Adams W L, Yuan Z, Barboriak J J, Rimm A A
Department of Medicine, Medical College of Wisconsin, Milwaukee.
JAMA. 1993 Sep 8;270(10):1222-5.
To determine the prevalence, geographic variation, and charges to Medicare of alcohol-related hospitalizations among elderly people in the United States.
A cross-sectional prevalence study using 1989 hospital claims data from the Health Care Financing Administration (HCFA). Rates were determined using (1) hospital claims records from the HCFA's Medicare Provider Analysis and Review Record (MEDPAR) database for all Medicare Part A beneficiaries aged 65 years and older; (2) county population estimates for 1985 from the Bureau of the Census; and (3) per capita consumption of alcohol by state in 1989 as estimated by the US Department of Health and Human Services.
Data include all hospital inpatient Medicare Part A beneficiaries aged 65 years and older in the United States in 1989.
The prevalence of alcohol-related hospitalizations among people aged 65 years and older nationally in 1989 was 54.7 per 10,000 population for men and 14.8 per 10,000 for women. Comparison with hospital records showed that MEDPAR data had a sensitivity of 77% to detect alcohol-related hospitalizations. There was considerable geographic variation; prevalence ranged from 18.9 per 10,000 in Arkansas to 77.0 per 10,000 in Alaska. A strong correlation existed between alcohol-related hospitalizations and per capita consumption of alcohol by state (Spearman correlation coefficient, .64; P < .0001). In 1989, the hospital-associated charges to Medicare for all admissions where the primary diagnosis was alcohol related (N = 33,039) totaled $233,543,500. Median charge per hospital stay was $4514.
Alcohol-related hospitalizations among elderly people are common; rates were similar to those for myocardial infarction as detected by the same method. The charges to Medicare for this preventable problem are considerable. Ecological analysis suggests that per capita consumption in the total US population predicts alcohol-related hospitalizations in the elderly population.
确定美国老年人中与酒精相关的住院治疗的患病率、地理差异以及医疗保险费用。
一项横断面患病率研究，使用了来自医疗保健财务管理局（HCFA）的1989年医院索赔数据。患病率的确定方法如下：（1）来自HCFA的医疗保险提供者分析和审查记录（MEDPAR）数据库中所有65岁及以上医疗保险A部分受益人的医院索赔记录；（2）1985年人口普查局的县人口估计数；（3）美国卫生与公众服务部估计的1989年各州人均酒精消费量。
数据包括1989年美国所有65岁及以上的医疗保险A部分住院受益人。
1989年全国65岁及以上人群中与酒精相关的住院患病率，男性为每10000人中有54.7例，女性为每10000人中有14.8例。与医院记录的比较显示，MEDPAR数据检测与酒精相关住院治疗的敏感性为77%。存在相当大的地理差异；患病率从阿肯色州的每10000人中有18.9例到阿拉斯加州的每10000人中有77.0例不等。与酒精相关的住院治疗与各州人均酒精消费量之间存在很强的相关性（斯皮尔曼相关系数为0.64；P < 0.0001）。1989年，所有主要诊断与酒精相关的住院病例（N = 33039）的医疗保险相关医院费用总计233543500美元。每次住院的中位费用为4514美元。
老年人中与酒精相关的住院治疗很常见；患病率与用相同方法检测到的心肌梗死患病率相似。对于这个可预防问题，医疗保险费用相当可观。生态分析表明，美国总人口中的人均消费量可预测老年人群中与酒精相关的住院治疗情况。
