title: Neurologic disorders, in-hospital deaths, and years of potential life lost in the USA, 1988-2011.
abstract: Premature mortality is a public health concern that can be quantified as years of potential life lost (YPLL). Studying premature mortality can help guide hospital initiatives and resource allocation. We investigated the categories of neurologic and neurosurgical conditions associated with in-hospital deaths that account for the highest YPLL and their trends over time. Using the Nationwide Inpatient Sample (NIS), we calculated YPLL for patients hospitalized in the USA from 1988 to 2011. Hospitalizations were categorized by related neurologic principal diagnoses. An estimated 2,355,673 in-hospital deaths accounted for an estimated 25,598,566 YPLL. The traumatic brain injury (TBI) category accounted for the highest annual mean YPLL at 361,748 (33.9% of total neurologic YPLL). Intracerebral hemorrhage, cerebral ischemia, subarachnoid hemorrhage, and anoxic brain damage completed the group of five diagnoses with the highest YPLL. TBI accounted for 12.1% of all inflation adjusted neurologic hospital charges and 22.4% of inflation adjusted charges among neurologic deaths. The in-hospital mortality rate has been stable or decreasing for all of these diagnoses except TBI, which rose from 5.1% in 1988 to 7.8% in 2011. Using YPLL, we provide a framework to compare the burden of premature in-hospital mortality on patients with neurologic disorders, which may prove useful for informing decisions related to allocation of health resources or research funding. Considering premature mortality alone, increased efforts should be focused on TBI, particularly in and related to the hospital setting.
authors.affiliation: Department of Neurosurgery, Neurological Institute, Cleveland Clinic, S40, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Central Campus, Biomedical Information Communication Center (BICC), Portland, OR, USA. Electronic address: rosenbb@ccf.org.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Rosenbaum
authors.affiliation: Department of Neurosurgery, Neurological Institute, Cleveland Clinic, S40, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kelly
authors.affiliation: Department of Neurosurgery, Neurological Institute, Cleveland Clinic, S40, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Varun R
authors.initials: VR
authors.lastname: Kshettry
authors.affiliation: Department of Neurosurgery, Neurological Institute, Cleveland Clinic, S40, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA; Department of Neurosurgery, Geisinger Health System, Danville, PA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
mesh_terms: D001930:Brain Injuries / Q000191:economics / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000191:economics / Q000401:mortality; D016208:Databases, Factual; D017722:Hospital Charges / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D002534:Hypoxia, Brain / Q000191:economics / Q000401:mortality; D015994:Incidence; D007250:Inflation, Economic; D038801:International Classification of Diseases; D008017:Life Expectancy; D009422:Nervous System Diseases / Q000191:economics / Q000401:mortality*; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Hospital mortality; Nationwide Inpatient Sample; Neurologic disease burden; Premature mortality; Public health; Traumatic brain injury