Bulletin No. 17-02

Leading Causes of Hospitalizations

And

In-Hospital Mortality

- An Update -

S. M. El-Zein, PhD, Actuary

MedNet Liban

December 2002

TABLE OF CONTENTS

Page

Introduction

How are Patients Admitted to the Hospital?

What are the Most Frequent Reasons for Being Admitted to the Hospital

Through the Emergency Department?

How do Hospital Admissions Through the Emergency Department Differ by

Age Group? Gender?

What are the Most Frequent Reasons for Admissions Through the Emergency

Department, by Body System?

How do Hospital Admissions Compare to Population’s Age and Gender?

What are the Most Frequent Reasons for Hospitalization?

What are the Most Common Reasons for Hospital Stays, by Body System?

What are the Most Common Reasons for Hospitalization by Gender?

What are the Most Common Reasons for Hospitalization for Various Age

Groups?

What are the Most Common Principal Comorbidities?

How do Comorbidities Differ for Various Age Groups?

How do Comorbidities Differ by Gender?

What Conditions Lead to the Longest Hospital Stays?

Which Conditions Have the Highest Charges on Average?

Which Conditions Have the Highest In-Hospital Mortality?

Which Conditions Have the Highest Number of In-Hospital Death, by Body

System?

What are the Leading Causes of Death by Age Group?

How do Leading Causes of Death Differ by Gender?

Glossary

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List of Tables

Top Ten Admission Causes Through the Emergency Department 3

Top Ten Admission Causes Through the ED by Body System 6

Most Frequent Reasons for Hospitalizations 11

Top Ten Reasons for Hospital Stays, by Body System 14

Top Ten Reasons for Hospitalizations by Gender 15

Top Ten Conditions for Hospitalization by Age Group 17

Top Ten Comorbidities 19

Top Ten Comorbidities by Age Group 21

About 55% of Personal health care expenditures go toward hospital care*, making it the most expensive component of the health care sector. This report gives an overview of hospital care during the 1995 – 2001 period, providing insight for anyone interested in understanding the types of services rendered by hospitals and the characteristics of patients who receive them.

This report summarizes information from the MedNet Liban In patient population; a database uniquely suited to provide a comprehensive picture of hospital care.

The MedNet Liban database includes patients covered by public payers (National Social Security Fund), private insurance companies, mutual funds and self-funded schemes. It also provides information on total hospital charges for those patients. The MedNet Liban database also includes all types of hospitals (teaching and non-teaching hospitals) that are spread throughout Lebanon.

This report provides information on:

Ø Age and gender of hospitalized patients.

Ø Sources of admission to the hospital.

Ø Emergency admissions to the hospital.

Ø Most frequent reasons for hospitalization through the Emergency Department.

Ø Most frequent reasons for routine hospitalizations.

Ø Most frequent comorbidities.

Ø Charges for hospitalizations, by type of condition.

Ø Conditions with the longest lengths of hospitalization.

Ø Leading causes of in-hospital mortality.

Ø In-hospital mortality by age and gender.

*: MedNet Liban 2000 statistics.

HOW ARE PATIENTS ADMITTED TO THE HOSPITAL?

· About 6.5% of all hospital admissions are through the Emergency Department (ED).

· 93.5% are routine admissions – not through the ED.

WHAT ARE THE MOST FREQUENT REASONS FOR BEING ADMITTED TO THE HOSPITAL THROUGH THE EMERGENCY DEPARTMENT?

· Ten conditions account for about 37% of all hospital admissions through the Emergency Department.

· The top 3 conditions are pain-related: Abdominal, Chest and Renal (Kidney/urinary tracts).

· Fever is the fourth leading cause of admissions.

Top Ten Admission Causes Through The ED
	PRINCIPAL DIAGNOSIS	Number	Percent of All ED Admissions
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.	Abdominal Pain Chest Pain Renal Colic Fever Intestinal Infectious Diseases Ischemic Heart Disease Pneumonia & Influenza Syncope & Collapse Concussion Dyspnea and Respiratory Abnormalities	649 503 382 379 330 324 208 179 171 164	7.2% 5.6% 4.3% 4.2% 3.7% 3.6% 2.3% 2.0% 1.9% 1.8%
			36.6%

HOW DO HOSPITAL ADMISSIONS THROUGH THE EMERGENCY DEPARTMENT DIFFER BY AGE GROUP? GENDER?

· 38.7 percent of all admissions through the ED are for persons aged 18 to 44 years.

· Of all children admissions through the ED, about 61% are for males.

