STATISTICAL BRIEF #9
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June 2006
C. Allison Russo, M.P.H. and Anne Elixhauser, Ph.D.
Introduction Life expectancy for males is about 7 percent lower than for females.* Because of differences in health-seeking behaviors and attitudes, males tend to delay the care and treatment of diseases more often than females. Policy makers and healthcare providers are concerned about the health status of men because many common chronic diseases afflict men more frequently than women. This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on hospitalizations among males. General characteristics of hospital stays, including conditions that commonly cause male hospitalizations, are described. Additionally, comparisons of hospital stays between males and non-obstetric females are provided.† All differences between estimates noted in the text are statistically significant at the 0.05 level or better. Findings In 2003, males accounted for 15.5 million discharges from U.S. acute care, non-Federal hospitals (table 1). Male discharges comprised 40.6 percent of all hospital stays, or 46.2 percent of all non-obstetrical hospitalizations. The national bill for hospital stays among males was nearly $353 billion�almost half of the total national hospital bill for non-obstetrical hospitalizations. General characteristics of hospital stays among males compared with females Table 1 also illustrates the characteristics of hospitalizations among males compared with females. The mean length of stay for males was 4.9 days�identical to that for non-obstetric females. The mean age for hospitalized males was nearly five years younger than the mean age for hospitalized non-obstetric females. The age distribution for hospitalized males and non-obstetric females was similar, except in the case of children (17 years and younger) and the very old (85 years and older). Compared with non-obstetric female hospitalizations, male children were hospitalized at a higher rate (21.4 percent versus 16.7 percent), and elderly males 85 years and older were hospitalized at a lower rate (5.7 percent versus 10.4 percent). The mean charge for hospitalizations for males was $22,700 compared with $20,000 for non-obstetric females. This resulted in a daily mean hospital charge that was 13 percent higher in males. Compared with stays among non-obstetric females, the in-hospital death rate was about 12 percent higher in males�2.7 percent versus 2.4 percent. †The most common reason for hospitalization among females is pregnancy and childbirth. In order to provide more accurate descriptions of any sex differences in health status, hospitals stays for males are compared with non-obstetric hospital stays for females; that is, only those stays that were not for pregnancy or delivery. Figure 1 demonstrates the difference in mean hospital charges for males versus non-obstetrical females by age. For each age group, males had higher mean hospital charges than non-obstetric female patients. The highest mean hospital charges for males were in the 45�64 and 65�84 age ranges ($27,500 and $28,000, respectively). Compared with non-obstetric female hospitalizations, hospital charges for males were 20 percent higher in the 18�44 age group, 17 percent higher in the 45�64 age group, and about 15 percent higher in the 65 and older age groups. Most frequent conditions causing hospital stays among males, by body system |
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Conditions of the circulatory system accounted for nearly a quarter of all hospitalizations among males (figure 2). Approximately one in 10 hospital stays among males was either for a respiratory or a digestive condition. One in 11 stays for males was related to injury. Compared with hospital stays among non-obstetric females, males experienced more hospital stays for conditions related to the circulatory system, injuries, and mental disorders. Conversely, there were fewer male hospital stays for digestive disorders, neoplasms, musculoskeletal disorders, endocrine disorders, and genitourinary disorders.
