Care of Women in U.S. Hospitals, 2000

HCUP Fact Book No. 3

To help fulfill its mission of providing information on the U.S. health care system, the Agency for Healthcare Research and Quality (AHRQ) develops and sponsors databases that include the Healthcare Cost and Utilization Project (HCUP). Through HCUP, AHRQ has taken a lead in developing databases, software tools, and statistical reports to inform policymakers, health system leaders, and researchers at the Federal, regional, and State levels.

This third Fact Book answers many questions about hospital care for women such as: In what ways do hospitalized women differ from hospitalized men? What are the most common reasons for hospitalizations? For what preventable conditions are women hospitalized? Who is billed for various types of hospital stays? What are the patterns of hospital care for pregnancy and delivery?

To print the entire Fact Book, download PDF File (522 KB). PDF Help.

By H. Joanna Jiang, Ph.D.; Anne Elixhauser, Ph.D.; Joyce Nicholas, M.P.H.; Claudia Steiner, M.D., M.P.H.; Carolina Reyes, M.D.; Arlene S. Bierman, M.D., M.S.

Contents

Foreword
Contributors
Introduction
Summary
Hospital Stays for Men and Women
Hospital Stays for Obstetric Patients
Sources
Methods
For More Information

Foreword

The unprecedented volume and pace of change in the U.S. health care delivery system requires new information on health care and its delivery. The mission of the Agency for Healthcare Research and Quality (AHRQ) is to provide information on the health care system—on quality, outcomes, access, cost, and utilization—that decisionmakers can use to improve health care. To help fulfill this mission, the Agency develops and sponsors a number of databases, including the powerful Healthcare Cost and Utilization Project (HCUP). HCUP is a Federal-State-Industry partnership to build a standardized, multi-State health data system.

Through HCUP, AHRQ has taken a lead in developing databases, software tools, and statistical reports to inform policymakers, health system leaders, and researchers at the Federal, regional, and State levels. But for data to be useful, they must be disseminated in a timely, accessible way. In 1999, AHRQ launched HCUPnet, an interactive, Internet-based tool for identifying, tracking, analyzing, and comparing statistics on hospital utilization, outcomes, and charges. Menu-driven HCUPnet guides users in tailoring specific queries about hospital care online; and, with a click of a button, users receive answers within seconds.

A second way we have developed to make these data more accessible and useful is the HCUP Fact Book series—reports that provide data about hospital care in the United States in an easy-to-use, readily accessible format. Each Fact Book will provide information about specific aspects of hospital care—the single largest component of our health care dollar. The first Fact Book provided an overview of hospital stays in the United States and types of conditions that were treated. The second Fact Book provided information on procedures performed in U.S. hospitals.

This third Fact Book answers many questions about hospital care for women such as:

We invite you to tell us how you are using this Fact Book and other HCUP data and tools and to share suggestions on how HCUP products might be enhanced to further meet your needs. In addition, AHRQ continually seeks to learn how HCUP and other AHRQ products have influenced practice, patient outcomes, and health policy. Please E-mail us at hcup@ahrq.gov or send a letter to the address below.

Irene Fraser, Ph.D.
Director
Center for Organization and Delivery Studies
Agency for Healthcare Research and Quality
540 Gaither Road, Suite 5000
Rockville, MD 20850

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Contributors

Without the following 28 State partner organizations, the Healthcare Cost and Utilization Project would not be possible:

In May 2000, HCUP State partners and AHRQ received the Secretary of Health and Human Services' Award for Distinguished Service for "leadership, teamwork, and creative thinking in increasing availability, utility, and value of data for policy-makers and researchers concerned with hospital quality, utilization and cost."

Acknowledgments: Thanks to James Maedke and Shiqiang Li at Social and Scientific Systems, Inc., for their invaluable assistance in statistical programming and to DonnaRae Castillo, AHRQ Office of Health Care Information, for editorial assistance.

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Introduction

Women accounted for about 60 percent of all adult hospital stays during 2000. This report provides an overview of hospital care for women and compares hospital stays for women and men. It also includes a special section on obstetric care in hospitals.

This report summarizes information from the Nationwide Inpatient Sample, or NIS, a database maintained by the Agency for Healthcare Research and Quality (AHRQ). The NIS is uniquely suited to providing a comprehensive picture of hospital care. Because of its tremendous size (about 7 million records), the NIS can provide information on relatively uncommon diagnoses and procedures, as well as on subpopulations, such as various age groups. The NIS covers all patients discharged from hospitals, including the uninsured, those covered by public payers (Medicare and Medicaid), and those with private insurance. It also provides information on total hospital charges for all patients, unlike any other data source in the United States.

This report provides information on:

Hospital stays for men and women:

Hospital stays for obstetric patients:

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Summary

Hospital Stays for Men and Women

Hospital Stays for Obstetric Patients

Hospital Stays for Men and Women

How Does Age Composition Differ for Men and Women?