· Most admissions through the ED for persons aged 18 to 44 years are males (54.2%).

· Overall, 56.6 percent of all admissions through the ED are for males.

Admissions Through The Emergency Department

By Age and Gender

WHAT ARE THE MOST FREQUENT REASONS FOR ADMISSIONS THROUGH THE ED, BY BODY SYSTEM?

· The leading cause of admission through the ED is the Circulatory system, accounting for 19.0% of all admissions through the ED.

· The Digestive system is the second leading cause of admission through the ED; accounting for nearly 14% of all ED admissions.

· Injury and Poisoning account for 13.5% of all admissions through the ED.

Top Ten Admission Causes Through The ED By Body System
	REASON BY BODY SYSTEM	Number	Percent of All ED Admissions
1.	Diseases of the Circulatory System	1,709	19.02
2.	Diseases of the Digestive System	1,220	13.58
3.	Injury and Poisoning	1,212	13.49
4.	Symptoms, Signs and Ill-Defined Conditions	995	11.07
5.	Diseases of the Respiratory System	933	10.38
6.	Diseases of the Genitourinary System	775	8.62
7.	Infectious and Parasitic Diseases	669	7.44
8.	Neoplasms	397	4.42
9.	Diseases of the Nervous System and Sense Organs	363	4.04
10.	Diseases of the Musculoskeletal System and Connective Tissue	267	2.97

Top Ten Admission Causes Through The ED

By Body System

HOW DO HOSPITAL ADMISSIONS COMPARE TO POPULATION’S AGE AND GENDER?

Combining routine as well as admissions through the Emergency Department yields the following interesting statistics:

· Females constitute about half of the population but account for over 55% of all hospitalizations. Excluding childbirth related claims would reverse the picture. Males would then account for 53% of all hospitalizations and females for 47%.

· Males outnumber females by a ratio of 1.4 to 1 when comparing admissions for the group of less than 17 years old. That ratio would drop to 1.3 when adjusted for gender distribution among the less than 17 years old people. Most males in this age group are admitted for “male specific” reasons such as hernia and they have more tonsils problems than do females.

· There are 2 female admissions for every 1 male admission in the group of 18 to 44 years old. Excluding maternity-related claims, the ratio would drop to just 1.06, yielding almost equal proportions of males and females’ admissions.

· Persons over the age of 64 years constitute about 6% of the entire population but account for about 10% of all hospitalizations.

Hospitalized Patients By Age and Gender

1995 - 2001

Age of Hospitalized Patients Versus Age of Population

Calendar Years: 1995 – 2001

Hospitalized Patients by Gender Versus Population’s Gender

Calendar Years: 1995 - 2001

Male Population Versus Male Patients

Calendar Years: 1995 - 2001

Female Population Versus Female Patients

Calendar Years: 1995 - 2001

WHAT ARE THE MOST FREQUENT REASONS FOR HOSPITALIZATION?

· Nearly 35% of all hospitalizations are related to 10 principal diagnoses.

· Childbirth remains the most common reason for hospitalization. About 9% of all discharges from the hospital are infants born in the hospital.

· Abdominal pain has become the second most common reason for hospitalization; accounting for about 4% of all discharges.

· Two of the top ten conditions are pregnancy-related, accounting for about 11% of all discharges.

· Ischemic heart disease accounts for about 2.5% of all discharges.

· Chemotherapy that requires an overnight stay in the hospital accounts for nearly 4% of all discharges. It has moved up in rank from 5 (in the prior study) to 4.

Most Frequent Reasons For Hospitalizations
	PRINCIPAL DIAGNOSIS	Number of Discharges	Percent of all Discharges
1.	Normal Delivery and Other Indications for Care in Pregnancy, Labor and Delivery	11,956	8.60
2.	Abdominal Pain	5,369	3.86
3.	Intestinal Infectious Diseases	5,246	3.77
4.	Chemotherapy	5,230	3.76
5.	Fever	4,205	3.03
6.	Complications Occurring Mainly in the Course of Labor and Delivery	4,006	2.88
7.	Ischemic Heart Disease	3,403	2.45
8.	Pneumonia and Influenza	3,306	2.38
9.	Renal Colic	3,280	2.36
10.	Inguinal Hernia	2,592	1.87
	TOTAL	48,593	34.97

Most Frequent Reasons of Hospitalizations

Number of

Discharges

WHAT ARE THE MOST COMMON REASONS FOR HOSPITAL STAYS, BY BODY SYSTEM?

· Pregnancy and childbirth tops the list of the most common reasons for hospitalizations, accounting for nearly 15% of all discharges.

