Geographic and racial patterns of preventable hospitalizations for hypertension: Medicare beneficiaries, 2004-2009.

OBJECTIVES: Hypertension as the primary reason for hospitalization is often used to indicate failure of the outpatient health-care system to prevent and control high blood pressure. Investigators have reported increased rates of these preventable hospitalizations for black people compared with white people; however, none have mapped them nationally by race. METHODS: We used Medicare Part A data to estimate preventable hypertension hospitalizations from 2004-2009 using technical specifications published by the Agency for Healthcare Research and Quality. Rates per 100,000 beneficiaries were age- and sex-standardized to 2000 U.S. Census data. We mapped county-level rates by race and identified clusters of counties with extreme rates. RESULTS: Black people had higher crude rates of these hospitalizations than white people for every year studied, and the test for an increasing linear time trend for the standardized rates was significant for both black and white people; that is, the gap between the races increased over time. For both races, clusters of high-rate counties occurred primarily in parts of Oklahoma, Texas, Southern Alabama, and Louisiana. High rates for white people were also found in parts of Appalachia. Large differences in rates among black and white people were found in a number of large urban areas and in parts of Florida and Alabama. CONCLUSIONS: Racial disparities in preventable hospitalizations for hypertension persisted through 2009. The gap between black and white people is increasing, and these inequities exist unevenly across the country. Although this study was intended to be purely descriptive, future studies should use multivariate analyses to examine reasons for these unequal distributions.

Geographic variations in heart failure hospitalizations among medicare beneficiaries in the Tennessee catchment area.

INTRODUCTION: Although differences in heart failure (HF) hospitalization rates by race and sex are well documented, little is known about geographic variations in hospitalizations for HF, the most common discharge diagnosis for Medicare beneficiaries. METHODS: Using exploratory spatial data analysis techniques, the authors examined hospitalization rates for HF as the first-listed discharge diagnosis among Medicare beneficiaries in a 10-state Tennessee catchment area, based on the resident states reported by Tennessee hospitals from 2000 to 2004. RESULTS: The age-adjusted HF hospitalization rate (per 1000) among Medicare beneficiaries was 23.3 [95% confidence interval (CI), 23.3-23.4] for the Tennessee catchment area, 21.4 (95% CI, 21.4-21.5) outside the catchment area and 21.9 (95% CI, 21.9-22.0) for the overall United States. The age-adjusted HF hospitalization rates were also significantly higher in the catchment area than outside the catchment area and overall, among men, women and whites, whereas rates among the blacks were higher outside the catchment area. Beneficiaries in the catchment area also had higher age-specific HF hospitalization rates. Among states in the catchment area, the highest mean county-level rates were in Mississippi (30.6 ± 7.6) and Kentucky (29.2 ± 11.5), and the lowest were in North Carolina (21.7 ± 5.7) and Virginia (21.8 ± 6.6). CONCLUSIONS: Knowledge of these geographic differences in HF hospitalization rates can be useful in identifying needs of healthcare providers, allocating resources, developing comprehensive HF outreach programs and formulating policies to reduce these differences.

The economic burden of chronic cardiovascular disease for major insurers.

Accounting models provide less precise estimates of disease burden than do econometric models. The authors seek to improve these estimates for cardiovascular disease using a nationally representative survey and econometric modeling to isolate the proportion of medical expenditures attributable to four chronic cardiovascular diseases: stroke, hypertension, congestive heart failure, and other heart diseases. Approximately 17% of all medical expenditures, or $149 billion annually, and nearly 30% of Medicare expenditures are attributable to these diseases. Of the four diseases, hypertension accounts for the largest share of prescription expenditures across payers and the largest share of all Medicaid expenditures. The large number of people with cardiovascular disease who are eligible for both Medicare and Medicaid could lead to large shifts in the burden to these payers as prescription drug coverage is included in Medicare. A societal perspective is important when describing the economic burden of cardiovascular disease.