Findings (continued)

In-Hospital Mortality

Which Conditions Have the Highest In-Hospital Mortality Rate?

• Some patients are admitted to the hospital for end-of-life care; therefore mortality for some conditions is expected to be high.
• Four of the top 10 conditions with the highest in-hospital mortality are related to cancer:
  • Malignant neoplasm without specification of site.
  • Leukemias.
  • Cancer of liver and intrahepatic bile duct.
  • Cancer of bronchus or lung.
• Some of the conditions listed below are not necessarily the underlying cause of death. For example, shock and cardiac arrest are immediate reasons for death, but other conditions such as trauma may be the underlying reasons.

Table 14. Conditions with Highest In-Patient Mortality Rate

Principal diagnosis	In-hospital mortality (percent)
1. Shock	51.2
2. Cardiac arrest and ventricular fibrillation	51.0
3. Malignant neoplasm without specification of site	29.8
4. Adult respiratory failure, insufficiency, arrest	22.7
5. Lack of oxygen in infants (intrauterine hypoxia and birth asphyxia)	20.4
6. Aspiration pneumonitis (from food or vomit)	19.0
7. Leukemias	18.9
8. Cancer of liver and intrahepatic bile duct	17.8
9. Coma, stupor, and brain damage	16.3
10. Cancer of bronchus or lung	15.2

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Which Conditions Have the Highest Mortality for Various Age Groups?

• Among infants less than 1 year old, the major causes of in-hospital mortality include lack of oxygen, low birth weight, birth trauma, respiratory distress syndrome, heart defects, and immunity disorders.
• For children and adolescents up to 17 years of age, the major causes of in-hospital mortality include immunity disorders, injuries, cancers, and cystic fibrosis.
• For people ages 18-44, major causes of in-hospital mortality include HIV infection, cancers, injury, and alcohol-related liver disease.
• For people ages 45-64, liver disease (alcohol-related and other) and cancers are the major causes of morality in the hospital.
• For people 65-79 years old, major causes of mortality in the hospital include aneurysm and cancers.
• For people 80 years of age and older, the major causes of mortality include stroke, blood infection, kidney failure, aspiration pneumonitis (from food or vomit), aneurysm, and cancers.

Table 15. Conditions with the Highest In-Hospital Mortality

Top 10 diagnoses by age group
	<1	1-17	18-44	45-64	65-79	80+
In-hospital mortality (percent)
Lack of oxygen in infants (intrauterine hypoxia and birth asphyxia)	20.4
Prematurity (short gestation) and low birth weight	4.6
Respiratory distress syndrome (infant)	4.6
Birth trauma	4.0
Other perinatal conditions	1.6
Other congenital anomalies	0.6
Nervous system congenital anomalies	0.4
Heart defects (cardiac and circulatory congenital anomalies)	2.6	0.4
Immunity disorders	0.4	1.4
Cardiac arrest and ventricular fibrillation	0.5	0.5	3.3	12.5	21.1	12.9
Cystic fibrosis	0	0.6
Other injuries and conditions due to external causes		0.5
Cancer, other and unspecified primary		0.5
Intracranial injury		0.8	2.5
Coma, stupor, and brain damage		0.6	1.8			4.0
Leukemia		0.5	2.1	4.6	7.9
Shock		0.7	3.1	8.4	17.2	21.5
HIV infection			6.1
Hodgkin's disease			3.3
Crushing injury or internal injury			1.9
Liver disease, alcohol related			2.5	6.4
Malignant neoplasm without specification of site			1.8	8.4	13.7	5.8
Cancer of esophagus				5.1
Secondary malignancy				4.2
Other liver diseases				3.9
Cancer of liver and intrahepatic bile duct				6.0	7.0
Cancer of bronchus or lung				4.7	7.9
Cancer of pancreas					6.4
Myeloma					6.2
Respiratory failure, insufficiency, arrest (adult)					10.2	7.4
Aneurysm					6.9	4.5
Aspiration pneumontis (from food or vomit)						11.2
Acute and unspecified kidney failure						6.4
Blood infection (septicemia)						6.4
Stroke (acute cerebrovascular disease)						4.2

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Source of Data for This Report

The data presented in this report are drawn from the Healthcare Cost and Utilization Project (HCUP), a Federal-State industry partnership to build a multi-State health care data system. This partnership is sponsored by the Agency for Healthcare Research and Quality and is managed by staff in AHRQ's Center for Organization and Delivery Studies (now renamed Center for Delivery, Organization, and Markets (CDOM)). HCUP is based on data collected by individual States and forwarded to AHRQ by the States. HCUP would not be possible without State data collection projects and their partnership with AHRQ.

For 1997, 22 State data organizations contributed their data to AHRQ where all data are edited and transformed into a uniform format. The uniform data in HCUP databases make possible comparative studies of health care services and the use and cost of hospital care, including:

• The effects of market forces on hospitals and the care they provide.
• Variations in medical practice.
• The effectiveness of medical technology and treatments.
• Use of services by special populations.

HCUP includes short-term, non-Federal, community hospitals. General and specialty hospitals such as pediatric, obstetrics-gynecology, short-term rehabilitation, and oncology hospitals are included, but long-term care and psychiatric hospitals are excluded.

HCUP includes two sets of databases for health services research The State Inpatient Databases (SID) for 1997 cover inpatient care in community hospitals in 22 States and include nearly 60 percent of all hospital discharges in the U.S. The Nationwide Inpatient Sample includes all discharges from a sample of about 1,000 hospitals drawn from the SID, adjusted to approximate a national sample.

This report is based on data from the NIS. The NIS approximates a 20-percent sample of U.S. "community" hospitals, as defined by the American Hospital Association (AHA). The NIS for 1997 includes information from 7.1 million discharges which were weighted to obtain estimates that represent the total number of inpatient hospital discharges in the United States (35.4 million).

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Methods

The Clinical Classifications Software (CCS), developed by AHRQ, has been used throughout this chartbook to aggregate diagnosis codes into a limited number of categories. Diagnoses recorded on hospital discharge records are coded using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Fifth Edition. Although ICD-9-CM may be used to provide descriptive statistics, aggregating similar diagnoses or procedures into clinically meaningful categories, such as the CCS, can be more helpful.

Frequencies and rankings of diagnoses are based on principal, or first-listed, diagnosis. The unit of analysis is the inpatient stay rather than the patient. All discharges have been weighted to produce national estimates.

Total charges in HCUP data are the amount the hospital charged or billed for the entire hospital stay and do not necessarily reflect reimbursements or costs. Charges do not include professional (physician) fees. Charge data were present for 98 percent of all discharges. Charges are generally higher than costs.

Because the NIS is limited to inpatient hospital data, conditions treated in outpatient settings are not reflected here.

Many medical terms are used throughout this report. For help in understanding these terms, refer to the Glossary.

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