· The next most common reasons for hospitalization include those related to respiratory system, accounting for nearly 13% of all discharges. These include Pneumonia and Influenza and acute respiratory infections.

· Digestive-related discharges account for about 11% of all hospitalizations; making those the third most common reason for hospitalization.

· Hospitalizations for all circulatory conditions make up about 10% of all discharges. Those include ischemic heart diseases,

hypertension, cerebrovascular conditions and acute rheumatic fever.

· Neoplasm’s (cancer-related) conditions account for about 8% of all discharges. Those include malignant bone, skin and breast cancers.

TOP TEN REASONS FOR HOSPITAL STAYS, BY BODY SYSTEM:

	REASONS	Number of Discharges	Percent of All Discharges
1.	Complications of Pregnancy, Childbirth and the Puerperium	21,034	15.14
2.	Diseases of the Respiratory System	18,740	13.48
3.	Diseases of the Digestive System	15,618	11.24
4.	Diseases of the Circulatory System	13,842	9.96
5.	Diseases of the Genitourinary System	13,601	9.79
6.	Neoplasms	11,101	7.99
7.	Infectious & Parasitic Diseases	9,140	6.58
8.	Injury and Poisoning	7,816	5.62
9.	Symptoms, Signs and Ill-Defined Conditions	7,550	5.43
10.	Diseases of the Nervous System & Sense Organs	7,518	5.41
			90.63

Number of Discharges

WHAT ARE THE MOST COMMON REASONS FOR HOSPITALIZATION BY GENDER?

Female		Male
1.	Normal Delivery & Other Indications for Care in Pregnancy, Labor and Delivery: 15.4%	Intestinal Infectious Diseases: 5.3%
2.	Complications Occurring Mainly in the Course of Labor and Delivery: 5.4%	Pneumonia and Influenza: 3.6%
3.	Intestinal Infectious Diseases: 4.2%	Inguinal Hernia: 3.5%
4.	Other Pregnancy with Abortive Outcome: 3.1%	Ischemic Heart Disease: 3.4%
5.	Chemotherapy: 2.7%	Chemotherapy: 2.5%
6.	Pneumonia and Influenza: 2.4%	Acute Bronchitis and Bronchiolitis: 2.4%
7.	Cholelithiasis: 2.0%	Calculus of Kidney and Ureter: 2.3%
8.	Acute Bronchitis and Bronchiolitis: 1.7%	Chronic Disease of Tonsils and Adenoids: 2.1%
9.	Complications Mainly Related to Pregnancy: 1.6%	Deviated Nasal Septum: 1.6%
10.	Gastritis and Duodenitis: 1.3%	Renal Colic: 1.5%

· Four out of the top ten conditions for hospitalizations for males are also among the top ten conditions for females. Those are: Pneumonia and Influenza, Intestinal infections, Chemotherapy and Acute Bronchitis.

· Hernia, Ischemic Heart Disease, Calculus of Kidney, Tonsils, Renal Colic and Angina Pectoris are male only top ten conditions.

· Four of the top ten conditions for females’ hospitalization are childbirth related; accounting for nearly 25% of all female discharges.

· Excluding Pregnancy and Childbirth for females, Intestinal Infections become the most common reason for hospitalization stay for both males and females.

· The second most common reason for males’ hospitalization is Pneumonia & Influenza while that for females is Infectious Diseases.

WHAT ARE THE MOST COMMON REASONS FOR HOSPITALIZATION FOR VARIOUS AGE GROUPS?

· Intestinal Infections are one of the top 10 conditions for all patients that are less than 65 years old.

· Pneumonia and Influenza is one of the top ten conditions for those below 18 years and those above 45 years.

· For the group 18 to 44 years of age, four of the top ten reasons for hospitalization pertain to Pregnancy and Delivery. Excluding those four conditions, Intestinal Infections would top the list, followed by Calculus of Kidney.

· A person aged 45 to 64 years is most likely to be hospitalized for heart-related conditions. Ischemic heart disease tops the list of the most common ten reasons for hospitalizations for the group of 45 to 79 years of age.

· Chemotherapy (treatment of malignant cancers) is now second to Ischemic Heart Diseases as the leading cause of hospitalization for the 45 to 79 years old.

· Cataract is the most frequent reason for hospitalization for those over the age of 79 years.

· Some conditions, such as fracture of the neck, appear in the top ten only for patients 80 years old or older.

· Concussion, Acute Tonsillitis and Appendicitis are three top ten conditions that are unique to the group 1 to 17 years of age.

