Current Trends Increase in National Hospital Discharge Survey Rates for Septicemia -- United States, 1979-1987

Septicemia* is the 13th leading cause of death in the United States (1) and accounts for $5-$10 billion of health-care expenditures annually in the United States (2). This report compares hospital discharge rates for septicemia from 1979 to 1987.

Data were obtained from the National Hospital Discharge Survey (NHDS) of CDC's National Center for Health Statistics (NCHS) (3). NHDS obtains abstracted medical record data from a two-stage, stratified sample of nonfederal short-stay hospitals in the 50 states and the District of Columbia; these data are weighted to produce national estimates of hospital use. The analysis in this report included all discharge records for persons greater than or equal to 1 year of age in which a discharge diagnosis of septicemia (community- or hospital-acquired) (International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 038.0-038.9 (4)) was recorded from 1979 through 1987.

From 1979 through 1987, septicemia discharges totaled 2,570,000. Septicemia rates increased 139%, from 73.6 per 100,000 persons (164,000 discharges) to 175.9 per 100,000 persons (425,000 discharges) (Figure 1). The proportion of all septicemia diagnoses in which septicemia was the principal or first-listed diagnosis increased from 33.5% to 40.5%. For all geographic regions, the proportion of all discharges that included septicemia increased (Figure 2). The percentage of infectious disease diagnoses that included a septicemia diagnosis also increased, from 9.2% to 25.2% (Figure 3).

Although the septicemia rate increased for all age groups, the increase was greatest (162%) for persons greater than or equal to 65 years of age--from 326.3 per 100,000 in 1979 to 854.7 per 100,000 by 1987. During this period, the proportion of discharged persons greater than or equal to 65 years of age in this study increased from 50.0% to 60.1%; however, age-adjusted septicemia rates increased 111%, from 73.6 to 155.6 per 100,000 persons.

For 15-44-year-olds, age-specific rates increased 91%--from 24.0 per 100,000 to 45.9 per 100,000. In the West, rates increased 161%--from 27.1 to 70.6 per 100,000; overall rates increased less in the other regions. The percentage of 15-44-year-olds with septicemia discharges who were male increased substantially in the West (from 39.9% to 58.3%) and Northeast (from 43.6% to 57.7%), increased slightly in the North Central region (from 46.7% to 50.2%), and decreased in the South (from 47.4% to 39.4%).

The fatality rate for patients with a discharge diagnosis of septicemia declined during the study period for all age groups, from 31.0% to 25.3%. However, even by 1987, patients were at significantly greater risk for death if septicemia was one of the discharge diagnoses (relative risk=8.6; 95% confidence interval=8.14-9.09). Reported by: Office of Planning and Extramural Programs and Hospital Care Statistics Br, Div of Health Care Statistics, National Center for Health Statistics; Hospital Infections Program, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The discharge diagnosis of septicemia may reflect hospital-acquired infection, community-acquired infection, or both. At least four factors may account for the increase in the rate of discharges for septicemia: 1) improved medical technology may have increased the number of immunocompromised patients who are at risk for septicemia; 2) the increased use of invasive devices (e.g., single and multiple lumen catheters) inside and outside the hospital may place patients at increased risk for both hospital- and community-acquired septicemia (5); 3) physicians' ability to diagnose septicemia increased; and 4) the number of immunocompromised patients (e.g., with human immunodeficiency virus (HIV) infection) who developed community-acquired septicemia increased.

The high septicemia rates in male 15-44-year-olds residing in the West and Northeast may reflect, in part, the emergence of the acquired immunodeficiency syndrome epidemic in the United States since 1981. These findings are consistent with a recent change in trends for septicemia-associated mortality among 25-44-year-old men with HIV infection (6). However, further analyses of smaller geographic clusters, secondary diagnoses, marital status, and other NHDS-listed variables are needed to confirm this hypothesis.

During the period studied, both the proportion of the U.S. population and the proportion of hospitalized patients aged greater than or equal to 65 years increased. However, even though elderly persons had the highest rate of septicemia, the rate increased the most in that age group. Furthermore, age-adjustment of the national rates resulted in a 111% increase from 1979 to 1987.

The NHDS depends on the accuracy and consistency of the listed discharge diagnoses. Increased use and sensitivity of diagnostic methods and the implementation of a reimbursement system based on discharge diagnoses may have influenced the trend (7). Septicemia remains a potentially increasing problem for the national health-care system. Further study is necessary to identify the causes of the increased septicemia rate and to identify control measures to reduce the incidence of septicemia.

References

1. NCHS. Annual summary of births, marriages, divorces, and deaths: United States, 1988. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1989:7. (Monthly vital statistics report; vol 37, no. 13).

2. Wenzel RP. Nosocomial infections, diagnosis-related groups, and study on the efficacy of nosocomial infection control: economic implications for hospitals under the prospective payment system. Am J Med 1985;78(suppl 6B):3-7.

3. NCHS. National Hospital Discharge Survey, 1979-1987 (machine-readable public-use data tapes). Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC.

4. Health Care Financing Administration. The international classification of diseases, ninth revision, clinical modification. 3rd ed. Washington, DC: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (PHS)89-1260.

5. Haley RW, Culver DH, Morgan WM, White JW, Emori TG, Hooton TM. Increased recognition of infectious diseases in U.S. hospitals through increased use of diagnostic tests, 1970-1976. Am J Epidemiol 1985;121:168-81.

6. Buehler J, Berkelman R, Devine O, Chevarley F. Impact of the HIV epidemic on mortality trends in men 25-44 years of age, United States (Abstract). V International Conference on AIDS. Montreal, June 4-9, 1989:66.

7. NCHS, Pokras R. Utilization of short-stay hospitals by diagnosis-related groups: United States, 1980-84. Washington, DC: US Department of Health and Human Services, Public Health Service, CDC, 1986; DHHS publication no. (PHS)86-1748. (Vital and health statistics; series 13, no. 87). *Systemic disease associated with the presence and persistence of pathogenic microorganisms or their toxins in the blood.

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