Newborn infants accounted for 14.0 percent of all male hospitalizations compared with 11.4 percent of all non-obstetric female hospital stays. However, most of this difference can be attributed to the lower overall number of hospital stays in males. The number of hospitalizations for male and female newborns was similar�2,173,400 for males and 2,050,300 for females. Most frequent specific reasons for hospital stays among males Table 2 highlights frequent specific health conditions causing hospitalization among males. Coronary atherosclerosis was the most common reason for admission among males, accounting for 4.9 percent of all hospital stays. Five of the top 10 principal conditions were related to the heart: coronary atherosclerosis, congestive heart failure, acute myocardial infarction, nonspecific chest pain, and cardiac dysrhythmias. Collectively, these five conditions accounted for over 2.4 million hospital discharges, or almost 16 percent of all hospital stays among males. Pneumonia was the second most common reason for male hospitalization, accounting for 4.0 percent of all male hospital stays. Complications of medical devices, back problems, affective disorders (depression and bipolar disorder), and chronic obstructive pulmonary disease (COPD) each accounted for around 2 percent of all hospital stays among males. Certain conditions ranked considerably higher among males than among females. Acute myocardial infarction ranked 4th among males and 12th among females. Complications of medical devices ranked 7th among males and 15th among females. Back problems ranked 8th among males and 11th among females. Conditions noted more often during hospitalizations among males Although the overall volume of hospital stays for non-obstetric females was higher than for males, the burden of disease for certain conditions was greater in males. Table 3 displays conditions noted during male hospital stays that were at least 15 percent higher than the rate observed in non-obstetric females. Figure 3 highlights conditions for which rates were 50 percent higher or more for male hospital stays than for female stays. Many of these conditions are related to lifestyle. Other high frequency conditions for which males made up a larger proportion of inpatients included coronary atherosclerosis, substance abuse, hyperlipidemia (high cholesterol), and conduction disorders (table 3). Data Source The estimates in this Statistical Brief are based upon data from the HCUP 2003 Nationwide Inpatient Sample (NIS). Definitions Types of hospitals included in HCUP HCUP is based on data from community hospitals, defined as short-term, non-Federal, general, and other hospitals, excluding hospital units of other institutions (e.g., prisons). HCUP data include OB-GYN, ENT, orthopedic, cancer, pediatric, public, and academic medical hospitals. They exclude long-term care, rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals, but these types of discharges are included if they are from community hospitals. Unit of analysis The unit of analysis is the hospital discharge (i.e., the hospital stay), not a person or patient. This means that a person who is admitted to the hospital multiple times in one year will be counted each time as a separate "discharge" from the hospital. Charges Charges represent what the hospital billed for the case. Hospital charges reflect the amount the hospital charged for the entire hospital stay and do not include professional (MD) fees. For the purposes of this Statistical Brief, charges are rounded to the nearest hundred dollars. Diagnoses, ICD-9-CM, and Clinical Classifications Software (CCS) The principal diagnosis is that condition established after study to be chiefly responsible for the patient�s admission to the hospital. Secondary diagnoses are concomitant conditions that coexist at the time of admission or that develop during the stay. All-listed diagnoses include the principal diagnosis plus these additional secondary conditions. ICD-9-CM is the International Classification of Diseases, Ninth Revision, Clinical Modification, which assigns numeric codes to diagnoses. There are about 12,000 ICD-9-CM diagnosis codes. CCS categorizes ICD-9-CM diagnoses into 260 clinically meaningful categories. This "clinical grouper" makes it easier to quickly understand patterns of diagnoses and procedures. About the NIS The HCUP Nationwide Inpatient Sample (NIS) is a nationwide database of hospital inpatient stays. The NIS is nationally representative of all community hospitals (i.e., short-term, non-Federal, non-rehabilitation hospitals). The NIS is a sample of hospitals and it includes all patients from each hospital, regardless of payer. It is drawn from a sampling frame that contains hospitals comprising 90 percent of all discharges in the United States. The vast size of the NIS allows the study of topics at both the national and regional