title: National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010).
abstract: Little is known about national trends of pulmonary embolism (PE) hospitalizations and outcomes in older adults in the context of recent diagnostic and therapeutic advances. Therefore, we conducted a retrospective cohort study of 100% Medicare fee-for-service beneficiaries hospitalized from 1999 to 2010 with a principal discharge diagnosis code for PE. The adjusted PE hospitalization rate increased from 129/100,000 person-years in 1999 to 302/100,000 person-years in 2010, a relative increase of 134% (p <0.001). Black patients had the highest rate of increase (174 to 548/100,000 person-years) among all age, gender, and race categories. The mean (standard deviation) length of hospital stay decreased from 7.6 (5.7) days in 1999 to 5.8 (4.4) days in 2010, and the proportion of patients discharged to home decreased from 51.1% (95% confidence interval [CI] 50.5 to 51.6) to 44.1% (95% CI 43.7 to 44.6), whereas more patients were discharged with home health care and to skilled nursing facilities. The in-hospital mortality rate decreased from 8.3% (95% CI 8.0 to 8.6) in 1999 to 4.4% (95% CI 4.2 to 4.5) in 2010, as did adjusted 30-day (from 12.3% [95% CI 11.9 to 12.6] to 9.1% [95% CI 8.5 to 9.7]) and 6-month mortality rates (from 23.0% [95% CI 22.5 to 23.4] to 19.6% [95% CI 18.8 to 20.5]). There were no significant racial differences in mortality rates by 2010. There was no change in the adjusted 30-day all-cause readmission rate from 1999 to 2010. In conclusion, PE hospitalization rates increased substantially from 1999 to 2010, with a higher rate for black patients. All mortality rates decreased but remained high. The increase in hospitalization rates and continued high mortality and readmission rates confirm the significant burden of PE for older adults.
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Graduate School of Arts and Sciences, Yale University, New Haven, Connecticut.
authors.forename: Karl E
authors.initials: KE
authors.lastname: Minges
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Behnood
authors.initials: B
authors.lastname: Bikdeli
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Nancy
authors.initials: N
authors.lastname: Kim
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut; Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Desai
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut. Electronic address: harlan.krumholz@yale.edu.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D006278:Medicare / Q000639:trends; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data* / Q000639:trends; D010359:Patient Readmission / Q000706:statistics & numerical data* / Q000639:trends; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*