221761 Hospitalization rates for chronic conditions among California adults: Age-adjusted versus disease prevalence-adjusted rates?

Sunday, November 7, 2010

Camillia K. Lui, MPH, MA , Department of Community Health Sciences, UCLA School of Public Health, Los Angeles, CA
Steven Wallace, PhD , UCLA Center for Health Policy Research, Los Angeles, CA
Background: Hospitalization rates are a key measure to assess the quality and access to care for ambulatory-sensitive chronic health conditions. To account for demographic differences, hospitalization rates are often adjusted by age. However, age-adjusted hospitalization rates are based on the total number of people in the population rather than the total number of people who are at-risk for hospitalization in the population.

Methods: We compared relative hospitalization rates between crude (un-adjusted), simple age-adjusted and age-/disease prevalence-adjusted rates by California counties. California OSHPD's Patient Discharge Data were used to identify the number of hospitalizations by ICD-9 codes for diabetes, asthma, heart failure, hypertension, and psychological distress. California Health Interview Survey data were used to estimate prevalence of adults reporting each chronic condition. Hospitalization rates were adjusted by age and adjusted by proportion of adults reporting the disease.

Results: Crude rates of ambulatory-sensitive conditions such as diabetes vary from 4.3 hospitalizations per 10,000 adults in Nevada county to 11.8 in San Bernardino county. When rates are only age-adjusted, they range from 3.1 hospitalizations per 10,000 adults in Nevada county to 9.7 in San Bernardino county. Adding diabetes prevalence by age refines the analysis to include an adjustment for risk of hospitalization. The resulting rates range from 58.3 hospitalizations per 10,000 adults in San Mateo county to 251.3 in San Luis Obispo county.

Conclusions: With the rising number of people living with a chronic health condition and increasing health care expenditures to treat ambulatory-sensitive conditions, better measures of hospitalization rates are needed to document preventable hospitalizations.

Learning Areas:
Chronic disease management and prevention
Epidemiology

Learning Objectives:
1. Explain the relevance of ambulatory-sensitive chronic conditions as indicators of quality and access to medical care. 2. Describe the differences between age-adjusted and disease prevalence-adjusted hospitalization rates. 3. Understand how the distribution of certain populations can alter the pattern of apparent ambulatory-sensitive hospitalizations.

Keywords: Chronic Diseases, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conducted data analysis and prepared the findings for this research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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