levels for specific subgroups of patients. In addition, NIS data are standardized across years to facilitate ease of use. About HCUP HCUP is a family of powerful healthcare databases, software tools, and products for advancing research. Sponsored by the Agency for Healthcare Research and Quality (AHRQ), HCUP includes the largest all-payer encounter-level collection of longitudinal healthcare data (inpatient, ambulatory surgery, and emergency department) in the United States, beginning in 1988. HCUP is a Federal-State-Industry Partnership that brings together the data collection efforts of many organizations�such as State data organizations, hospital associations, private data organizations, and the Federal government�to create a national information resource. For more information about HCUP, visit http://www.hcup-us.ahrq.gov/. HCUP would not be possible without the contributions of the following data collection Partners from across the United States: Arizona Department of Health Services California Office of Statewide Health Planning & Development Colorado Health & Hospital Association Connecticut Integrated Health Information (Chime, Inc.) Florida Agency for Health Care Administration Georgia GHA: An Association of Hospitals & Health Systems Hawaii Health Information Corporation Illinois Health Care Cost Containment Council Indiana Hospital & Health Association Iowa Hospital Association Kansas Hospital Association Kentucky Department for Public Health Maine Health Data Organization Maryland Health Services Cost Review Commission Massachusetts Division of Health Care Finance and Policy Michigan Health & Hospital Association Minnesota Hospital Association Missouri Hospital Industry Data Institute Nebraska Hospital Association Nevada Center for Health Information Analysis New Hampshire Department of Health & Human Services New Jersey Department of Health and Senior Services New York State Department of Health North Carolina Department of Health and Human Services Ohio Hospital Association Oregon Office of Oregon Health Policy and Research and the Office of Oregon Health Pennsylvania Health Care Cost Containment Council Rhode Island Department of Health South Carolina State Budget and Control Board South Dakota Association of Healthcare Organizations Tennessee Hospital Association Texas Department of State Health Services Utah Department of Health Vermont Association of Hospitals and Health Systems Virginia Health Information Washington State Department of Health West Virginia Health Care Authority Wisconsin Department of Health and Family Services For additional HCUP statistics, visit HCUPnet, our interactive query system at https://datatools.ahrq.gov/hcupnet. References For a detailed description of HCUP and more information on the design of the NIS and methods to calculate estimates, please refer to the following publications: Steiner, C., Elixhauser, A., Schnaier, J. The Healthcare Cost and Utilization Project: An Overview. Effective Clinical Practice 5(3):143—51, 2002 Design of the HCUP Nationwide Inpatient Sample, 2003. Online. June 14, 2005. U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/db/nation/nis/reports/NIS_2003_Design_Report.jsp Houchens, R., Elixhauser, A. Final Report on Calculating Nationwide Inpatient Sample (NIS) Variances, 2001. HCUP Methods Series Report #2003-2. Online. June 2005 (revised June 6, 2005). U.S. Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports/methods/2003_02.pdf Suggested Citation Russo, C. A. and Elixhauser, A. Hospitalizations among Males, 2003. HCUP Statistical Brief #9. June 2006. Agency for Healthcare Research and Quality, Rockville, Md. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb9.pdf *** AHRQ welcomes questions and comments from readers of this publication who are interested in obtaining more information about access, cost, use, financing, and quality of healthcare in the United States. We also invite you to tell us how you are using this Statistical Brief and other HCUP data and tools, and to share suggestions on how HCUP products might be enhanced to further meet your needs. Please e-mail us at hcup@ahrq.gov or send a letter to the address below:Irene Fraser, Ph.D., Director Center for Delivery, Organization, and Markets Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850 *Arias, E. United States Life Tables, 2002. National Vital Statistics Reports; vol 53 no 6. Hyattsville, Maryland: National Center for Health Statistics. 2004. http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_06.pdf. |
| Table 1. Characteristics of hospitalizations among males and females, 2003 | |||
| Males | Females | ||
| Percentage of U.S. population* | 49.2% | 50.8% | |
| Stays for non-obstetric females | Stays for all females | ||
| Number of hospital stays (percent) | 15,534,700 (46.2%; 40.6%)† |
17,955,400 (53.4%) |
22,533,700 (59.0%) |
| Mean length of stay, days | 4.9 | 4.9 | 4.4 |
