Center for Outcomes Research and Evaluation, Yale New Haven Hospital, CT (Y.L., Y.W., E.S.S., O.O. H.M.K.).
Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (Y.L., E.S.S., O.O. H.M.K.).
Circulation. 2021 Nov 23;144(21):1683-1693. doi: 10.1161/CIRCULATIONAHA.121.057056. Epub 2021 Nov 8.
In the past 2 decades, hypertension control in the US population has not improved and there are widening disparities. Little is known about progress in reducing hospitalizations for acute hypertension.
We conducted serial cross-sectional analysis of Medicare fee-for-service beneficiaries age 65 years or older between 1999 and 2019 using Medicare denominator and inpatient files. We evaluated trends in national hospitalization rates for acute hypertension overall and by demographic and geographical subgroups. We identified all beneficiaries admitted with a primary discharge diagnosis of acute hypertension on the basis of International Classification of Diseases codes. We then used a mixed effects model with a Poisson link function and state-specific random intercepts, adjusting for age, sex, race and ethnicity, and dual-eligible status, to evaluate trends in hospitalizations.
The sample consisted of 397 238 individual Medicare fee-for-service beneficiaries. From 1999 through 2019, the annual hospitalization rates for acute hypertension increased significantly, from 51.5 to 125.9 per 100 000 beneficiary-years; the absolute increase was most pronounced among the following subgroups: adults ≥85 years (66.8-274.1), females (64.9-160.1), Black people (144.4-369.5), and Medicare/Medicaid insured (dual-eligible, 93.1-270.0). Across all subgroups, Black adults had the highest hospitalization rate in 2019, and there was a significant increase in the differences in hospitalizations between Black and White people from 1999 to 2019. Marked geographic variation was also present, with the highest hospitalization rates in the South. Among patients hospitalized for acute hypertension, the observed 30-day and 90-day all-cause mortality rates (95% CI) decreased from 2.6% (2.27-2.83) and 5.6% (5.18-5.99) to 1.7% (1.53-1.80) and 3.7% (3.45-3.84) and 30-day and 90-day all-cause readmission rates decreased from 15.7% (15.1-16.4) and 29.4% (28.6-30.2) to 11.8% (11.5-12.1) and 24.0% (23.5-24.6).
Among Medicare fee-for-service beneficiaries age 65 years or older, hospitalization rates for acute hypertension increased substantially and significantly from 1999 to 2019. Black adults had the highest hospitalization rate in 2019 across age, sex, race and ethnicity, and dual-eligible strata. There was significant national variation, with the highest rates generally in the South.
在过去的 20 年里，美国人口的高血压控制情况并没有改善，而且差距还在扩大。人们对降低急性高血压住院率的进展知之甚少。
我们使用医疗保险按服务付费受益人的分母和住院文件，对 1999 年至 2019 年期间年龄在 65 岁或以上的医疗保险按服务付费受益者进行了一系列的横断面分析。我们评估了急性高血压全国住院率的总体趋势以及按人口统计学和地理亚组的趋势。我们根据国际疾病分类代码确定了所有以急性高血压为主要出院诊断的住院患者。然后，我们使用具有泊松链接函数和州特定随机截距的混合效应模型，调整年龄、性别、种族和民族以及双重保险状况，评估住院趋势。
该样本由 397238 名个别医疗保险按服务付费受益者组成。从 1999 年到 2019 年，急性高血压的年住院率显著上升，从每 10 万受益人数的 51.5 上升到 125.9；在以下亚组中，绝对值的增幅最为显著：年龄在 85 岁及以上的成年人（66.8-274.1）、女性（64.9-160.1）、黑人（144.4-369.5）和医疗保险/医疗补助保险（双重保险，93.1-270.0）。在所有亚组中，黑人成年人在 2019 年的住院率最高，并且从 1999 年到 2019 年，黑人和白人之间的住院率差异显著增加。显著的地域差异也存在，南部的住院率最高。在因急性高血压住院的患者中，观察到的 30 天和 90 天全因死亡率（95%CI）从 2.6%（2.27-2.83）和 5.6%（5.18-5.99）降至 1.7%（1.53-1.80）和 3.7%（3.45-3.84），30 天和 90 天全因再入院率从 15.7%（15.1-16.4）和 29.4%（28.6-30.2）降至 11.8%（11.5-12.1）和 24.0%（23.5-24.6）。
在 65 岁及以上的医疗保险按服务付费受益人群中，急性高血压的住院率从 1999 年到 2019 年大幅且显著上升。在所有年龄、性别、种族和民族以及双重保险人群中，黑人成年人在 2019 年的住院率最高。存在显著的全国性差异，南部的比率通常最高。