WHAT ARE THE MOST COMMON PRINCIPAL COMORBIDITIES?

Comorbidities can make a hospital stay more expensive and complicated. Conditions are designated as comorbidities if they are not directly related to the principal diagnosis and are likely to have originated prior to the hospital stay. As such, they have to be distinguished from complications that arise out of the hospitalization itself. Comorbidities are coexisting medical problems that are listed as secondary diagnoses (not the principal diagnosis or the main reason for admission).

About 13.0% of hospitalized patients have one or more comorbidities. Of those with comorbidities, about 70% have one comorbidity, 22% have 2 comorbidities and the remainder 8% have 3 comorbidities.

The top comorbidity pertains to hypertension, accounting for about 25% of all comorbidities.

Number of Comorbidities	Number of Patients	Percent
1	8,331	69.8
2	2,615	21.9
3	996	8.3
	11,942	100.0

That is followed by diabetes mellitus, accounting for about 17% of all comorbidities.

Three of the top 10 comorbidities are related to hypertension, two are related to diabetes and those two conditions account for about 42% of all comorbidities.

Top Ten Comorbidities
	PRINCIPAL COMORBIDITIES	Number of Discharges	Percent of Discharges
1.	Hypertensive Diseases	1,654	8.6
2.	Diabetes Mellitus	1,492	7.8
3.	Essential Hypertension	960	5.0
4.	Disorders of Lipoid Metabolism	857	4.5
5.	Ischemic Heart Disease	697	3.6
6.	Hypertrophy of Nasal Turbinates	607	3.2
7.	Diabetes Mellitus With Other Specified Manifestations, Type II or Unspecified Type, Not Stated as Uncontrolled	519	2.7
8.	Chronic Disease of Tonsils and Adenoids	347	1.8
9.	Hypertensive Heart Disease	334	1.7
10.	Asthma	256	1.3
		7,723	40.15

HOW DO COMORBIDITIES DIFFER FOR VARIOUS AGE GROUPS?

· The most common comorbidity is hypertension. That is the first leading comorbidity for patients aged 45 to 79 years and the third leading comorbidity for patients aged 18 to 44 years old.

· The second most common comorbidity is diabetes; especially among the 45 to 64 years of age patients.

· Ischemic and hypertensive heart diseases are the most common

comorbidities for those in the group 45 to 64 years of age. In fact, hypertension accounts for about 20% of all this age group’s comorbidities; followed by diabetes (16%).

· Some comorbidities are unique to certain age groups; such as hernia and congenital anomalies of the heart for infants less than 1 year old, otitis for the group 1 to 17 years of age and nasal septum for the 18 to 44 years old patients.

· Hypertension and diabetes are common comorbidities to all patients over the age of 18 years.

HOW DO COMORBIDITIES DIFFER BY GENDER?

· Nine out of the top ten comorbidities are common to both males and females.

· Diabetes is more prevalent among males than among females.

· Males and Females are equally likely to have a hypertension-related comorbidity.

· Cholelithiasis is a comorbidity that is unique to females.

· Hernia is a comorbidity that is unique to males.

· Male patients are more than twice as likely to have a heart-related comorbidity as are female patients.

Top Ten Comorbidities for Overnight Hospitalizations By Gender
	Number of Discharges
Rank	Females	Males
1.	Hypertensive Diseases : 8.8%	Diabetes Mellitus: 8.7%
2.	Diabetes Mellitus: 6.7%	Hypertensive Diseases : 8.4%
3.	Essential Hypertension: 4.9%	Disorders of Lipoid Metabolism: 5.3%
4.	Disorders of Lipoid Metabolism: 3.6%	Essential Hypertension: 5.1%
5.	Hypertrophy of Nasal Turbinates: 3.3%	Ischemic Heart Disease: 4.5%
6.	Ischemic Heart Disease: 2.7%	Diabetes Mellitus With Other Specified Manifestations, Type II or Unspecified Type, Not Stated as Uncontrolled: 3.5%
7.	Diabetes Mellitus With Other Specified Manifestations, Type II or Unspecified Type, Not Stated as Uncontrolled: 1.9%	Hypertrophy of Nasal Turbinates: 3.0%
8.	Chronic Disease of Tonsils and Adenoids: 1.7%	Chronic Disease of Tonsils and Adenoids: 1.9%
9.	Hypertensive Heart Disease: 1.7%	Hypertensive Heart Disease: 1.8%
10.	Cholelithiasis: 1.5%	Inguinal Hernia: 1.3%

Top Ten Comorbidities By Gender

WHAT CONDITIONS LEAD TO THE LONGEST HOSPITAL STAYS?

