Pulmonary hypertension surveillance: United States, 2001 to 2010 - PubMed (original) (raw)

Multicenter Study

Pulmonary hypertension surveillance: United States, 2001 to 2010

Mary G George et al. Chest. 2014 Aug.

Abstract

Pulmonary hypertension (PH) is an uncommon but progressive condition, and much of what we know about it comes from specialized disease registries. With expanding research into the diagnosis and treatment of PH, it is important to provide updated surveillance on the impact of this disease on hospitalizations and mortality. This study, which builds on previous PH surveillance of mortality and hospitalization, analyzed mortality data from the National Vital Statistics System and data from the National Hospital Discharge Survey between 2001 and 2010. PH deaths were identified using International Classification of Diseases, Tenth Revision codes I27.0, I27.2, I27.8, or I27.9 as any contributing cause of death on the death certificate. Hospital discharges associated with PH were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes 416.0, 416.8, or 416.9 as one of up to seven listed medical diagnoses. The decline in death rates associated with PH among men from 1980 to 2005 has reversed and now shows a significant increasing trend. Similarly, the death rates for women with PH have continued to increase significantly during the past decade. PH-associated mortality rates for those aged 85 years and older have accelerated compared with rates for younger age groups. There have been significant declines in PH-associated mortality rates for those with pulmonary embolism and emphysema. Rates of hospitalization for PH have increased significantly for both men and women during the past decade; for those aged 85 years and older, hospitalization rates have nearly doubled. Continued surveillance helps us understand and address the evolving trends in hospitalization and mortality associated with PH and PH-associated conditions, especially regarding sex, age, and race/ethnicity disparities.

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Figures

Figure 1

Figure 1

– International Classification of Diseases coding for pulmonary hypertension mortality: United States, 2001-2010. I27.0 = primary pulmonary hypertension; I27.2 = other secondary pulmonary hypertension; I27.8 = other specified pulmonary heart diseases; and I27.9 = pulmonary heart disease, unspecified. Data are from the Multiple Cause of Death Files, 1999-2010, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. (Reprinted from the Centers for Disease Control and Prevention, National Center for Health Statistics.)

Figure 2

Figure 2

– Age-standardized death rates for pulmonary hypertension as a contributing cause of death and trend lines among individuals of all ages, by sex: United States, 2001-2010. The National Vital Statistics System was used to ascertain deaths due to pulmonary hypertension, which were considered those with decedents having International Classification of Diseases, 10th Revision (ICD-10) codes I27.0, I27.2, I27.8, or I27.9 reported as any contributing cause of death (ie, any of the possible 20 conditions, including the underlying cause of death). All trend lines are compared with the referent group, men; P < .05. Both parallelism and coincident comparison of trend lines were rejected. Rates are per 100,000 population and are age standardized to the 2000 US standard population (eight age groups). See Table 5 for additional data.

Figure 3

Figure 3

– Age-standardized death rates for pulmonary hypertension as a contributing cause of death and trend lines among individuals of all ages, by race/ethnicity: United States, 2001-2010. The National Vital Statistics System was used to ascertain deaths due to pulmonary hypertension, which were considered those with decedents having ICD-10 codes I27.0, I27.2, I27.8, or I27.9 reported as any contributing cause of death (ie, any of the possible 20 conditions, including the underlying cause of death). aRates are per 100,000 population and are age standardized to the 2000 US standard population (eight age groups); ball race/ethnicity trend lines are parallel to the referent group of NHW, P < .05. There are no statistically significant coincident trend lines to the referent group of NHW. See Table 6 for additional data. NHAIAN = non-Hispanic American Indian/Alaska native; NHAPI = non-Hispanic Asian/Pacific Islander; NHB = non-Hispanic black; NHW = non-Hispanic white. See Figure 2 legend for expansion of other abbreviation.

Figure 4

Figure 4

– Age-specific death rates for pulmonary hypertension as a contributing cause of death and trend lines among individuals of all ages, by six age groups: United States, 2001-2010. The National Vital Statistics System was used to ascertain deaths due to pulmonary hypertension, which were considered those with decedents having ICD-10 codes I27.0, I27.2, I27.8, or I27.9 reported as any contributing cause of death (ie, any of the possible 20 conditions, including the underlying cause of death). aRates are per 100,000 population and age-specific death rates were calculated for each of six age groups; ball age-specific trend lines are compared with the referent age group of 0 to 12 mo, P < .05. Both parallelism and coincident comparison of trend lines were rejected. See Table 9 for additional data. See Figure 2 legend for expansion of abbreviation.

Figure 5

Figure 5

– Age-standardized death rates for pulmonary hypertension as any cause of death among all ages by state. A, Death rates in 2001. B, Death rates in 2010. The National Vital Statistics System was used to ascertain deaths due to pulmonary hypertension, which were considered those with decedents having ICD-10 codes I27.0, I27.2, I27.8, or I27.9 reported as any contributing cause of death (ie, any of the possible 20 conditions, including the underlying cause of death). Rates are per 100,000 population and are age standardized to the 2000 US standard population (eight age groups). See Figure 2 legend for expansion of abbreviation.

Figure 6

Figure 6

– Comparison of average length of hospital stay by age groups for discharges for pulmonary hypertension (PH) as any listed International Classification of Diseases, Ninth Revision, Clinical Modification _(ICD-9-CM) diagnosis: United States, 2001/2002 and 2009/2010. In both 2001/2002 and 2009/2010, the average length of stay for PH hospitalizations for those aged ≤ 35 y was longer than for all other age groups (_P < .05). (Adapted with permission from Centers for Disease Control and Prevention, National Center for Health Statistics.)

Figure 7

Figure 7

– _Hospital discharge status by sex for pulmonary hypertension as any listed ICD-9-CM diagnosis: United States, 2009/2010. In 2009/2010, more men than women were discharged home (_P _< .03), and more women than men were discharged to LTC (_P < .01). LTC = long-term care; STC = short-term care. See Figure 6 legend for expansion of other abbreviation. (Adapted with permission from Centers for Disease Control and Prevention, National Center for Health Statistics.)

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