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Findings (continued)

How Do Comorbidities Differ for Various Age Groups?

  • Three conditions rank among the top 10 comorbidities in each age group: fluid and electrolyte disorders, chronic obstructive lung disease, and anemias.
  • Hypertension and diabetes are among the top 10 comorbidities in all adult age groups (18 years and older).
  • Drug abuse, psychoses and depression are present as top 10 comorbidities for adolescents and adults up to age 44.
  • Alcohol abuse is a top 10 comorbidity for adults ages 18-64.

Table 6. Top 10 Comorbidities by Age Group

Comorbidity < 1 1-17 18-44 45-64 65-79 80+
  Number of discharges (in thousands)
Fluid and electrolyte disorders 104 228 665 947 1,525 1,330
Chronic and obstructive lung disease (emphysema or chronic bronchitis) 14 106 382 843 1,629 869
Anemias 23 49 411 421 681 580
Other neurological disorders 8 45 182      
Blood clotting disorder (coagulopathy) 6 16        
Irregular heartbeat (cardiac dysrhythmia) 18     295 993 970
Hypothyroidism 2       552 413
Congestive heart failure 2       753 823
Heart valve disease 4         339
Pulmonary circulation disease 3          
Drug abuse   33 517      
Depression (affective disorders)   27 230      
Psychoses   17 185      
Solid tumor without metastasis   15   425 934 548
Paralysis   42        
Hypertension     472 1,942 3,073 1,735
Diabetes mellitus without
complications
    239 961 1,505 665
Alcohol abuse     366 303    
Kidney (renal) failure       297    
Diabetes with chronic complications       365    
Hardening of the arteries (peripheral vascular disease)         523  

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Most Expensive and Longest Stays

Which Conditions Have the Highest Charges on Average?

  • The conditions with the highest charges are relatively uncommon. The 10 most expensive conditions combined represent less than 1 percent of all discharges.
  • Many of these expensive conditions involve invasive or high technology procedures. For example, infant respiratory distress syndrome can involve lengthy stays in intensive care.
  • Four of the top 10 most expensive conditions in the hospital are related to care of infants with complications (respiratory distress, prematurity, heart defects, lack of oxygen).
  • Two of the top 10 most expensive conditions are related to trauma (spinal cord injury and burns).
  • Three of the top 10 most expensive conditions are related to the circulatory system (heart valve disorders, heart defects, aneurysms).
  • Even though long lengths of stay can result in high expense, four of the most expensive reasons for hospital stays are not among the longest stays: heart valve disorders, cardiac congenital anomalies, aneurysms, and burns.
  • For all conditions, the average charge for a hospital stay is $11,000.

Table 7. Conditions with the Highest Charges


Principal diagnosis Mean charges* Mean length of stay
(in days)
1. Respiratory distress syndrome (infant) $68,000 24.6
2. Spinal cord injury 53,000 15.9
3. Prematurity (short gestation) and low birth weight 50,000 21.7
4. Heart valve disorders 48,000 9.1
5. Leukemias 44,000 13.5
6. Heart defects (cardiac and circulatory congenital anomalies) 42,000 7.9
7. Lack of oxygen in infants (intrauterine hypoxia and birth asphyxia) 39,000 12.7
8. Central nervous system infections other than meningitis 39,000 13.6
9. Aortic, peripheral, and visceral artery aneurysms 38,000 8.9
10. Burns 34,000 8.9

* Charges shown reflect those only for acute hospital care and do not include professional fees, rehabilitation, followup care or home care costs.
Note: Diagnoses in bold are also among the longest lengths of stay in the hospital.

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What Conditions Lead to the Longest Hospital Stays?

  • The two conditions with the longest hospital stays are related to infants (respiratory distress and prematurity).
  • Conditions with lengthy hospital stays are relatively uncommon. Collectively, the 10 conditions with the longest stays represent less than 2 percent of all discharges.
  • Six of the most expensive conditions also have the longest lengths of stay in the hospital.
  • For all conditions, the average overall length of stay is 5 days.