· Conditions with lengthy hospital stays are relatively uncommon. Collectively, the 10 conditions with the longest stays represent less than 0.05% of all discharges.

· Two of the top conditions with the longest hospital stays pertain to Cancer. The top condition relates to heart problems with an average stay of 120 days.

Top Ten Conditions With The Longest Hospital Stay
Rank	CONDITIONS WITH THE LONGEST HOSPITAL STAYS	Average Stay (Days)
1.	Other Ill-Defined Heart Diseases	120.0
2.	Care Involving Other Specified Rehabilitation Procedure	92.0
3.	Diabetes Mellitus With Neurological Manifestations, Type II Or Unspecified Type, Not Stated As Uncontrolled	79.0
4.	Malignant Neoplasm Of Other And Ill-Defined Sites	70.0
5.	Chronic Respiratory Failure	60.5
6.	Care Involving Other Physical Therapy	53.1
7.	Benign Neoplasm of Pancreas, Except Islets of Langerhans	51.0
8.	Traumatic Amputation of Leg(s) (Complete) (Partial), Unilateral, At Or Above Knee, Complicated	50.0
9.	Other Specified Disorders of Arteries and Arterioles	48.0
10.	Malignant Neoplasm Of Other Specified Parts Of Mouth	46.0

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 0.05% of all discharges.

Two of the top 10 most expensive conditions are related to cancer:

· A malignant cancer of the mouth (very rare) costs about 59,000 U.S. Dollars.

· A Hodgkins case costs more than 64,000 U.S. Dollars; topping the list of the most expensive cases.

Top Ten Conditions With The Highest Average Cost
Rank	CONDITIONS WITH HIGHEST AVERAGE CHARGE	Average Cost (US $)
1.	Hodgkins Disease, Lymphocytic-Histiocytic Predominance, Unspecified Site	64,555.60
2.	Malignant Neoplasm Of Other Specified Parts Of Mouth	59,206.75
3.	Benign Neoplasm Of Pancreas, Except Islets Of Langerhans	53,324.17
4.	Diverticulitis Of Colon With Hemorrhage	42,074.85
5.	Postcholecystectomy Syndrome	33,938.26
6.	Traumatic Amputation of Leg(s) (Complete) (Partial), Unilateral, At Or Above Knee, Complicated	30,613.70
7.	Other Specified Disorders Of Arteries And Arterioles	30,140.75
8.	Other Ill-Defined Heart Diseases	29,104.06
9.	Occlusion And Stenosis Of Vertebral Artery Without Mention Of Cerebral Infarction	26,334.04
10.	Other Specified Peritonitis	26,123.37

WHICH CONDITIONS HAVE THE HIGHEST IN-HOSPITAL MORTALITY?

· Four of the top ten conditions with the highest in-hospital probability of death* are related to cancer:

- Malignant neoplasm of the Brain.

- Malignant neoplasm of Pancreas.

- Malignant neoplasm of Trachea, Bronchus and Lung.

- Secondary malignant neoplasm of other sites.

· The leading cause of in-hospital mortality is cardiac arrest: about two-thirds of those hospitalized due to cardiac arrest do not survive.

· The second leading cause of in-hospital mortality is intracerebral Hemorrhage (Brain-related).

· Cancer and heart problems account for 7 out of the top 10 leading causes of death following hospitalization.

*: The probability of death is related to the condition itself. For example, if

a person was hospitalized for Cardiac Arrest, then the probability of

death is 66%. In other words, nearly two thirds of those hospitalized for

Cardiac Arrest are not expected to survive.

Top Ten Conditions With The Highest Probability of Death
Rank	PRINCIPAL DIAGNOSIS	In-Hospital Mortality (Percent)
1.	Cardiac Arrest	68.0
2.	Intracerebral Hemorrhage	15.6
3.	Acute Respiratory Failure	12.6
4.	Acute Pulmonary Heart Disease	9.6
5.	Chronic Liver Disease And Cirrhosis	9.3
6.	Heart Failure	8.9
7.	Malignant Neoplasm Of Brain	8.1
8.	Secondary Malignant Neoplasm Of Other Specified Sites	6.7
9.	Malignant Neoplasm Of Pancreas	5.8
10.	Malignant Neoplasm Of Trachea, Bronchus And Lung	5.1

WHICH CONDITIONS HAVE THE HIGHEST NUMBER OF IN-HOSPITAL DEATH, BY BODY SYSTEM?

· About 69.5% of all in-hospital deaths are attributed to two body systems: Circulatory and Neoplasms.

