Part 1. Hospital Stays for Men and Women (continued)

How Do Women and Men Differ in Potentially Avoidable Hospitalizations?

• Ambulatory care sensitive (ACS) conditions are hospital stays that can potentially be avoided through good outpatient care.
• Congestive heart failure, bacterial pneumonia, and chronic obstructive pulmonary disease are the top three ACS conditions for both nonobstetric female and male patients.
• Over twice as many hospital stays for urinary tract infection occur for women as for men—269,000 vs. 112,000. Women are nearly three times as likely to be hospitalized for asthma—176,000 stays for women vs. 63,000 for men.
• The number of hospital stays for diabetes-related lower extremity amputation is 50 percent higher for men than for women—56,000 vs. 37,000.

Select Figure 5 (12 KB), Hospitalization for Ambulatory Care Sensitive Conditions, by Sex.

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How Do Potentially Avoidable Hospitalizations Vary by Payer?

• Among nonobstetric patients, about 18 percent of women's stays and 16 percent of men's stays are for ACS conditions (data not shown).
• Patients with private insurance have the lowest percentage of hospital stays attributed to ACS conditions.
• Among those who are covered by Medicaid or who are uninsured, the percentage of hospital stays for ACS conditions is higher for nonobstetric female patients than that for male patients.

Select Figure 6 (5 KB), Total Hospitalizations Attributed to Ambulatory Care-Sensitive Conditions, by Payer and Sex.

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How Do Sources of Payment Differ for Men and Women?

• Private insurance is billed for slightly over one-third of hospital stays for all female patients.
• Almost two-thirds of nonobstetric stays for women is billed to public programs—Medicare and Medicaid.
• Excluding obstetric patients, Medicare is billed for 48.6 percent of all hospitalizations for women and 46.3 percent of those for men.
• Nearly 1 in 5 hospitalizations for nonobstetric female patients and male patients is covered by Medicaid or uninsured. Among nonelderly adults who have no private insurance, women are more likely to be covered by Medicaid, while men are more likely to be uninsured.

Select Figure 7 (16 KB), Sources of Payment.

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What Are the Most Common Reasons for Hospitalization of Nonobstetric Female Patients, by Payer?

• Regardless of who is billed for the hospital stay, pneumonia and hardening of the arteries of the heart are among the top 10 conditions for nonobstetric female patients.
• Five of the top 10 conditions billed to Medicare are related to the circulatory system.
• Three ACS conditions—diabetes with complications, asthma, and urinary tract infection—are among the top 10 conditions for Medicaid patients and the uninsured.
• Chest pain and depression are among the top 10 conditions for non-Medicare patients only.

Principal diagnosis	Medicare	Private	Medicaid	Uninsured
	Number of discharges in thousands (percent of all discharges)
Congestive heart failure	394 (5.8)		95 (4.4)	10 (1.9)
Pneumonia	353 (5.2)	99 (2.4)	103 (4.8)	17 (3.0)
Coronary atherosclerosis (hardening of the arteries of the heart)	315 (4.6)	137 (3.3)	69 (3.2)	16 (2.9)
Cardiac dysrhythmia (irregular heartbeat)	228 (3.3)
Acute cerebrovascular disease (stroke)	219 (3.2)
Chronic obstructive lung disease	210 (3.1)		67 (3.1)
Acute myocardial infarction (heart attack)	204 (3.0)
Rehabilitation	196 (2.9)
Hip fracture	186 (2.7)
Osteoarthritis	173 (2.5)	75 (1.8)
Benign neoplasm of uterus		212 (5.1)
Chest pain		165 (4.0)	65 (3.0)	24 (4.4)
Spondylosis, intervertebral disc disorders, other back problems		138 (3.3)
Biliary tract disorders (gallbladder disease)		137 (3.3)		21 (3.7)
Affective disorders (depression)		128 (3.1)	101 (4.7)	26 (4.7)
Prolapse of female genital organs		79 (1.9)
Complication of procedures or medical care		78 (1.9)
Schizophrenia and other related disorders			60 (2.8)
Diabetes mellitus with complications			57 (2.6)	13 (2.4)
Urinary tract infection			53 (2.5)	13 (2.4)
Asthma			48 (2.2)	13 (2.4)
Skin and subcutaneous tissue infections				10 (1.8)

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How Do Length of Stay and Total Charges Differ for Male and Nonobstetric Female Patients, by Age Group?

