Singh Jasvinder A, Yu Shaohua
Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA.
Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
BMC Health Serv Res. 2016 Jul 26;16:303. doi: 10.1186/s12913-016-1563-7.
Hypertension is one of the commonest chronic diseases, yet limited data are available for related health care utilization. Our study objective was to describe the emergency department (ED) and subsequent hospitalization related health care utilization and charges due to hypertension in the U.S.
We used the National ED sample (NEDS) to study hypertension-related utilization and charges. Multivariable-adjusted linear or logistic regression was used to assess hypertension-associated ED and hospitalization outcomes (disposition, length of stay, charges), adjusted for patient demographic, comorbidity and hospital characteristics.
There were 0.92, 0.97 and 1.04 million ED visits (0.71-0.77 % of all ED visits) with hypertension as the primary diagnosis in 2009, 2010 and 2012, respectively; 23 % resulted in hospitalization. ED charges were $2.00, $2.27 and $2.86 billion, and for those hospitalized, total charges (ED plus inpatient) were $6.62, $7.09 and $7.94 billion, in 2009, 2010 and 2012, respectively. Older age (50 to 65 years), female sex, metropolitan area residence, South or West U.S. hospital location, private insurance and the presence of congestive heart failure were each associated with higher charges for an ED visit with hypertension as the primary diagnosis. Younger age, metropolitan residence, Medicaid insurance, hospital location in the Northeast and co-existing diabetes, gout, coronary heart disease, chronic obstructive pulmonary disease, hyperlipidemia and osteoarthritis were associated with higher risk, whereas male sex was associated with lower risk of hospitalization after ED visit for hypertension. In 2012, 71.6 % of all patients hospitalized with hypertension as the primary diagnosis were discharged home. Older age, metropolitan residence and most comorbidities were associated with lower odds, whereas male sex, payer other than Medicare, South or West U.S. hospital location were associated with higher odds of discharge to home.
Hypertension is associated with significant healthcare burden in the U.S. Future studies should assess strategies to reduce hypertension-associated cost and health care burden.
高血压是最常见的慢性病之一，但关于相关医疗保健利用的可用数据有限。我们的研究目的是描述美国因高血压导致的急诊科（ED）就诊及随后住院的医疗保健利用情况和费用。
我们使用国家急诊科样本（NEDS）来研究与高血压相关的利用情况和费用。采用多变量调整的线性或逻辑回归来评估与高血压相关的急诊科就诊和住院结局（处置方式、住院时间、费用），并根据患者人口统计学、合并症和医院特征进行调整。
2009年、2010年和2012年，分别有92万、97万和104万次急诊科就诊（占所有急诊科就诊的0.71 - 0.77%）以高血压作为主要诊断；其中23%导致住院。2009年、2010年和2012年，急诊科费用分别为20亿美元、22.7亿美元和28.6亿美元，对于住院患者，总费用（急诊科加住院部）分别为66.2亿美元、70.9亿美元和79.4亿美元。年龄较大（50至65岁）、女性、居住在大都市地区、美国南部或西部的医院位置、私人保险以及存在充血性心力衰竭均与以高血压作为主要诊断的急诊科就诊费用较高相关。年龄较小、居住在大都市、医疗补助保险、医院位于东北部以及并存糖尿病、痛风、冠心病、慢性阻塞性肺疾病、高脂血症和骨关节炎与较高风险相关，而男性与高血压急诊科就诊后住院风险较低相关。2012年，以高血压作为主要诊断住院的所有患者中，71.6%出院回家。年龄较大、居住在大都市以及大多数合并症与出院回家的几率较低相关，而男性、医疗保险以外的支付方、美国南部或西部的医院位置与出院回家的几率较高相关。
在美国，高血压与巨大的医疗负担相关。未来的研究应评估降低高血压相关成本和医疗负担的策略。