Table 8. Conditions Leading to the Longest Hospital Stays

Principal diagnosis Mean length of stay
(in days)
Mean charges*
1. Respiratory distress syndrome (infant) 25 $68,000
2. Prematurity (short gestation) and low birth weight 22 50,000
3. Spinal cord injury 16 53,000
4. Paralysis 15 22,000
5. Tuberculosis 14 27,000
6. Rehabilitation care 14 17,000
7. Late effects of stroke (cerebrovascular disease) 14 16,000
8. Central nervous system infections other than meningitis 14 39,000
9. Leukemias 14 44,000
10. Lack of oxygen in infants (intrauterine hypoxia and birth asphyxia) 13 40,000

* Charges shown reflect those only for acute hospital care and do not include professional fees, rehabilitation, followup care or home care costs.
Note: Shaded diagnoses are also among the highest charges in the hospital.

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Insurance and Hospital Stays

Who Is Billed for the Largest Share of Hospital Stays?

  • Private insurance is billed for 37 percent of all hospitalizations.
  • Government (Medicare and Medicaid) is billed for over half (54 percent) of all hospitalizations.
  • Elderly people (65 and over) in the United States comprise about 13 percent3 of the population. However, about 35 percent of all hospitalizations are covered by Medicare, the most common insurance for the elderly.
  • Although nearly 17 percent4 of people in the United States are uninsured, only 5 percent of hospitalized patients are uninsured at discharge from the hospital.

Select Figure 8 (14 KB), Primary Pay Sources.

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What Sorts of Hospital Care Are Billed to Private Insurers?

  • Private insurers are billed for 57 percent of all stays for infants born in the hospital, 59 percent of all stays for trauma to perineum due to childbirth, and 51 percent of all normal pregnancy stays.
  • Five of the top 10 conditions billed to private insurers are related to infancy and childbirth. These conditions make up about one-quarter of all private pay discharges.
  • Three of the top 10 conditions billed to private insurers are related to the heart.

Table 9. Privately Insured

Principal diagnosis Number of discharges (in thousands) Private insurers' share of all hospital stays for this condition (in percent)
1. Infants born in the hospital 2,195 57.1
2. Hardening of the arteries of the heart (coronary artherosclerosis) 473 33.0
3. Trauma to perineum due to childbirth 428 58.9
4. Normal pregnancy 284 51.2
5. Pneumonia 271 21.5
6. Degenerative joint disease of spine (spondylosis) 265 48.4
7. Fetal distress and abnormal forces of labor 247 57.8
8. Other complications of birth 242 59.9
9. Nonspecific chest pain 240 43.9
10. Heart attack (acute myocardial infarction) 235 31.5

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What Sorts of Hospital Care Are Billed to Medicaid?

  • Six of the top 10 reasons for hospitalization billed to Medicaid are related to infancy and childbirth. These six conditions make up one-third of all Medicaid hospitalizations.
  • Almost 12 percent5 of the U.S. population is covered by Medicaid. However, Medicaid is billed for over a third of all hospital stays for infants born in the hospital, normal pregnancy and delivery, fetal distress, and other complications of pregnancy.
  • Medicaid is billed for over half of all hospital stays for schizophrenia and over a fourth of all stays for depression.
  • Medicaid is billed for about one-third of all hospital stays for asthma.

Table 10. Medicaid

Principal diagnosis Number of discharges
(in thousands)
Medicaid's share of al
l hospital stays for this
condition (in percent)
1. Infants born in the hospital 1,303 33.9
2. Pneumonia 242 19.2
3. Trauma to perineum due to childbirth 241 33.2
4. Normal pregnancy and/or delivery 224 40.4
5. Depression (affective disorders) 166 27.9
6. Other complications of pregnancy 155 41.6
7. Fetal distress and abnormal forces of labor 147 34.3
8. Asthma 144 33.2
9. Schizophrenia and related disorders 135 50.7
10. Other complications of birth 131 32.4

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What Sorts of Hospital Care Are Uninsured?