• The average length of hospital stay increases with age. On average, patients age 65 or older spend 6 days in the hospital compared with fewer than 5 days for those age 18 to 64.
• Although average length of hospital stay is highest among patients age 80+, the highest average hospital charges are in the 65-79 age group. This may be an indication of higher intensity of service in the younger age group.
• For each age group, male patients have higher total hospital charges than nonobstetric female patients.

Select Figure 8 (18 KB), Charges for Male and Nonobstetric Female Patients.

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What Conditions Have the Highest In-Hospital Mortality, by Age Group?

• HIV disease is among the top 10 conditions with the highest in-hospital mortality for nonobstetric female patients age 18-44.
• Among patients age 45 and older, women have a higher in-hospital mortality rate than men for cardiac arrest and ventricular fibrillation; men have a higher in-hospital mortality rate than women for respiratory failure.
• For men and women age 45-79, half of the top 10 conditions with the highest in-hospital mortality are related to cancers.
• Stroke is among the top 10 conditions with the highest in-hospital mortality for both male and nonobstetric female patients in the youngest age group (18-44).

Table 8. Top 10 Conditions with the Highest In-Hospital Mortality

Principal diagnosis	18-44 years		45-64 years		65-79 years		80+ years
	Non-obstetric female patients	Male patients	Non-obstetric female patients	Male patients	Non-obstetric female patients	Male patients	Non-obstetric female patients	Male patients
	In-hospital mortality (percent)
Cardiac arrest and ventricular fibrillation			60.0	42.6	62.9	48.7	71.3	69.8
Shock							65.5
Respiratory failure, insufficiency, arrest	11.4	14.9	14.7	16.9	21.7	25.3	34.6	37.3
Peritonitis and intestinal abscess							28.4
Aortic, peripheral, and visceral artery aneurysms							25.6
Leukemias	13.4	12.5	17.6	17.8	23.9	25.8	25.2	25.4
Septicemia (except in labor)		8.4	13.1	13.8	17.4	17.5	22.7	23.1
Aspiration pneumonitis, food/vomitus	7.4		14.8		18.8	19.6	22.0	23.3
Cancer of liver and intrahepatic bile duct			17.3	22.6	17.2	20.0	19.1
Cancer of bronchus, lung	13.6	15.6	14.6	15.7	14.8	17.5	17.8	21.0
Cancer of pancreas			14.0	16.7	15.8	17.0		23.8
Non-Hodgkins lymphoma	9.0	8.7						20.5
Intracranial injury		9.0						19.2
Chronic renal failure								18.9
Malignant neoplasm without specification of site			21.6	21.8	27.8	29.0
Coma, stupor, and brain damage	9.3	12.8	15.8	18.3	14.9	20.1
Cancer of esophagus				13.0
Acute cerebrovascular disease (stroke)	10.6	11.4
Secondary malignancies	9.9	9.4
Liver disease, alcohol-related	7.3	8.0
HIV infection	7.1

Note: Because mortality rates may fluctuate over years for those conditions with a relatively small number of discharges, for each sex-age cohort only conditions with more than 1,000 weighted discharges were included in the analysis.

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Part 2. Hospital Stays for Obstetric Patients

What Is the Age Composition of Obstetric Patients?

• Obstetric patients account for about 1 in 4 hospital stays for women overall.
• Over half of adult obstetric hospitalizations occur in the 25-34 age group.
• Nearly 1 in 7 obstetric hospital stays is for women age 35 years or older.

Select Figure 9 (11 KB), Age Composition of Obstetric Patients.

What Are the Most Common Reasons Associated with Obstetric Hospital Stays?

• Most obstetric hospital stays (88 percent) are for delivery of a child.
• Nearly 1 in 10 obstetric hospitalizations is for antepartum or postpartum care.
• Only 1 in 50 obstetric hospitalizations is due to pregnancy loss.

Select Figure 10 (3 KB), Most Common Reasons Associated with Obstetric Hospital Stays.

What Are the Most Common Reasons for Hospital Stays Related to Pregnancy Loss?

• Over half of hospitalizations involving pregnancy loss are due to ectopic/molar pregnancy.
• Spontaneous abortion accounts for more than one-fourth of all hospital stays related to pregnancy loss while induced abortion is associated with about 1 in 10 such hospital stays.

