joint disease) |
300 |
405 |
419 |
0.9 |
1.0 |
1.1 |
2.4 |
2.9 |
3.1 |
| Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. *Includes a small number of discharges (less than 55,000 or 0.1 percent) with missing age. |
The principal diagnoses for hospitalizations generally varied by age. Older patients were more frequently admitted with cardiovascular and musculoskeletal conditions and younger patients were more frequently admitted with pregnancy- and childbirth-related conditions.
- Pneumonia was a top five condition for four out of the five age groups in 2005—children under 1 year of age, children ages 1–17, adults ages 45–64, and adults 65 and above.
- Asthma was the second most common reason for hospital admission among children ages 1–17.
- Mood disorders (depression and bipolar disorders) were the fifth and third most common diagnoses among children ages 1–17 and adults ages 18–44, respectively. For the 18–44 age group, this was the only non-childbirth diagnosis to rank among the top five diagnoses.
- Cardiovascular conditions were the most common diagnoses for adults ages 45 and above. However, specific diagnoses differed somewhat between age groups for older adults:
- Coronary atherosclerosis (coronary artery disease) and non-specific chest pain were the most frequent cardiac conditions for adults ages 45–64.
- Congestive heart failure, coronary atherosclerosis, and irregular heart beat were the most common cardiac conditions for adults 65 years and older.
- For patients ages 45 and older, the number of discharges with a principal diagnosis of coronary atherosclerosis dropped over time, but remained among the top 3 reasons for hospitalization.
- For individuals ages 45–64, hospital stays for coronary atherosclerosis dropped by 12 percent—from 526,000 in 1997 to 461,000 in 2005.
- For those 65 years and older, hospital stays for coronary atherosclerosis declined by 26 percent—from 810,000 in 1997 to 596,000 in 2005.
- Among 45–64 year olds, discharges with a principal diagnosis of non-specific chest pain rose by 60 percent from 1997 to 2005.
- Among individuals 65 and older, hospital stays for congestive heart failure exhibited very little change between 1997 and 2005.
- Among individuals 65 and older, hospital stays for irregular heart beat rose 19 percent between 1997 and 2004, but stabilized between 2004 and 2005.
(text version)
Number of Discharges,* Percent Distribution, and Rank of Most Frequent Principal Diagnoses for Inpatient Hospital Stays by Gender, 2005
| PRINCIPAL DIAGNOSIS |
MALES |
FEMALES |
| NUMBER OF DISCHARGES IN THOUSANDS |
PERCENT OF MALE DISCHARGES |
RANK |
NUMBER OF DISCHARGES IN THOUSANDS |
PERCENT OF FEMALE DISCHARGES |
RANK |
| All diagnoses |
16,053 |
100.0 |
|
22,980 |
100.0 |
|
| Pregnancy and childbirth |
- |
- |
- |
4,705 |
20.5 |
1 |
| Liveborn (newborn infant) |
2,160 |
13.5 |
1 |
2,058 |
9.0 |
2 |
| Coronary atherosclerosis (coronary artery disease) |
691 |
4.3 |
2 |
418 |
1.8 |
7 |
| Pneumonia (except that caused by tuberculosis or sexually transmitted disease) |
645 |
4.0 |
3 |
708 |
3.1 |
3 |
| Congestive heart failure, nonhypertensive |
524 |
3.3 |
4 |
566 |
2.5 |
4 |
| Acute myocardial infarction (heart attack) |
392 |
2.4 |
5 |
270 |
1.2 |
20 |
| Non-specific chest pain |
365 |
2.3 |
6 |
459 |
2.0 |
5 |
| Cardiac dysrhythmias (irregular heart beat) |
341 |
2.1 |
7 |
355 |
1.5 |
10 |
| Complication of medical device, implant or graft |
316 |
2.0 |
8 |
298 |
1.3 |
15 |
| Skin and subcutaneous tissue infections |
307 |
1.9 |
9 |
273 |
1.2 |
19 |
| Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones in spinal column) |
304 |
1.9 |
10 |
339 |
1.5 |
13 |
| Mood disorders (depression and bipolar disorders) |
296 |
1.8 |
11 |
414 |
1.8 |
8 |
| Osteoarthritis (degenerative joint disease) |
280 |
1.7 |
12 |
455 |
2.0 |
6 |
| Urinary tract infections |
151 |
0.9 |
27 |
377 |
1.6 |
9 |
Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.
