title: The Impact of Repeat Hospitalizations on Hospitalization Rates for Selected Conditions Among Adults With and Without Diabetes, 12 US States, 2011.
abstract: BACKGROUND
  Hospitalization data typically cannot be used to estimate the number of individuals hospitalized annually because individuals are not tracked over time and may be hospitalized multiple times annually. We examined the impact of repeat hospitalizations on hospitalization rates for various conditions and on comparison of rates by diabetes status.
  
  
  METHODS
  We analyzed hospitalization data for which repeat hospitalizations could be distinguished among adults aged 18 or older from 12 states using the 2011 Agency for Healthcare Research and Quality's State Inpatient Databases. The Behavioral Risk Factor Surveillance System was used to estimate the number of adults with and without diagnosed diabetes in each state (denominator). We calculated percentage increases due to repeat hospitalizations in rates and compared the ratio of diabetes with non-diabetes rates while excluding and including repeat hospitalizations.
  
  
  RESULTS
  Regardless of diabetes status, hospitalization rates were considerably higher when repeat hospitalizations within a calendar year were included. The magnitude of the differences varied by condition. Among adults with diabetes, rates ranged from 13.0% higher for stroke to 41.6% higher for heart failure; for adults without diabetes, these rates ranged from 9.5% higher for stroke to 25.2% higher for heart failure. Ratios of diabetes versus non-diabetes rates were similar with and without repeat hospitalizations.
  
  
  CONCLUSIONS
  Hospitalization rates that include repeat hospitalizations overestimate rates in individuals, and this overestimation is especially pronounced for some causes. However, the inclusion of repeat hospitalizations for common diabetes-related causes had little impact on rates by diabetes status.
authors.affiliation: California State University, Northridge - Health Sciences, 18111 Nordhoff St, Northridge, CA 91330-8285. Email: stephanie.benjamin@csun.edu.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Benjamin
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Geiss
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Thompson
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology; D014481:United States; D055815:Young Adult