  • Five percent of stays for infants born in the hospital are uninsured.
  • Among uninsured patients, 3 of the top 10 conditions are related to mental health or substance abuse. It is not possible to determine if this is because insurance does not pay for these conditions or if these conditions occur more frequently among uninsured patients.
  • About 19 percent of hospital stays for alcohol-related mental disorders, 23 percent of stays for substance-related mental disorders, and 8 percent of stays for depression are uninsured.
  • Asthma and diabetes are both ambulatory care sensitive conditions—conditions for which appropriate outpatient care should be able to prevent the need for hospitalization.

Table 11. Uninsured


Principal diagnosis Number of discharges (in thousands) Percent of all hospital stays for this condition that are uninsured
1. Infants born in the hospital 191 5.0
2. Pneumonia 51 4.0
3. Alcohol-related mental disorders 47 19.3
4. Depression (affective disorders) 45 7.6
5. Substance-related mental disorders 43 22.5
6. Hardening of the arteries of the heart (coronary artherosclerosis) 41 2.8
7. Nonspecific chest pain 40 7.3
8. Asthma 34 7.9
9. Diabetes mellitus with complications 31 7.5
10. Trauma to perineum due to childbirth 30 4.1

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Discharges

What Happens to Patients When They Are Discharged From the Hospital?

  • Most discharges are routine; patients return home following completion of treatment in the hospital.
  • Overall, 2.5 percent of all hospitalizations end in death.
  • Another 2.5 percent of patients are sent to different hospitals.
  • About 11 percent of discharges go to long-term care and other facilities.
  • Less than 1 percent of hospital discharges leave against medical advice.

Select Figure 9 (16 KB), Hospital Discharges.

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How Do Discharges to Other Institutions Vary by Age?

  • Older patients are more often discharged to other institutions from the hospital than are younger patients.
  • About 41 percent of patients ages 85 and older are discharged to long-term care and other facilities, including skilled nursing facilities, intermediate care facilities, and nursing homes.

Select Figure 10 (18 KB), Discharges to Other Institutions.

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What Conditions Are Most Common in Patients Who Leave Against Medical Advice or Are Discharged to Another Institution?

  • Among the top 10 diagnoses for patients who leave the hospital against medical advice, 4 are mental health-related illnesses.
  • Over 20 percent of all patients who leave the hospital against medical advice have a substance- or alcohol-related diagnosis.
  • The other most common conditions among patients who leave against medical advice are medical problems, such as pneumonia or diabetes, rather than surgical problems.
  • Conditions where discharge is to other institutions tend to be those in which functional status has been compromised, such as stroke and hip fracture.

Table 12. Left Hospital Against Medical Advice


Principal diagnosis Number of discharges (in thousands) Percent of all discharges who left against medical advice
1. Substance-related mental disorders 32 11.0
2. Alcohol-related mental disorders 28 9.9
3. Affective disorders (principally depression) 15 5.4
4. Coronary artherosclerosis 11 3.9
5. Nonspecific chest pain 10 3.5
6. Pneumonia 9 3.3
7. Diabetes 7 2.5
8. Congestive heart failure 7 2.4
9. Asthma 6 2.2
10. Schizophrenia 6 2.2

Table 13. Discharged to Other Institutions


Principal diagnosis Number of discharges
(in thousands)
Percent of all discharges to other institutions
1. Acute cerebrovascular disease (stroke) 291 6.5
2. Hip fracture 259 5.8
3.Pneumonia 248 5.6
4. Acute myocardial infarction (heart attack) 211 4.8
5. Coronary artherosclerosis 202 4.6
6. Congestive heart failure 183 4.1
7. Osteoarthritisin 179 4.0
8. Septicemia 120 2.7
9. Urinary tract infections 96 2.2
10. Fluid and electrolyte disorder 95 2.1

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