*Excludes a small number of discharges (less than 135,000 or 0.3 percent) with missing gender. |
Most diagnoses are common to both males and females if those related to childbirth are excluded. However, some diagnoses were more frequent in one gender, in part because of differences between males and females in health-seeking behaviors and attitudes.
- Females accounted for 6 out of every 10 hospital stays—23.0 million stays in 2005. About 20 percent of all female hospitalizations were related to pregnancy and childbirth.
- Males accounted for 16.1 million hospitalizations in 2005.
- Four heart-related diagnoses—coronary atherosclerosis, congestive heart failure, non-specific chest pain, and cardiac dysrhythmias—were among the ten most common principal diagnoses for both male and female hospitalizations.
- Heart attacks (acute myocardial infarctions) ranked as the fifth most common diagnosis among males, but only the twentieth most common among females. Males accounted for 59 percent of all discharges with heart attack as the principal diagnosis.
- Complications of medical device, skin and subcutaneous tissue infections, and back problems were common diagnoses among both males and females.
- Though these conditions were three of the ten most frequent diagnoses for men, these diagnoses were outranked by other diagnoses for women—namely, mood disorders (depression and bipolar disorders), degenerative joint disease (osteoarthritis), and urinary tract infections—which were all less common among males.
In general, longer lengths of stay are associated with higher average charges. While full charges are seldom paid because of negotiated discounts, they can be used as a benchmark for comparing the costliness of different types of hospital stays.
- The two conditions with the longest hospital stays for all patients regardless of age were related to infants—infant respiratory distress syndrome and premature birth and low birth weight.
- These diagnoses averaged stays of 26 days, which is 11 days longer than for the next longest stay diagnosis—leukemia.
- Infant respiratory distress syndrome also had the highest average charge for all conditions. The average charge for premature birth and low birth weight ranked sixth in 2005.
- Conditions treated with expensive technology or requiring intensive care—including spinal cord injuries, heart valve disorders, cardiac and circulatory disorders, and leukemia—had mean charges significantly higher than expected based on their average length of stay (represented by the solid line in the graph).
- Even though long lengths of stay can be costly, 3 of the 14 conditions with the longest lengths of stay had average charges that were lower than the average for all diagnoses in 2005. These were all mental health conditions—impulse control disorders, schizophrenia, and pre-adult mental disorders—that typically do not require expensive procedures as part of the hospitalization.
(text version)
Although the share of all discharges for circulatory disease was essentially equal between male (51 percent) and female (49 percent) in 2005, the gender share differed according to conditions.
- Males made up the majority of discharges with a diagnosis of coronary atherosclerosis (62 percent of the diagnosis-specific discharges), acute myocardial infarction (59 percent), and stenosis of precerebral arteries (57 percent).
- Females accounted for a larger share of discharges for transient cerebral ischemia (60 percent of diagnosis-specific discharges), non-specific chest pain (56 percent), phlebitis, thrombophlebitis, and thromboembolism (55 percent), stroke (55 percent), high blood pressure (54 percent), peripheral atherosclerosis (54 percent), and congestive heart failure (52 percent).
- Discharges with a diagnosis of irregular heart beat (cardiac dysrhythmias) were as likely to be for males as for females.
(text version)
Number of Discharges, Percent Distribution, and Rank for the Most Frequent Principal Diagnoses of Circulatory Conditions by Gender, 2005
| Principal Diagnosis |
Total* |
Male |
Female |
| Discharges in Thousands |
Percent Male |
Rank for Males |
Percent Female |
Rank for Females |
| All circulatory disease discharges |
6,627 |
51 |
|
49 |
|
| Coronary atherosclerosis (coronary artery disease) |
1,110 |
62 |
1 |
38 |
3 |
| Congestive heart failure, nonhypertensive |
1,090 |
48 |
2 |
52 |
1 |
| Acute myocardial infarction (heart attack) |
662 |
59 |
3 |
41 |
6 |
| Non-specific chest pain |
825 |
44 |
4 |
56 |
2 |
| Cardiac dysrhythmias (irregular heart beat) |
697 |
49 |
5 |
51 |
4 |
| Acute cerebrovascular disease (stroke) |
526 |
46 |
6 |
54 |
5 |
| Hypertension with complications and secondary hypertension (high blood pressure with complications) |
215 |
46 |
7 |
54 |
7 |
| Peripheral and visceral atherosclerosis (hardening of arteries other than heart) |
183 |
46 |
8 |
54 |
9 |
| Occlusion or stenosis of precerebral arteries (blockage of arteries before brain) |
141 |
57 |
9 |
43 |
13 |
| Transient cerebral ischemia (mini-stroke) |
183 |
40 |
10 |
60 |
8 |
| Phlebitis, thrombophlebitis, and thromboembolism (inflammation and blood clots in the veins) |
161 |
45 |
11 |
55 |
10 |
Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.