· The Circulatory system alone accounts for about 41% of the total number of in-hospital deaths.

· Injury and poisoning account for about 5.2% of all in-hospital deaths.

In-Hospital Deaths By Body System
	BODY SYSTEM	Total Number of Deaths	Percent of Total
1.	Diseases of the Circulatory System	215	41.43
2.	Neoplasm	146	28.13
3.	Diseases of the Respiratory System	40	7.71
4.	Diseases of the Digestive System	32	6.17
5.	Injury and Poisoning	27	5.20
6.	Diseases of the Genitourinary System	11	2.12
7.	Congenital Anomalies	11	2.12
8.	Diseases of the Nervous System and Sense Organs	10	1.93
9.	Infectious and Parasitic Diseases	7	1.35
10.	Symptoms, Signs And Ill-Defined Conditions	6	1.16
11.	Disease Of The Blood And Blood Forming Organs	4	0.77
12.	Certain Conditions Originating in the Perinatal Period	3	0.58
13.	Endocrine, Nutritional, Metabolic Diseases	2	0.39
14.	Diseases of the Musculoskeletal System and Connective Tissue	2	0.39
15.	Diseases of the Skin and Subcutaneous Tissue	1	0.19
16.	Mental Disorders	1	0.19
17.	Persons Encountering Health Services For Specific Procedures And Aftercare	1	0.19
	TOTAL	519	100.00

In-Hospital Deaths By Body System

WHAT ARE THE LEADING CAUSES OF DEATH BY AGE GROUP?

· Cardiac arrest and Congenital anomalies of heart lead the causes of deaths for infants less than 1 year old.

· Crushing injury and poisoning are the leading causes of death for children in the group 1 to 17 years of age.

· Cerebral hemorrhage leads the causes of death for the 18 to 44 years old.

· Cardiac arrest and heart failures lead the causes of death for all those above the age of 45 years. In fact, death related to heart problems has become one of the top 10 causes of death for all age groups.

· On a more alarming note, cancer has edged the list of the top 10 causes of deaths for all age groups; except infants less than 1 year old.

Top Ten Conditions For Hospitalization By Age Group
Rank	<1yr	1-17	18-44	45-64	65-79	80+
1.	Intestinal Infectious Diseases: 21.2%	Intestinal Infectious Diseases: 13.1%	Normal Delivery & Other Indications for Care in Pregnancy, Labor & Delivery: 17.6%	Ischemic Heart Disease: 5.5%	Ischemic Heart Disease: 5.2%	Cataract: 5.9%
2.	Acute Bronchitis and Bronchiolitis: 12.1%	Chronic Disease of Tonsils and Adenoids: 8.5%	Complications Occurring Mainly in the Course of Labor & Delivery: 6.2%	Chemotherapy: 5.2%	Chemotherapy: 4.9%	Pneumonia & Influenza: 5.7%
3.	Pneumonia & Influenza: 11.6%	Pneumonia & Influenza: 7.9%	Other Pregnancy with Abortive Outcome: 3.5%	Cholelithiasis: 2.4%	Cataract: 4.8%	Heart Failure: 1.7%
4.	Inguinal Hernia: 5.3%	Acute Bronchitis & Bronchiolitis: 4.7%	Intestinal Infectious Diseases: 2.9%	Angina Pectoris: 2.2%	Pneumonia & Influenza: 2.6%	Ischemic Heart Disease: 2.7%
5.	Urinary Tract Infection, Site not Specified: 2.7%	Acute Tonsillitis: 2.7%	Deviated Nasal Septum: 2.1%	Inguinal Hernia: 2.2%	Hyperplasia of Prostate: 2.4%	Transient Cerebral Ischemia: 2.7%
6.	Suppurative & Unspecified Otitis Media: 2.5%	Suppurative & Unspecified Otitis Media: 2.3%	Calculus of Kidney and Ureter: 2.0%	Calculus of Kidney and Ureter: 2.0%	Cholelithiasis: 2.0%	Hyperplasia of Prostate: 2.5%
7.	Fever: 2.4%	Inguinal Hernia: 2.3%	Complications Mainly Related to Pregnancy: 1.9%	Cataract: 1.9%	Inguinal Hernia: 1.9%	Fracture of Neck of Femur: 2.2%
8.	Other Perinatal Jaundice: 1.3%	Appendicitis: 2.3%	Renal Colic: 1.8%	Pneumonia & Influenza: 1.7%	Angina Pectoris: 1.8%	Chemotherapy: 2.0%
9.	Bronchitis not Specified as Acute or Chronic: 1.3%	Concussion: 1.7%	Hypertrophy of Nasal Turbinates: 1.8%	Intestinal Infectious Diseases: 1.7%	Heart Failure: 1.7%	Acute Bronchitis and Bronchiolitis: 1.7%
10.	Disorders Relating to Short Gestation & Unspecified Low Birthweight: 1.1%	Nonsuppurative Otitis Media & Eustachian Tube Disorders: 1.7%	Cholelithiasis: 1.7%	Displacement of Lumbar Intervertebral Disc Without Myelopathy: 1.5%	Senile Cataract, Unspecified: 1.4%	Acute Myocardial Infarction: 1.6%

