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Health Care for the Elderly

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Hospitalizations of the elderly for bloodstream infections rose sharply in the early to mid-1990s

Elderly people are at particular risk of developing septicemia (bloodstream infection) and dying from it. Unfortunately, during the 1990s, there was a substantial, unexplained increase in the rate of elderly men and women in this country who were hospitalized for septicemia, according to William B. Baine, M.D., of the Agency for Healthcare Research and Quality. Dr. Baine and his colleagues William Yu, M.A., and James P. Summe, M.S., used Medicare claims data for hospital discharges from 1991 through 1998 to study nearly 76,000 hospitalizations for septicemia or bacteremia in patients aged 65 or older.

From 1991 through 1997, annual discharges for "unspecified septicemia" increased 108 percent, and discharges for pneumococcal septicemia increased 310 percent. These increases exceeded the growth of the elderly Medicare population. Of particular concern was the marked upsurge in hospitalizations for pneumococcal septicemia, for which specific vaccine prophylaxis is available and reimbursed by Medicare. Also disturbing in most diagnoses was an apparent excess morbidity associated with male sex and black race. With the exceptions of pneumococcal septicemia and septicemia due to E. coli (often associated with female urinary tract infections), men had higher hospitalization rates than women of the same race, with significant differences for most diagnoses.

With the exception of pneumococcal septicemia, elderly blacks had significantly higher age-adjusted hospitalization rates than elderly whites. In fact, septicemia hospitalization rates were usually highest for black men and lowest for white women within each age group. The case-fatality rate in hospitals ranged from 4.2 percent for bacteremia and 6.9 percent for E. coli septicemia to 22.2 percent for septicemia due to unspecified gram-negative organisms and 26.8 percent for unspecified septicemia.

For more information, see "The epidemiology of hospitalization of elderly Americans for septicemia or bacteremia in 1991-1998: Application of Medicare claims data," by Dr. Baine, Mr. Yu, and Mr. Summe, in the February 2001 Annals of Epidemiology 11, pp. 118-126.

Reprints (AHRQ Publication No. 01-R061) are available from the AHRQ Publications Clearinghouse.

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