Agency for Health Care Policy and Research Center for General Health Services Intramural Research Trends in Hospital Diagnoses for Black Patients and White Patients: 1980-87 Provider Studies Research Note U.S Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research PUPLIC HEALTH LIBRARY BERL ELEY LIERARY UNIVER 1 7y oF | CAL: atin Sell gency for Health Care Policy and didi Center for General Health Services Intramural Research Trends in Hospital Diagnoses for Black Patients and White Patients: 1980-87 Provider Studies Research Note U.S Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research Rockville, Maryland The following is the recommended bibliographic citation for this publication: Elixhauser, A., Harris, D.R., and Coffey, RM. (1995). Trends in hospital diagnoses for black patients and white patients: 1980-87. (AHCPR Publication Mo. 95-0048). Provider Studies Research Note 24, Agency for Health Care Policy and Research, Rockville, MD: Public Health Service. Abstract Previous research has identified significant differences in discharge rates between black patients and white patients in the United States. However, most of these studies have been limited to populations from a single payer or have reported on a limited number of diagnoses. This study reports trends and variations in discharge rates for black patients and white patients from a national sample of U.S. hospitals for a comprehensive list of diseases. This study used discharge abstract data from the Hospital Cost and Utilization Project, 1980-87 (HCUP-2), a sample of more than 500 short-term, general, non-Federal hospitals in the United States. The study was based on a random sample of 20 percent of discharges from these hospitals during the period 1980-87, totaling 6.8 million discharges. The principal diagnosis listed on the discharge abstract was classified into one of 185 mutually exclusive diagnosis categories. Discharges were weighted to the national level and were age- and sex-adjusted through direct methods of standardization. National estimates of discharge rates per 100,000 population per year are presented with confidence interval estimates (CIEs). The estimated annual percent change (with CIEs) is used to summarize trends over time. Detailed graphs and tables are provided for each diagnosis category and statistically significant results are summarized. This report should serve as the basis for generating hypotheses and guiding research. A number of differences between the races observed in this study are similar to those reported in the literature; other differences identify variations not previously described. Because discharge-level data do not allow for control of alternative explanations for racial differences in discharge rates, such as variations in disease incidence, health AHCPR Pub. No. 95-0048 June 1995 care delivery systems, health status, and medical practice patterns, the apparent differences identified can be understood only through more focused research. Background Research Notes are derived from research conducted by the staff of the Division of Provider Studies (DPS), Center for General Health Services Intramural Research, Agency for Health Care Policy and Research (AHCPR). This series provides results of analyses on health policy issues important to the Nation's health care providers and patients. Overview DPS was established in 1978 as the Hospital Studies Program. At that time, the Hospital Studies Program was charged with planning and implementing a research program and developing appropriate data resources (0 explore patterns of hospital use and costs and to analyze hospital behavior in response to changes in Federal policies and in the structure of the industry. Recognizing the changing role of acute care hospitals in the United States, DPS was created in 1989 with a broader mandate—to study the use and cost of services provided by various health care providers, including but not limited to hospitals. The national and State databases maintained by DPS can be used for studies that address a variety of issues, including: e Variations in medical practice. e Diffusion of medical technology. e Effectiveness of medical treatments. e Hospital financial distress. e Utilization by special populations. e Quality of health services. e Impact of State and Federal health care reform initiatives. DPS has the capacity for research at many different levels: hospitalizations, patient care, treatment of diseases, physician practice, hospital group differences, small-area variations, State-to-State comparisons, and changes across time. DPS’ hospital research focuses on cost (hospital, disease, and treatment), quality (volume-outcome, treatment variations, adverse events, and guideline diffusion), and access (uncompensated care, HIV/AIDS [human immunodeficiency virus/acquired immunodeficiency syndrome], organ transplantation, and vulnerable populations). These