Top Ten Common Comorbidities By Age Group
	Percent of Discharges
	Age Group
Rank	<1yr	1-17	18-44	45-64	65-79	80+
1.	Intestinal Infectious Diseases: 9.4%	Chronic Disease of Tonsils and Adenoids: 18.4%	Hypertrophy of Nasal Turbinate: 9.1%	Hypertensive Diseases: 12.3%	Hypertensive Diseases: 12.3%	Hypertensive Diseases: 10.4%
2.	Suppurative & Unspecified Otitis Media: 5.7%	Intestinal Infectious Diseases: 6.0%	Disorders of Lipoid Metabolism: 3.7%	Diabetes Mellitus: 10.8%	Diabetes Mellitus: 12.1%	Essential Hypertension: 8.6%
3.	Acute Bronchitis & Bronchiolitis: 5.7%	Suppurative and Unspecified Otitis Media: 5.3%	Hypertensive Diseases: 3.5%	Disorders of Lipoid Metabolism: 6.9%	Essential Hypertension: 8.7%	Diabetes Mellitus: 7.8%
4.	Esophagitis: 4.7%	Nonsuppurative Otitis Media & Eustachian Tube Disorders: 5.0%	Deviated Nasal Septum: 3.3%	Essential Hypertension: 6.1%	Ischemic Heart Disease: 6.4%	Ischemic Heart Disease: 5.2%
5.	Urinary Tract Infection, Site Not Specified: 4.7%	Acute Bronchitis and Bronchiolitis: 3.9%	Diabetes Mellitus: 2.6%	Ischemic Heart Disease: 4.9%	Diabetes Mellitus With Other Specified Manifestations, Type II or Unspecified Type, Not Stated as Uncontrolled: 3.8%	Diabetes Mellitus With Other Specified Manifestations, Type II or Unspecified Type, Not Stated as Uncontrolled: 4.1%
6.	Pneumonia & Influenza: 3.8%	Hypertrophy of Nasal Turbinate: 3.9%	Normal Delivery & Other Indications for Care in Pregnancy, Labor & Delivery: 2.5%	Diabetes Mellitus With Other Specified Manifestations, Type II or Unspecified Type, Not Stated as Uncontrolled: 4.2%	Disorders of Lipoid Matabolism: 3.8%	Hypertensive Heart Disease: 2.6%
7.	Inguinal Hernia: 2.8%	Pneumonia & Influenza: 2.7%	Asthma: 1.9%	Hypertensive Heart Disease: 2.5%	Hypertensive Heart Disease: 2.6%	Chronic Renal Failure: 2.6%
8.	Other Congenital Anomalies of Heart: 2.8%	Asthma: 2.7%	Essential Hypertension: 1.8%	Cholelithiasis : 1.3%	Diseases of the Circulatory System : 1.9%	Atrial Fibrillation and Flutter: 2.2%
9.	Chronic Disease of Tonsils and Adenoids: 2.4%	Other Disorders of Tympanic Membrane: 2.4%	Diseases of Esophagus, Stomach & Duodenum: 1.4%	Diseases of the Circulatory System: 1.1%	Chronic Renal Failure: 1.8%	Malignant Neoplasm of Prostate: 1.9%
10.	Congenital Anomalies of Urinary System: 2.4%	Epilepsy: 1.8%	Cholelithiasis: 1.4%	Diabetes Mellitus With Other Specified Manifestations, Type I Not Stated as Uncontrolled: 1.1%	Unspecified Essential Hypertension: 1.7%	Disorders of Lipoid Matabolism: 1.9%