| Mean charges | $22,700 | $20,000 | $17,700 |
| Mean age, years | 47.8 | 52.5 | 47.4 |
| Age distribution | |||
| 17 and younger | 21.4% | 16.7% | 14.1% |
| 18�44 | 16.6% | 17.1% | 33.1% |
| 45�64 | 26.2% | 23.6% | 18.9% |
| 65�84 | 30.2% | 32.2% | 25.7% |
| 85 and older | 5.7% | 10.4% | 8.3% |
| National bill (aggregate charges) (percent) | $353 billion (49.3%; 46.8%)† |
$359 billion (50.3%) |
$398 billion (52.8%) |
| Percentage admitted through the emergency department | 48.5% | 48.5% | 40.1% |
| Percentage died in hospital | 2.7% | 2.4% | 1.9% |
| *U.S. Census Bureau, Population Division, Census 2003. †Percentages are for all non-obstetrical hospital stays and all stays, respectively. Note: A small number of hospital stays not represented in the table were missing sex classifications. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2003. | |||
| Table 2. Top 10 Conditions causing hospitalization among males, 2003 | ||||
| Rank for male hospital stays* | Principal diagnosis | Number of male hospital stays | Percentage of all male hospital stays | Rank for non-obstetric female hospital stays* |
| 1 | Coronary atherosclerosis | 764,900 | 4.9 | 3 |
| 2 | Pneumonia (except that caused by tuberculosis and sexually transmitted diseases) | 626,400 | 4.0 | 1 |
| 3 | Congestive heart failure, nonhypertensive | 517,900 | 3.3 | 2 |
| 4 | Acute myocardial infarction (heart attack) | 443,400 | 2.9 | 12 |
| 5 | Nonspecific chest pain | 378,000 | 2.4 | 4 |
| 6 | Cardiac dysrhythmias | 344,200 | 2.2 | 7 |
| 7 | Complication of medical devices | 310,800 | 2.0 | 15 |
| 8 | Back problems | 309,700 | 2.0 | 11 |
| 9 | Affective disorders (depression and bipolar disorder) | 278,300 | 1.8 | 5 |
| 10 | Chronic obstructive pulmonary disease (COPD) | 273,100 | 1.8 | 10 |
| Total for the top 10 conditions | 4,246,700 | 27.3 | ||
| *Excludes newborn infants. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2003. | ||||
| Table 3. Selected conditions noted more often in hospital stays among males than in hospital stays among females, 2003* | |||||
| All-listed diagnoses | Total number of male hospital stays | Percentage of hospital stays that were for males | Rate per 1,000 male hospital stays | Rate per 1,000 female hospital stays† | |
| Coronary atherosclerosis | 3,667,300 | 55.5 | 236.1 | 163.7 | |
| Substance-related mental disorders | 2,520,600 | 53.0 | 162.3 | 124.3 | |
| High cholesterol | 2,132,300 | 50.2 | 137.3 | 117.8 | |
| Alcohol-related mental disorders (abuse) | 912,900 | 71.9 | 58.8 | ‡ | 19.6 |
| Conduction disorders | 685,500 | 53.0 | 44.1 | 33.8 | |
| Acute myocardial infarction (heart attack) | 591,900 | 56.9 | 38.1 | ‡ | 25.0 |
| Complication of medical devices | 583,500 | 53.7 | 37.6 | 28.0 | |
| Peripheral and visceral atherosclerosis | 571,500 | 50.8 | 36.8 | 30.8 | |
| Skin and subcutaneous tissue infections | 558,400 | 50.3 | 35.9 | 30.5 | |
| Peri-, endo-, and myocarditis, cardiomyopathy | 543,200 | 55.8 | 35.0 | 23.9 | |
| Acute renal failure | 531,800 | 52.0 | 34.2 | 27.3 | |
| Hemolytic and perinatal jaundice | 424,400 | 52.7 | 27.3 | 21.1 | |
| Coagulation and hemorrhagic disorders | 414,300 | 50.9 | 26.7 | 22.2 | |
| Chronic renal failure | 299,600 | 53.2 | 19.3 | 14.7 | |
| Hepatitis | 294,400 | 58.7 | 19.0 | ‡ | 11.5 |
| Short gestation, low birth weight, and fetal growth retardation | 275,300 | 52.0 | 17.7 | 14.1 | |
| Lung cancer | 274,200 | 54.3 | 17.7 | 12.8 | |
| Schizophrenia | 266,300 | 51.6 | 17.1 | 13.8 | |
| Gout | 259,200 | 66.9 | 16.7 | ‡ | 7.1 |
| Paralysis | 242,900 | 53.8 | 15.6 | 11.6 | |
| Aspiration pneumonitis, food/vomitus | 225,000 | 55.6 | 14.5 | 10.0 | |
| Calculus of urinary tract | 195,600 | 52.3 | 12.6 | 9.9 | |
| Occlusion or stenosis of precerebral arteries | 191,200 | 51.7 | 12.3 | 9.9 | |
| Liver disease, alcohol-related | 186,600 | 73.4 | 12.0 | ‡ | 3.8 |
| Injuries due to motor vehicle traffic (MVT) accidents | 184,800 | 59.3 | 11.9 | ‡ | 6.9 |
| Intracranial (head) injury | 172,200 | 63.1 | 11.1 | ‡ | 5.5 |
| Arterial aneurysms | 172,200 | 63.3 | 11.1 | ‡ | 5.6 |
| Appendicitis | 171,200 | 52.9 | 11.0 | 8.0 | |
| Parkinson's disease | 171,000 | 52.2 | 11.0 | 8.7 | |
| Crushing injury or internal injury | 153,200 | 70.5 | 9.9 | ‡ | 3.5 |
| *Includes conditions noted during hospital stays for males that were at least 15 percent higher than the rate observed in non-obstetric females. †Figures for females include hospitalizations for non-obstetrical diagnoses only. ‡Rates in males are at least 50 percent higher. Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2003. | |||||
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| Internet Citation: Statistical Brief #9. Healthcare Cost and Utilization Project (HCUP). June 2006. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/statbriefs/sb9.jsp. |
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