examples do not exhaust the issues that can be addressed with the DPS databases. DPS staff consult with industry experts, public officials, and other researchers in selecting topics for study. DPS Databases The HCUP databases contain the central data supporting the DPS research program. Each database is built around a core of data on inpatient hospital stays. Hospital Cost and Utilization Project (HCUP-1 and HCUP-2)—Since 1978, the HCUP databases (HCUP-1 and HCUP-2) have grown in both the breadth of their samples and the depth of their hospital and discharge abstract data. These HCUP databases were derived from two national samples of approximately 500 hospitals each and contain nearly 60 million hospital discharges. The HCUP-1 sample spans the period 1970-77; the HCUP-2 sample covers the period 1980-87. In HCUP-1, hospitals were selected from clients of discharge abstracting companies; in HCUP-2, hospitals were added to improve representation of the universe of short- term, general, non-Federal hospitals with at least 30 beds. Because the data for HCUP-1 and HCUP-2 were collected under special agreements with individual hospitals, only DPS staff have direct access to these data. Healthcare Cost and Utilization Project (HCUP-3)—DPS is currently in the third phase of the HCUP project, the collection of data for the years 1988-94 from State and private health data organizations. By integrating data from statewide health data organizations, HCUP-3 will create a multi-State database in a uniform format that promotes comparative studies of health care services by researchers both inside and outside AHCPR, thereby providing information to those who shape health policy. The HCUP-3 hospital inpatient databases are built around core data elements comparable to those in a typical discharge abstract, with safeguards to protect the privacy of individual patients and physicians. There are two hospital inpatient databases. One database provides uniform data on all inpatient stays in all community hospitals in selected States and will be distributed by the States. The second database approximates a 20-percent sample of hospitals and will be distributed through AHCPR. HCUP-3 will also include information on services other than inpatient hospital care, such as ambulatory surgery centers. e The HCUP-3 Statewide Inpatient Database (SID) will contain 100 percent of hospitals and discharges from States with statewide hospital inpatient data systems selected by DPS. This database will contain common inpatient data elements, variables derived from sensitive data elements, and State-specific variables (such as readmission or community characteristics). Each State database in SID is returned to the respective data source in the uniform HCUP-3 format. Dissemination of those data is controlled by the data source. eo The HCUP-3 Nationwide Inpatient Sample (NIS) will include data from about 1,000 U.S. hospitals, ap- proximating a 20-percent sample of hospitals. This database will include core inpatient data elements but will exclude information that could result, directly or indirectly, in the identification of individual patients or physicians. When data sources consider other variables (such as hospital identifiers) to be confidential, those variables will be excluded or encrypted, as required by the State. The NIS will be available to researchers who sign a data use agreement restricting the use of the data to research purposes only. Inpatient databases are supplemented with data on hospitals and local communities from a variety of sources. The American Hospital Association (AHA) has provided data from its Annual Survey of Hospitals and various special surveys since 1970. County-level statistics are obtained from the Area Resource File, compiled by the Bureau of Health Professions of the Health Resources and Services Administration (HRSA). Statistics from the Bureau of the Census at the ZIP-Code level are also used. The DPS databases will support a variety of studies to be conducted across hospital types, communities, and time. Studies that are national in scope require NIS. State data from SID can be used to study small-area variations, hospital markets, and State health care reforms. These databases, augmented by the latest available information, permit comprehensive assessment of factors affecting the use and costs of health services. Acknowledgments Financial support for DPS has been provided by AHCPR. Parts of HCUP-2 were supported by the Office of the Assistant Secretary for Health and the Office of the Assistant Secretary for Planning and Evaluation. AHCPR contracting arrangements and data confidentiality safeguards for HCUP-1 and HCUP-2 precluded the identification of individual hospitals, physicians, or their patients. DPS cannot acknowledge individually the contributions they have made to this research; but without such cooperation, the empirical research published by