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Hospitalization rates can overestimate disease prevalence

A study of hospitalization rates found that repeat hospitalizations can skew estimates of disease prevalence, according to data published in Preventing Chronic Disease.

"Surveillance practice commonly uses hospitalization data that include repeat hospitalizations among individuals to monitor the burden of disease," Stephanie M. Benjamin, PhD, MPH, and colleagues wrote.

Benjamin, an assistant professor at California State University, Northridge, along with researchers from the CDC, analyzed hospitalization data, including repeat hospitalizations, on diabetes and other conditions among patients with and without diabetes. They used data from 10,384,306 hospital discharges in 12 states in 2011 from the State Inpatient Databases of the Agency for Healthcare Research and Quality. To estimate that number of adults with and without diabetes in each state, which would be used as the denominator in the calculation of hospitalization rates, the researchers used the Behavioral Risk Factor Surveillance System.

Benjamin and colleagues assessed repeat hospitalization rates for acute myocardial infarction, heart failure, major cardiovascular disease, ischemic heart disease, stroke, lower extremity amputation, peripheral arterial disease and lower extremity ulcer/inflammation. Hypoglycemia and hyperglycemic crisis hospitalization rates were measured for patients with diabetes.

The researchers reported that repeat hospitalizations occurred in all investigated conditions, but significance was varied.

In adults without diabetes, rates including repeat hospitalizations ranged from 9.5% higher for stroke to 25.2% higher for heart failure when compared with rates that excluded repeat hospitalizations. In adults with diabetes, rates including repeat hospitalizations ranged from 13% higher for stroke to 41.6% higher for heart failure when compared with rates that excluded repeat hospitalizations.

Additionally, researchers found that hospitalization rates for adults with diabetes were higher than rates for adults without diabetes, regardless of reason for hospitalization. Diabetes vs. nondiabetes rate ratios were similar both without and with repeat hospitalizations.

"To our knowledge, ours is the first study to quantify the overestimation of hospitalization rates of individuals for common diabetes-related causes due to the inclusion of repeat hospitalizations and to determine whether this in turn affects comparisons of diabetes to nondiabetes rates," Benjamin and colleagues wrote. "The results of this study demonstrated that the use of repeat hospitalizations substantially overestimated hospitalization rates for both the diabetic and nondiabetic populations and that this overestimation varied by cause." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.