Select Figure 1 (16 KB), Age Composition by Sex.

How Do Men and Women Differ in Source of Admission to the Hospital?

Select Figure 2 (29 KB), Source of Admission to Hospital.

What Are the Most Common Reasons for Hospitalization, by Body System?

Select Figure 3 (19 KB), Reasons for Hospitalization.

How Do the Most Common Reasons for Hospitalization of Women Differ from Those for Men?

Select for Table 1 (5 KB), Top 10 Principal Diagnoses, by Sex.

What Are the Most Common Reasons for Hospitalization of Nonobstetric Female Patients, by Age Group?

Select for Table 2 (4 KB), Top 10 Principal Diagnoses, by Age Group.

What Are the Most Common In-Hospital Procedures Received by Nonobstetric Female Patients?

Select for Table 3 (3 KB), Top 10 Procedures for Male and Nonobstetric Female Patients.

What Are the Most Common In-Hospital Procedures for Nonobstetric Female Patients, by Age Group?

Select for Table 4 (5 KB), Top 10 Procedures for Nonobstetric Female Patients, by Age Group.

How Does Procedure Use Differ for Men and Women Hospitalized for Two Common Cardiac Conditions?

Select Figure 4 (12 KB), Procedure Use for Two Cardiac Conditions.

How Do the Common Comorbidities for Nonobstetric Female Patients Compare with Those for Men?

Select for Table 5 (3 KB), Top 10 Comorbidities, by Age, Group, and Sex.

How Do Comorbidities Differ Across Age Groups?

Select for Table 6 (7 KB), Top 10 Comorbidities, by Sex.

How Do Women and Men Differ in Potentially Avoidable Hospitalizations?

Select Figure 5 (12 KB), Hospitalization for Ambulatory Care Sensitive Conditions, by Sex.

How Do Potentially Avoidable Hospitalizations Vary by Payer?

Select Figure 6 (5 KB), Total Hospitalizations Attributed to Ambulatory Care-Sensitive Conditions, by Payer and Sex.

How Do Sources of Payment Differ for Men and Women?

Select Figure 7 (16 KB), Sources of Payment.

What Are the Most Common Reasons for Hospitalization of Nonobstetric Female Patients, by Payer?

Select for Table 7 (5 KB), Common Principal Diagnoses for Nonobstetric Female Patients by Payer.

How Do Length of Stay and Total Charges Differ for Male and Nonobstetric Female Patients, by Age Group?

Select Figure 8 (18 KB), Charges for Male and Nonobstetric Female Patients.

What Conditions Have the Highest In-Hospital Mortality, by Age Group?

Select for Table 8 (8 KB), Top 10 Conditions with the Highest In-Hospital Mortality.

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Hospital Stays for Obstetric Patients

What Is the Age Composition of Obstetric Patients?

Select Figure 9 (11 KB), Age Composition of Obstetric Patients.

What Are the Most Common Reasons Associated with Obstetric Hospital Stays?

Select Figure 10 (3 KB), Most Common Reasons Associated with Obstetric Hospital Stays.

What Are the Most Common Reasons for Hospital Stays Related to Pregnancy Loss?

Select Figure 11 (4 KB), Most Common Reasons for Hospital Stays Related to Pregnancy Loss.

What Are the Most Common Conditions Associated with Hospitalizations for Antepartum Care?

Select Figure 12 (14 KB), Most Common Conditions Associated with Hospitalizations for Antepartum Care.

What Are Average Length of Stay and Total Charges for Obstetric Hospitalizations?

Select Figure 13 (8 KB), Average Length of Stay and Total Charges for Obstetric Hospitalizations.

Who Is Billed for Hospital Stays for Obstetric Care?

Select Figure 14 (7 KB), Billed for Obstetric Care.

How Old Are Obstetric Patients, by Type of Delivery?

Select Figure 15 (8 KB), Obstetric Patient Age, by Type of Delivery.

How Does Resource Use Differ for Women Who Have Cesarean Sections and Women Who Have Vaginal Delivery?

Select Figure 16 (10 KB), Resource Use by Women Having Cesarean Sections or Vaginal Deliveries.

How Does Cesarean Section Rate Differ by Payment Source?

Select Figure 17 (4 KB), Cesarean Section Rate by Payment Source.

How Is Obstetric Trauma Associated with Type of Delivery?

Select Figure 18 (5 KB), Obstetric Trauma Associated with Type of Delivery.

How Have Cesarean Section Rates and Vaginal Birth after Cesarean Section Rates Changed Over Time?

*Gregory K, Korst L, Platt L. Variation in elective primary cesarean rates by hospital organizational factors. American Journal of Obstetrics and Gynecology 2001; 184:1521-34.
Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final Data for 2000. National Vital Statistics Reports; vol. 50 No. 5. Hyattsville, MD: National Center for Health Statistics. 2002.

Select Figure 19 (4 KB), Changes Over Time in Rates of Cesarean Sections and Rates of Vaginal Births after Cesarean Section.

