Current Trends Hospitalizations for the Leading Causes of Death Among the Elderly -- United States, 1987

Seven of the 10 leading causes of death among the elderly (1) (i.e., persons greater than or equal to 65 years of age) in the United States are chronic diseases. However, public health officials have recognized that mortality data alone are insufficient for quantifying the public health impact of chronic diseases on the elderly (2). This report uses 1987 Medicare data to compare deaths among the elderly with the frequency and costs of hospitalization.

Medicare provides coverage for hospital expenses for greater than 95% of elderly persons (3). The Health Care Financing Administration (HCFA) collects data on all Medicare-reimbursed hospitalizations. HCFA's computerized records contain diagnostic, surgical, financial, demographic, and residential data for each Medicare-related discharge (4,5). Unique identifiers in discharge records make it possible to distinguish persons hospitalized more than once.

In 1987, the 10 leading causes of death (not all of which were among the 10 leading causes of hospitalization) among the elderly accounted for 86.3% of all deaths in this group and for 45.6% of all hospital discharges (Table 1).* Of the 10 leading causes of death, seven chronic diseases (diseases of the heart; malignant neoplasms; cerebrovascular disease; chronic obstructive pulmonary disease; diabetes mellitus; atherosclerosis; and nephritis, nephrotic syndrome, and nephrosis) accounted for 79.5% of deaths and 39.0% of hospital discharges (Table 1).

Of the more than $39 billion Medicare provided for hospitalizations for the elderly in 1987, approximately $20 billion (50.2%) was for hospitalization of persons with a principal diagnosis that ranked among the 10 leading causes of death. Forty-three percent of Medicare reimbursement was for hospitalizations for one of the seven chronic diseases (Table 1).

In 1987, nearly 20% of elderly persons were hospitalized at least once (Table 2). Among these, the number of persons hospitalized for heart diseases and malignant neoplasms was approximately twice the number who died from these diseases; for diabetes mellitus and cerebrovascular diseases, the number hospitalized was nearly four times the number who died (Table 2).

An additional 28% of discharges and 7% of deaths not among the 10 leading causes of death were for predominantly chronic conditions in five major disease categories (circulatory, digestive, genitourinary, musculoskeletal, and neurologic diseases). Reported by: AM McBean, MD, JL Warren, PhD, JD Babish, MPH, Div of Beneficiary Studies, Office of Research and Demonstrations, Health Care Financing Administration. Chronic Disease Surveillance Br, Office of Surveillance and Analysis, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Although surveillance for chronic diseases frequently uses mortality data, annual mortality statistics substantially underestimate the number of persons affected by these conditions. As this report and others (7) have demonstrated, Medicare hospital discharge data can be used to complement information provided by mortality statistics. The number and cost of hospitalizations provide a measure of both morbidity and the burden on the health-care system, and the number of persons hospitalized provides an estimate of the number of persons affected.

For at least five reasons, the data in this report may underestimate the total hospitalization burden attributable to chronic diseases. First, many chronic conditions were not ranked within the 10 leading causes of death and therefore were not represented in the tables. Second, some hospitalizations for which therapies (e.g., chemotherapy for cancer) are listed as principal "diagnoses" probably should be attributed to chronic disease. Third, certain chronic diseases can contribute etiologically to hospitalizations with a principal diagnosis other than a chronic disease (e.g., osteoporosis, which can contribute to hip fractures). Fourth, chronic diseases coded as secondary rather than primary diagnoses may contribute to the need for hospitalization. Fifth, persons receiving care from organizations such as health maintenance organizations, the Veteran's Administration, and the Indian Health Service may not be routinely reported to HCFA, although these persons are included in denominators used here to calculate hospitalization and death rates.

Chronic diseases affect a large proportion of the elderly and are a major public health burden. Medicare data can be used to assess this burden and to examine the impact of specific conditions (e.g., ischemic heart disease or obstructive pulmonary diseases) on demographic and geographic subgroups of the elderly, to improve understanding of the burden of chronic disease in this rapidly growing population, and to identify priorities for primary or secondary prevention.

References

1. NCHS. Advance report of final mortality statistics, 1987. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1989; DHHS publication no.(PHS)89-1120.

2. Rothenberg RB, Koplan JP. Chronic disease in the 1990s. Ann Rev Public Health 1990;11:267-96.

3. Health Care Financing Administration. Medicare enrollment, 1986-87. Baltimore, Maryland: US Department of Health and Human Services, Health Care Financing Administration, 1989; HCFA publication no. 03282. (Annual Medicare program statistics.)

4. Health Care Financing Administration. Medicare statistical files manual. Baltimore, Maryland: US Department of Health and Human Services, Health Care Financing Administration, 1988; HCFA publication no. 03272.

5. Health Care Financing Administration. Medicare provider analysis and review--MEDPAR (machine-readable data tape). Baltimore, Maryland: US Department of Health and Human Services, Health Care Financing Administration, 1987.

6. NCHS. Vital statistics mortality data, underlying cause of death detail (machine-readable public-use data tape). Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1987.

7. Health Care Financing Administration. Special report: hospital data by geographic area for aged Medicare beneficiaries--selected diagnostic groups, 1986. Vol 1. Baltimore,Maryland: US Department of Health and Human Services, Health Care Financing Administration, 1990; HCFA publication no. 03300.

• In this report, "hospitalized for" or "accountable for" (when referring to hospitalization) mean principal diagnosis (i.e., the diagnosis deemed at the time of discharge to have been responsible for the patient's admission).

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