* Includes a small number of discharges (less than 5,500 or 0.1 percent) with missing gender. |
- In 2005, 473 out of every 100,000 men experienced a hospitalization for coronary artery disease. This was the most prevalent reason among men for a hospitalization for a circulatory condition.
- Men were more likely to be hospitalized for:
- coronary artery disease
- heart attack
- occlusion of precerebral arteries
- For women, 376 out every 100,000 women were hospitalized for congestive heart failure. This was the most prevalent reason among women for a hospitalization for a circulatory condition.
- Women were more likely to be hospitalized for:
- congestive heart failure
- non-specific chest pain
- stroke and mini-stroke
- high blood pressure
- peripheral atherosclerosis
- phlebitis
(text version)
Diabetes is a chronic condition characterized by high levels of blood glucose that can lead to serious complications, including lower limb amputations and premature death. There were 2,200 diabetes-related hospitalizations per 100,000 people in the U.S. The prevalence of diabetes discharges, however, varied across age, region, and income.
- About 17 percent of all hospitalizations in 2005 involved a diagnosis of diabetes.
- Among individuals 65 and older, there were three times as many hospital stays with a diagnosis of diabetes compared with those ages 45–64. These older patients had almost five times the number of discharges per 100,000 population as the national average.
- In the West region, there were only 1,585 hospital stays for diabetes per 100,000 population compared to more than 2,300 per 100,000 population in each of the other three regions.
- Individuals residing in the lowest median income communities were more likely to be hospitalized for diabetes. There were nearly 80 percent more diabetes admissions per 100,000 population for residents of the lowest income communities compared with the highest income communities.
(text version)
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Pressure sores typically result from prolonged periods of uninterrupted pressure on the skin, soft tissue, muscle, and bone. This often occurs in wheelchair- or bedridden-patients whose positions are not changed regularly. The presence of pressure sores for patients in the hospital increases their lengths of stay and total costs.
- In 2005, 496,500 hospital stays involved a diagnosis of pressure sores.
- The number of hospital stays during which pressure sores were noted (i.e., all-listed diagnoses) increased by 76 percent from 1993 to 2005.
- The number of hospital stays for which pressure sores were the principal diagnosis changed only slightly during the period—a 17 percent increase from 1993 to 2005, or 1.3 percent annually.
(text version)
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Alcohol abuse and dependence can result in illness, disability, and early death. About 14 million Americans abuse or have a dependency on alcohol. More than half of American adults have a close family member who has suffered from alcoholism.1
- In 2005, there were 298,000 discharges with a principal diagnosis of alcoholism.
- For children younger than 18 years of age, there was little gender difference in the percent of hospitalizations that involved alcoholism in 2005. This youngest age group accounted for less than one percent of all discharges with a principal diagnosis of alcoholism.
- Among adults, however, males accounted for most of the discharges in which alcoholism was the principal diagnosis in 2005.
- Three out of four admissions for an alcohol-related principal diagnosis in the 18–44, 45–64, and 65–84 age groups were for men.
- Although the proportion of alcohol-related stays attributable to males was lower for adults age 85 and older as compared to younger adults, the predominance of male hospitalizations for alcoholism within this oldest age group remained pronounced: Males accounted for more than two out of three hospital stays for alcohol abuse among the oldest patients.
1U.S. Department of Health and Human Services. National Institute on Alcohol Abuse and Alcoholism.