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Sources of Data for This Report

The data presented in this report are drawn from the Healthcare Cost and Utilization Project (HCUP), a Federal-State partnership to build a multi-State health care data system. This partnership is sponsored by the Agency for Healthcare Research and Quality (AHRQ) and is managed by staff in AHRQ's Center for Organization and Delivery Studies. HCUP is based on health care administrative data (such as hospital claims and discharge abstracts) collected by individual States and forwarded to AHRQ by the States. HCUP would not be possible without State data collection projects and their partnership with AHRQ.

For 2000, 28 State data organizations contributed their data to AHRQ, where all data are edited and transformed into a uniform format. The uniform data in HCUP databases make possible comparative studies of health care services and the use and cost of hospital care, including:

HCUP includes short-term, non-Federal, community hospitals (e.g., general and specialty hospitals such as pediatric, obstetrics-gynecology, and oncology hospitals are included; but long-term care, rehabilitation, and psychiatric hospitals are excluded).

HCUP includes two sets of databases for health services research. The State Inpatient Databases (SID) for 2000 covers inpatient care in community hospitals in 28 States and represent about 80 percent of all hospital discharges in the United States. The Nationwide Inpatient Sample (NIS) includes all discharges from 994 hospitals drawn from the SID, adjusted to approximate a national 20-percent sample of U.S. short-term, non-Federal, community hospitals, as defined by the American Hospital Association (AHA). Community hospitals are defined as general and specialty hospitals, including academic medical centers, but excluding long-term care and psychiatric hospitals.

This report is based on data from the NIS. The NIS for 2000 includes information from about 7 million discharges which were weighted to obtain estimates that represent the total number of inpatient hospital discharges in the United States (36.4 million).

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Methods

The Clinical Classifications Software (CCS), developed by AHRQ, has been used throughout this Fact Book to aggregate diagnosis codes into a limited number of categories. Diagnoses recorded on hospital discharge records are coded using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), Fifth Edition. Although ICD-9-CM may be used to provide descriptive statistics, aggregating similar diagnoses or procedures into clinically meaningful categories, such as the CCS, can be more helpful. More information on CCS can be downloaded from online (www.ahrq.gov/data/hcup).

Frequencies and rankings of diagnoses are based on principal, or first-listed diagnosis. Frequencies and rankings of procedures are based on all-listed procedures; that is, all procedures listed on the discharge record. The unit of analysis is the inpatient stay rather than the patient. All discharges have been weighted to produce national estimates.

Total charges in HCUP data are the amount the hospital charged or billed for the entire hospital stay and do not necessarily reflect reimbursements or costs. Charges do not include professional (physician) fees. Charge data were present for 98 percent of all discharges. Charges are generally higher than costs.

Because the NIS is limited to inpatient hospital data, conditions treated or procedures performed in outpatient settings are not reflected here.

Terms relating to differences such as "higher than," "lower than," "more than," "more likely" or "less likely" indicate that the difference is statistically significant at the 0.05 level of significance. The testing of statistical significance is based on the two-tailed test of Z-score with standard errors calculated in SUDAAN that takes into account the stratified probability sample design in NIS.

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For More Information

More information on HCUP data and the CCS can be obtained online at www.ahrq.gov/data/hcup. Additional descriptive statistics can be viewed through HCUPnet (http://hcup.ahrq.gov/HCUPNet.asp), a Web-based tool providing easy access to information on hospital stays, available at the same Web site.

Currently, NIS data can be purchased for data years 1988-2000. NIS 2000 may be purchased for $200 in a set of two CD-ROMs with accompanying documentation from the AHRQ-designated HCUP Central Distributor, Social and Scientific Systems, Inc., telephone: (866) 556-4287 (toll-free), fax: 301- 628-3201, or E-mail: hcup@s-3.com.

The HCUP Central Distributor can also provide information on how to purchase NIS CD-ROM data sets for earlier years (beginning 1988). Prices vary by data year and, as of August 2002, range from $160 to $322. All prices may be higher for customers outside the United States, Canada, and Mexico. Additional information is available on the AHRQ Web site.

Previously published HCUP Fact Books in this series are available from the AHRQ Publications Clearinghouse by calling 800-358-9295 (toll free). Order by title and publication number.

Other HCUP Fact Books currently in development include hospitalization for mental disorders, inpatient care for children and adolescents, and hospital care of the uninsured. Information on future availability will be posted on the AHRQ Web site.

Healthcare Cost and Utilization Project (HCUP)
Agency for Healthcare Research and Quality
Phone: 866-290-HCUP (4287), toll-free
E-mail: hcup@ahrq.gov

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AHRQ Publication No. 02-0044
Current as of October 2002

Internet Citation:

Care of Women in U.S. Hospitals, 2000. HCUP Fact Book No. 3. AHRQ Publication No. 02-0044, October 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/data/hcup/factbk3/factbk3.htm

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