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Hospitalization of the elderly for pneumonia and heart rhythm problems rose dramatically in the 1990s

Pneumonia and heart rhythm disorders are common and costly health problems among the elderly. The type of pneumonia and the type of heart arrhythmia suffered by elderly Medicare patients determine their risk of hospitalization. Two studies by researchers at the Agency for Healthcare Research and Quality show a dramatic increase in hospitalization of elderly Medicare patients for certain types of pneumonia and heart arrhythmias during the 1990s. The studies are summarized here.

Baine, W.B., Yu, W., and Summe, J.P. (2001, July). "Epidemiologic trends in the hospitalization of elderly Medicare patients for pneumonia, 1991-1998." American Journal of Public Health 91(7), pp. 1121-1123.

The risk that elderly Medicare patients would be hospitalized for pneumonia from 1991 to 1998 varied by pneumonia type, race, and sex. For example, hospitalizations for aspiration pneumonia (pneumonitis due to inhalation of food or vomit) nearly doubled during the 8-year period, far outpacing growth in the Medicare population. This type of pneumonia had a very high case-fatality rate, disproportionately affected black men, and represented a "smoldering epidemic," according to the investigators. They analyzed a 5 percent sample of Medicare hospital inpatient bills for patients 65 years and older who were discharged from 1991 through 1998 with a principal diagnosis of pneumonia.

Aspiration pneumonia and pneumonia caused by an "unspecified organism" accounted for 77 percent of pneumonia hospitalizations in 1998. All pneumonia diagnoses differed markedly in age-specific hospitalization by case-fatality rates, race, and mean hospital and intensive care stays. For example, aspiration pneumonia had the highest case-fatality rate (23 percent) during hospitalization, followed by pneumonia due to staphylococci (21 percent), pseudomonas (16 percent), Klebsiella pneumoniae (14 percent), and "other gram-negative bacteria" (11 percent). Fatal outcomes were least likely with pneumococcal (8 percent) or Haemophilus influenzae (4 percent) pneumonia.

The age-adjusted risk of hospitalization was higher among blacks than among whites of the same sex for aspiration pneumonia and pneumonia due to K. pneumoniae. In addition, only black men had significantly higher rates of hospitalization for pneumonia due to an unspecified organism. White men were at higher risk of being hospitalized than black men for pneumococcal pneumonia. Whites of both sexes were at higher risk than blacks for being hospitalized for pneumonia due to H. influenzae. Staphylococcal and pseudomonal pneumonia used the most health care resources, measured by mean length of hospital stay (12.4 and 11.9 days, respectively) and intensive care (1.6 days each). Pneumonia due to unspecified organisms had the briefest mean hospital stay (7.6 days).

Baine, W.B., Yu, W., and Weis, K.A. (2001, June). "Trends and outcomes in the hospitalization of older Americans for cardiac conduction disorders or arrhythmias, 1991-1998." Journal of the American Geriatrics Society 49, pp. 763-770.

The aging heart is susceptible to various types of disturbances in normal heart rhythm and conduction of electrical impulses. Each type of arrhythmia or conduction disorder carries a different risk of hospitalization. These researchers reviewed a 5 percent sample of Medicare discharge files from 1991 through 1998 with a principal diagnosis of heart arrhythmia or conduction disorder to identify risk of hospitalization associated with each type of disorder. Analysis revealed striking and unexplained variation in hospitalization for these problems. The observed trends and variation were not homogeneous among principal diagnoses or between men and women or blacks and whites.

Annual hospitalizations for sinoatrial node dysfunction, atrial flutter, atrial fibrillation, or ventricular fibrillation increased more rapidly than did the elderly Medicare population. Yet, hospitalizations for ventricular extrasystoles (extra heart contractions) or asystole (no contractions, cardiac arrest) showed steep declines. Hospitalizations for sinoatrial node dysfunction (a group of rhythms with a nonsinus pacemaker), atrial fibrillation, Mobitz I, or complete atrioventricular block all increased steeply and continuously with patient age. In contrast, hospitalizations for atrial flutter or ventricular tachycardia or fibrillation peaked among those 75 to 84 years of age.

White men were at particularly high risk for hospitalization for atrial flutter or ventricular tachycardia or fibrillation, and among the white majority, men had higher hospitalization rates than women for nine of the most common diagnoses. Whites, particularly women, had the highest hospitalization rates for atrial fibrillation. Blacks, especially black women, had a disproportionately higher risk for hospitalization for the group of nonsinus pacemaker rhythms.

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