Top Ten Conditions For Death By Age
	Age Group
Rank	<1Yr	1-17	18-44	45-64	65-79	³80
1.	Cardiac Arrest: 11.1%	Crushing Injury: 11.5%	Intracerebral Hemorrhage: 13.0%	Heart Failure: 9.4%	Cardiac Arrest: 11.9%	Heart Failure: 18.8%
2.	Other Congenital Anomalies Of Heart: 11.1%	Poisoning By Drugs, Medicinal & Biological Substances: 11.5%	Crushing Injury: 9.3%	Cardiac Arrest: 8.8%	Heart Failure: 8.3%	Cardiac Arrest: 12.5%
3.	Congenital Anomalies Of Respiratory System: 5.6%	Other Congenital Anomalies Of Heart: 7.7%	Cardiac Arrest: 7.4%	Ischemic Heart Disease: 4.7%	Malignant Neoplasm Of Trachea, Bronchus and Lung: 5.1%	Acute Respiratory Failure: 6.3%
4.	Dyspnea and Respiratory Abnormalities: 5.6%	Other Congenital Anomalies Of Digestive System: 7.7%	Malignant Neoplasm of Other and Unspecified Sites: 5.6%	Acute Myocardial Infarction: 4.7%	Acute Myocardial Infarction: 4.1%	Congestive Heart Failure: 3.1%
5.	Respiratory Distress Syndrome In Newborn: 5.6%	Encephalitis, Myelitis and Encephalomyelitis: 7.7%	Heart Failure: 3.7%	Malignant Neoplasm Of Trachea, Bronchus and Lung: 4.1%	Acute Respiratory Failure: 3.7%	Chronic Liver Disease and Cirrhosis: 3.1%
6.	Unspecified Congenital Anomaly Of Heart: 5.6%	Malignant Neoplasm Of Testis: 3.9%	Acute Pancreatitis: 3.7%	Intracerebral Hemorrhage: 3.5%	Acute Pulmonary Heart Disease: 3.2%	Chronic Airway Obstruction, Not Elsewhere Classified: 3.1%
7.	Disorders Relating To Short Gestation And Unspecified Low Birthweight: 5.6%	Malignant Neoplasm Of Brain: 3.9%	Acute Myocardial Infarction: 3.7%	Malignant Neoplasm Of Brain: 3.5%	Intracerebral Hemorrhage: 3.2%	Fracture Of Unspecified Trochanteric Section Of Femur, Closed: 3.1%
8.	Other Congenital Anomalies Of Circulatory System: 5.6%	Heart Failure: 3.9%	Malignant Neoplasm Of Trachea, Bronchus and Lung: 3.7%	Heart Disease Unspecified: 2.9%	Pneumonia and Influenza: 3.2%	Aplastic Anemia: 3.1%
9.	Other Diseases Of Respiratory System: 5.6%	Congenital Anomalies Of Eye: 3.9%	Secondary Malignant Neoplasm Of Other Specified Sites: 3.7%	Gastrointestinal Hemorrhage: 2.9%	Heart Disease Unspecified: 2.8%	Acute Respiratory Infections: 3.1%
10.	Urinary Tract Infection, Site Not Specified: 5.6%	Coma: 3.9%	Malignant Neoplasm Of Female Breast: 3.7%	Chronic Liver Disease and Cirrhosis: 2.9%	Malignant Neoplasm Of Pancreas: 2.8%	Acute Renal Failure, Unspecified: 3.1%

Top Ten Diseases for Death By Gender
Rank	Female	Male
1.	Cardiac Arrest: 9.0%	Cardiac Arrest: 10.3%
2.	Heart Failure: 7.9%	Heart Failure: 8.5%
3.	Malignant Neoplasm Of Female Breast: 4.7%	Intracerebral Hemorrhage: 4.9%
4.	Heart Disease, Unspecified: 3.7%	Acute Myocardial Infarction: 4.6%

Bulletin No. 17-02

December 2002

List of Tables

Page

List of Figures

PRINCIPAL DIAGNOSIS

Number

Chest Pain

REASON BY BODY SYSTEM

1.

Diseases of the Circulatory System

PRINCIPAL DIAGNOSIS

1.

Normal Delivery and Other Indications for Care in Pregnancy, Labor and Delivery

2.

Abdominal Pain

Intestinal Infectious Diseases

REASONS

Normal Delivery & Other Indications for Care in Pregnancy, Labor and Delivery: 15.4%

Rank

1.

Number of Patients

PRINCIPAL COMORBIDITIES

Hypertensive Diseases

Top Ten Common Comorbidities By Age Group

Percent of Discharges

Rank

1.

Hypertensive Diseases : 8.8%

CONDITIONS WITH THE LONGEST HOSPITAL STAYS

CONDITIONS WITH HIGHEST AVERAGE CHARGE

PRINCIPAL DIAGNOSIS