Select Figure 11 (4 KB), Most Common Reasons for Hospital Stays Related to Pregnancy Loss.

What Are the Most Common Conditions Associated with Hospitalizations for Antepartum Care?

• Antepartum hospital stays involve care for pregnant women who do deliver their babies during that stay. Early labor accounts for more than 1 in 4 of these antepartum stays.
• Excessive vomiting during pregnancy is the second most common reason for antepartum hospitalizations, accounting for 1 in 10 antepartum stays.
• One in 6 hospital stays for antepartum care is due to hypertension, bleeding, and diabetes during pregnancy.

Select Figure 12 (14 KB), Top Ten Reasons for Antepartum Hospital Stays.

What Are Average Length of Stay and Total Charges for Obstetric Hospitalizations?

• Obstetric patients admitted for antepartum or postpartum care have longer lengths of stay than those admitted for delivery.
• Hospitalizations for postpartum care incur the highest average total charges—$8,900.
• Women hospitalized due to pregnancy loss have shorter lengths of stay but much higher total charges than women admitted for delivery or antepartum care.

Select Figure 13 (8 KB), Average Length of Stay and Total Charges for Obstetric Hospitalizations.

Who Is Billed for Hospital Stays for Obstetric Care?

• Women with Medicaid coverage or who are uninsured account for about 2 in 5 obstetric hospital stays.
• Women hospitalized for antepartum or postpartum care are more likely to be uninsured or covered by Medicaid than women admitted for delivery.
• Women admitted to hospitals due to pregnancy loss are more than twice as likely to be uninsured than any other type of obstetric patients.

Select Figure 14 (7 KB), Billed for Obstetric Care.

How Old Are Obstetric Patients, by Type of Delivery?

• About 1 in 3 women with a primary cesarean section is age 18 to 24 and only 1 in 6 is age 35 or older.
• Among women with prior cesarean sections, those having repeat cesarean sections are more likely to be age 35 or older than those having vaginal delivery (about 1 in 4 vs. 1 in 5).

Select Figure 15 (8 KB), Obstetric Patient Age, by Type of Delivery.

How Does Resource Use Differ for Women Who Have Cesarean Sections and Women Who Have Vaginal Delivery?

• Average length of hospital stay and total charges are over 40 percent higher for women who have repeat cesarean sections than for women who have vaginal birth after C-section. (Among women who have repeat cesarean sections, some may have attempted a trial of labor first, which led to a longer length of stay.)
• Women who have primary cesarean sections incur the longest length of stay—4.1 days—and the highest total charges—$10,200. (This group of women includes those who were unsuccessful with a trial of labor, which may be reflected in the longer length of stay.)

Select Figure 16 (10 KB), Resource Use by Women Having Cesarean Sections or Vaginal Deliveries.

How Does Cesarean Section Rate Differ by Payment Source?

• Women with private insurance have the highest cesarean section rate (24.4 percent). In contrast, women without insurance are least likely to have cesarean sections (18.6 percent).
• Among women covered by Medicaid, about 1 in 5 undergoes cesarean section.

Select Figure 17 (4 KB), Cesarean Section Rate by Payment Source.

How Is Obstetric Trauma Associated with Type of Delivery?

• About 1 in 12 women who have a vaginal delivery without instrumentation experiences perineal or cervical laceration or other obstetric trauma. This compares with nearly 1 in 4 women who have a vaginal delivery that involves use of instruments, such as forceps or vacuum extraction.
• Only 6 in 1,000 women undergoing cesarean sections experience obstetrical trauma.

Select Figure 18 (5 KB), Obstetric Trauma Associated with Type of Delivery.

How Have Cesarean Section Rates and Vaginal Birth after Cesarean Section Rates Changed Over Time?

• The cesarean section rate increased slightly from 21.3 percent in 1997 to 23.2 percent in 2000.
• The rate for VBAC decreased from 35.3 percent to 28.6 percent from 1997 to 2000. Fewer than one-third of women with a previous cesarean section had vaginal births in 2000. This trend is consistent with other published trends (Gregory et al., 2001; Martin et al., 2002)*.

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*Gregory K, Korst L, Platt L. Variation in elective primary cesarean rates by hospital organizational factors. American Journal of Obstetrics and Gynecology 2001; 184:1521-34.
Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final Data for 2000. National Vital Statistics Reports; vol. 50 No. 5. Hyattsville, MD: National Center for Health Statistics. 2002.