Alcohol Research & Health: Highlights from the Tenth Special Report to Congress—Health Risks and
Benefits of Alcohol Consumption (Volume 24, Number 1). Washington, D.C.: U.S. Government
Printing Office, 2000. Retrieved April 27, 2006, at http://pubs.niaaa.nih.gov/publications/arh24-1/05-11.pdf.
(text version)
- The expected primary payer for alcohol-related stays was different than the expected payer for the typical hospital stay.
- Private insurance was the expected payer for 30 percent of discharges with a principal diagnosis of alcoholism, the highest share for any major payer. Nevertheless, this was lower than for all conditions (35 percent).
- Although Medicaid paid for 20 percent of all stays, it was the expected payer for 26 percent of these alcohol-related stays. Medicaid was the second most common payer for alcohol-related stays.
- Medicare was less likely to be the expected payer for alcoholism-related stays than for other conditions. This may be attributable, in part, to older, alcohol-dependent patients often having other complications, such as circulatory disease and diabetes, which may be listed as the principal reason for admission. In addition, Medicare patients are also more likely to be female and females tend to have a lower rate of alcoholism hospitalizations.
- Uninsured patients accounted for 21 percent of alcohol-related stays, but only 5 percent of hospitalizations in general.
The data for this report exclude discharges from mental health and substance abuse facilities. Nevertheless, mood disorders were the seventh most frequent reason for hospital admission in 2005 (see Exhibit 2.1). Mood disorders represented only one of many mental health conditions for which people were hospitalized in that year. These conditions generally differed with age.
- In 2005, there were 1.8 million community hospital stays with a principal diagnosis of mental illness or substance abuse.
Youth less than 18 years of age:
- Mood disorders (depression and bipolar disorders) accounted for 58 percent of mental disorders for which this age group was hospitalized.
- Attention deficit disorder (ADD), conduct, and disruptive behavior disorders accounted for 13 percent of all mental health discharges for this age group.
Patients 18–44 years of age:
- Mood disorders were the most common mental disorder for which adults ages 18–44 were admitted to the hospital, though mood disorders constituted a smaller share (43 percent) of admissions in this age group than among younger patients.
- The other common mental health conditions for this age group were substance-related disorders (26 percent) and schizophrenia and other psychotic disorders (23 percent), which were much more common in this age group than among youth.
(text version)
Patients 45–64 years of age:
- Mood disorders were also the most common mental disorder for this age group, representing 39 percent of all mental health stays for patients ages 45–64.
- Substance-related disorders (29 percent) were the second most common mental health condition for this group, while schizophrenia and other psychotic disorders (25 percent) were third.
Patients ages 65–84 years and ages 85 years and older:
- Delirium, dementia, amnestic, and other cognitive disorders were the most frequent mental health conditions for inpatients ages 65–84 (38 percent) and ages 85 years and older (69 percent).
- Mood disorders were the second most common mental
health reason for admission for these age groups: this condition accounted for 30 percent of mental health discharges for patients 65–84 years old and 15 percent for patients ages 85 years and older.
(text version)
Number of Stays, Average Cost per Stay, Average Length of Stay, and In-hospital Death Rate for Discharges with an Injury Diagnosis, 2005
| Principal Diagnosis |
Total Number of Stays in Thousands |
Average Costs per Stay |
Average Length of Stay in Days |
In-hospital Death Rate (Percent) |
| All injuries |
1,891 |
$10,300 |
4.6 |
3.1 |
| Spinal cord injury |
12 |
38,800 |
12.7 |
5.9 |
| Crushing injury or internal injury |
106 |
16,900 |
6.7 |
3.4 |
| Intracranial injury (brain injury) |
171 |
16,500 |
6.4 |
9.1 |
| Burns |
41 |
15,300 |
7.1 |
2.4 |
| Fracture of neck of femur (hip fracture) |
317 |
12,300 |
6.3 |
2.8 |
| Fracture of lower limb (leg) |
267 |
10,600 |
4.6 |
0.5 |
| Other fractures |
194 |
10,100 |
5.3 |
1.4 |
| Skull and face fractures |
53 |
9,600 |
3.4 |
0.4 |
| Joint disorders and dislocations, trauma-related |
33 |
9,100 |
3.1 |
0.3 |
| Fracture of upper limb (arm) |
154 |
8,000 |
3.2 |
0.4 |
| Open wounds of extremities (arms and legs) |
50 |
7,100 |
3.5 |
0.2 |
| Other injuries and conditions due to external causes |
102 |
7,000 |
3.5 |
3.3 |
| Open wounds of head, neck, and trunk |
38 |
6,900 |
2.6 |
0.6 |
| Poisoning by nonmedicinal substances (substances other than medicine) |
25 |
6,700 |
3.1 |
1.7 |
| Poisoning by other medications and drugs |
155 |
5,500 |
2.9 |
1.2 |
| Sprains and strains |
45 |
5,400 |
2.6 |
0.2 |
| Superficial injury, contusion (bruise) |
53 |
4,900 |
3.4 |
0.6 |
| Poisoning by psychotropic agents (psychiatric drugs) |
77 |
4,800 |
2.5 |
0.8 |
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2005. |
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In 2005, nearly 5 percent of all hospital stays—about 1.9 million hospitalizations—were for treatment of an injury. Costs, lengths of stay, and hospital death rates differed according to the type of injury.
