Trends in death due to adverse effects of medical and surgical care in the elderly

Introduction. The Centers for Medicare and Medicaid Services (CMS) conducted demonstrations and developed policy to deny charges related to preventable medical/surgical misadventures. This study attempts to examine 15 year historical trends before the policy shift. Methods. Deaths due to adverse effects of medical care were examined using ICD-9-CM codes E870-E879 (1990-1998) and ICD-10-codes Y60-Y84, Y88(.1-.3) (1999-2005) for ages 65+ years using the most applicable WISQARS categorization of “adverse effects, medical care”. Adverse drug events and properly administered anesthesia, infusion and transfusion were excluded. Results. In 2005, adverse effects were the 6th leading cause of injury-related death among persons 65 years and older with more than 1,700 deaths annually. The ICD-9 to ICD-10 transition was associated with a drop in adverse effect rates for all groups examined. Among black women, death from adverse effects emerges as a leading cause of injury death by age 45. By age 65, it ranks third (13.0%) among all injury deaths closely following falls (14.3%). Black mortality was 1.84 times higher than whites and 2.04 times higher than Hispanics. In 2005, white non-Hispanic (3.33/100,000) and black non-Hispanic (6.14/100,000) mortality had declined compared to baseline, but Hispanic mortality (3.02/100,000) had not. Black-white disparities widened slightly as declines in white rates exceeded that of blacks. Conclusions. This study is limited by the current data categorization practice that combines misadventures and abnormal reactions without mention of misadventure into adverse effects of medical care. Future efforts should disaggregate misadventures to allow for better surveillance of the impact of CMS policies.