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Select Figure 19 (4 KB), Changes Over Time in Rates of Cesarean Sections and Rates of Vaginal Births after Cesarean Section.

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Sources of Data for This Report

The data presented in this report are drawn from the Healthcare Cost and Utilization Project (HCUP), a Federal-State partnership to build a multi-State health care data system. This partnership is sponsored by the Agency for Healthcare Research and Quality (AHRQ) and is managed by staff in AHRQ's Center for Organization and Delivery Studies. HCUP is based on health care administrative data (such as hospital claims and discharge abstracts) 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 2000, 28 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 (e.g., general and specialty hospitals such as pediatric, obstetrics-gynecology, and oncology hospitals are included; but long-term care, rehabilitation, and psychiatric hospitals are excluded).

HCUP includes two sets of databases for health services research. The State Inpatient Databases (SID) for 2000 covers inpatient care in community hospitals in 28 States and represent about 80 percent of all hospital discharges in the United States. The Nationwide Inpatient Sample (NIS) includes all discharges from 994 hospitals drawn from the SID, adjusted to approximate a national 20-percent sample of U.S. short-term, non-Federal, community hospitals, as defined by the American Hospital Association (AHA). Community hospitals are defined as general and specialty hospitals, including academic medical centers, but excluding long-term care and psychiatric hospitals.

This report is based on data from the NIS. The NIS for 2000 includes information from about 7 million discharges which were weighted to obtain estimates that represent the total number of inpatient hospital discharges in the United States (36.4 million).

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Methods

The Clinical Classifications Software (CCS), developed by AHRQ, has been used throughout this Fact Book 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. More information on CCS can be downloaded from online (www.ahrq.gov/data/hcup).

Frequencies and rankings of diagnoses are based on principal, or first-listed diagnosis. Frequencies and rankings of procedures are based on all-listed procedures; that is, all procedures listed on the discharge record. 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 or procedures performed in outpatient settings are not reflected here.

Terms relating to differences such as "higher than," "lower than," "more than," "more likely" or "less likely" indicate that the difference is statistically significant at the 0.05 level of significance. The testing of statistical significance is based on the two-tailed test of Z-score with standard errors calculated in SUDAAN that takes into account the stratified probability sample design in NIS.

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For More Information

More information on HCUP data and the CCS can be obtained online at http://www.ahrq.gov/data/hcup/. Additional descriptive statistics can be viewed through HCUPnet (http://hcupnet.ahrq.gov/), a Web-based tool providing easy access to information on hospital stays, available at the same Web site.

Currently, NIS data can be purchased for data years 1988-2000. NIS 2000 may be purchased for $200 in a set of two CD-ROMs with accompanying documentation from the AHRQ-designated HCUP Central Distributor, telephone: (866) 556-4287 (toll-free), fax: 866-792-5313, or E-mail: HCUPDistributor@ahrq.go.

The HCUP Central Distributor can also provide information on how to purchase NIS CD-ROM data sets for earlier years (beginning 1988). Prices vary by data year and, as of August 2002, range from $160 to $322. All prices may be higher for customers outside the United States, Canada, and Mexico. Additional information is available on the AHRQ Web site.

Previously published HCUP Fact Books in this series are available from the AHRQ Publications Clearinghouse by calling 800-358-9295 (toll free). Order by title and publication number.

• Hospitalization in the United States, 1997 (HCUP Fact Book No. 1, AHRQ Pub No. 00-0031).
• Procedures in U.S. Hospitals, 1997 (HCUP Fact Book No. 2, AHRQ Pub No. 01-0016).

Other HCUP Fact Books currently in development include hospitalization for mental disorders, inpatient care for children and adolescents, and hospital care of the uninsured. Information on future availability will be posted on the AHRQ Web site.

Healthcare Cost and Utilization Project (HCUP)
Agency for Healthcare Research and Quality
Phone: 866-290-HCUP (4287), toll-free
E-mail: hcup@ahrq.gov

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AHRQ Publication No. 02-0044
Current as of October 2002

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Internet Citation:

Care of Women in U.S. Hospitals, 2000. HCUP Fact Book No. 3. AHRQ Publication No. 02-0044, October 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/data/hcup/factbk3/factbk3.htm

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