- The most common injury-related reason for hospitalization was hip fracture (317,000 stays), followed by leg fracture (267,000 stays), other fractures (194,000 stays), brain injury (171,000 stays) and poisoning by nonpsychiatric drugs (155,000 stays).
- The highest in-hospital death rates were for brain injury (9.1 percent) and spinal cord injury (5.9 percent).
- Spinal cord injury was the most expensive type of injury, with an average hospital cost per stay of $38,800 and a mean length of stay of 12.7 days. However, these hospitalizations accounted for less than 1 percent of all injury-related hospital stays.
Over time, the number of hospitalizations associated with each injury has changed.
- Admissions for poisoning by nonpsychiatric medications and drugs rose by 32 percent from 1997 to 2005, perhaps reflecting in part the increased use of pharmaceuticals.
- Hospitalizations for burns increased 18 percent from 1997 to 2005, as did poisonings by psychiatric drugs.
- Admissions for joint disorders and dislocations due to trauma, as well as sprains and strains, dropped by 39 and 40 percent, respectively, from 1997 to 2005, probably reflecting more outpatient treatment.
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Characteristics of All Hospital Stays and Stays with a Principal Diagnosis of Influenza, 2005
| Characteristics |
All Hospital Stays |
Hospital Stays for Influenza |
| Total number of discharges in thousands |
39,164 |
50 |
| Mean length of stay in days |
4.6 |
4.1 |
| Mean cost of hospitalization |
$7,900 |
$5,400 |
| Mean hospital cost per day |
$1,700 |
$1,300 |
| Aggregate costs for U.S. in millions |
$310,916.2 |
$272.0 |
| Percent of admissions through the emergency department |
43% |
68% |
| Percent died in hospital |
2.1% |
1.6% |
| Percent < 1 year (excluding newborns*) |
2% |
11% |
| Percent 1-64 years |
53% |
38% |
| Percent 65 years and above |
34% |
51% |
Source: Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.
*Newborns account for 11 percent of all hospital discharges. |
(text version)
Influenza (flu) is a contagious respiratory viral disease. In 2005, there were over 50,000 hospital stays principally for influenza, resulting in about $272 million in aggregate costs.
- Hospital stays for influenza in 2005, compared to all hospitalizations, were slightly shorter (4.1 versus 4.6 days) and somewhat less costly ($5,400 versus $7,900).
- Hospital admissions for influenza originated more often from the emergency department (68 percent of the time) than other conditions (43 percent of the time).
- The percent of patients admitted for influenza who died in the hospital was lower (1.6 percent) than the in-hospital death rate for all patients admitted (2.1 percent).
- Hospitalizations for influenza vary widely by year, whether counted by principal diagnosis or all-listed diagnoses. The variation by year is related to outbreaks of strains of influenza which occur in cycles.2 Like 1999 and 2003, 2005 was a peak year for influenza hospitalization.
- The elderly, young children, and individuals with certain health conditions are especially vulnerable to more severe symptoms of influenza and are more likely to require hospitalization.
2Centers for Disease Control and Prevention. Influenza (Flu): Clinical Description and Diagnosis.
August 23, 2006. http://www.cdc.gov/flu/professionals/diagnosis/
HOSPITAL INPATIENT STAYS BY PROCEDURE
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