DPS since 1982 would not have been possible. AHCPR thanks the following discharge abstracting companies for their timely contributions to HCUP-1 and HCUP-2: Commission on Professional and Hospital Activities, Ann Arbor, MI; McDonnell Douglas Health Information Systems Co., Hazelwood, MO; Health Data Service of Maryland (a subsidiary of Blue Cross and Blue Shield of Maryland), Towson, MD; ServiShare of Iowa, Des Moines, IA; Hospital Utilization Project, Monroeville, PA; Quadax, Inc., Cleveland, OH; Utilization Information Service/ Massachusetts Hospital Association, Burlington, MA; Utilization Information Service/Hospital Association of New York State, Albany, NY; Hospital Industry Data Institute, Jefferson City, MO; Shared Medical Systems, Malvern, PA; Commonwealth Clinical Systems, Charlottesville, VA; Infomed Associates, Inc./Rochester Area Hospitals Corp., Rochester, NY; MicroDecision Systems at the Center for Health Affairs, Princeton, NJ; MEDIX/Blue Cross of New Jersey, Florham Park, NJ; Kansas Health Data System/Blue Cross and Blue Shield of Kansas, Topeka, KS; and CHIP of Georgia/Blue Cross and Blue Shield of Georgia, Columbus, GA. In every case, these organizations released discharge abstract data only with the written authorization of the hospitals in the HCUP-1 and HCUP-2 samples. To protect the confidentiality of participating hospitals, data were sent directly to a data processing contractor. All identifying information was removed from files prior to their receipt by AHCPR. In all cases, data were provided with the understanding that analyses, interpretations, and conclusions would be the sole responsibility of AHCPR. AHCPR also acknowledges, for purposes other than HCUP-1 and HCUP-2, the generous provision of discharge abstract data from State agencies and/or their data processing centers, including the California Office of Statewide Health Planning and Development, Sacramento, CA; the Florida Health Care Cost Containment Board, Tallahassee, FL; the Maryland Health Services Cost Review Commission and the Information Service Center, Baltimore, MD; the New York State Department of Health, Statewide Planning and Research Cooperative System Bureau, Albany, NY; the Massachusetts Health Data Consortium, Inc., Waltham, MA; the State of Vermont, Agency of Human Services, Waterbury, VT; and the Wisconsin Office of Health Care Information, Madison, WI. In addition to the extensive AHA and American Medical Association data contributions discussed above, other hospital or program files were provided by the Office of Research and the Health Standards and Quality Bureau of the Health Care Financing Administration; the Bureau of Health Professions of the Health Resources and Services Administration; the Association of American Medical Colleges; Abt Associates, Inc.; and the United Hospital Fund. Several organizations generously shared with DPS the software they developed. They include SysteMetrics, Inc.; Health Systems International; the Health Care Research Department, Blue Cross of Western Pennsylvania; the Commission on Professional and Hospital Activities; the Institute for Health Policy Studies, University of California at San Francisco; and the School of Organization and Management, Yale University. Data files for HCUP were constructed under the technical direction of AHCPR by SysteMetrics, Inc., Santa Barbara, CA. Programming support for DPS researchers is provided by Social and Scientific Systems, Inc., Bethesda, MD. The authors would like to acknowledge Robert Huckman for his work in assembling relevant literature and John Sommers, Ph.D., for his statistical advice. Thanks also to Sophie Nemirovsky, Gregory M. Glover, Sandy Smoot, and Richard Stoll for programming support. Additional information on DPS and its databases is available from the Division of Provider Studies, AHCPR, 2101 East Jefferson Street, Suite 500, Rockville, MD 20852; phone (301) 594-1410. Copies of DPS publications are available from the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907; phone toll free 800-358-9295. 3 TY 19 5 ad PUBL “a Summary diagnosis categories and ICD-9-CM codes « . . «c+ + vv vers s vv vine 205 ~ B. Development of discharge weights for the Hospital Cost and Ulisation Project, 198087 . . . .. vi dr xan mean a rans vas anne a. 211 IC SERGI. +2 vie drwaiona va was mui Foo ss 0 pans ual Winns 217 _ D. Recalculation of confidence interval eStimates . . . . . . «ov vv een 219 Trends in Hospital Diagnoses for Black Patients and White Patients: 1980-87 Anne Elixhauser, Ph.D., D. Robert Harris, Ph.D., and Rosanna M. Coffey, Ph.D., Agency for Health Care Policy and Research Introduction Two important missions of the Agency for Health Care Policy and Research (AHCPR) are to foster an understanding of variations in medical care and to set priorities for health services research. The assessment of variations in medical practice patterns has been motivated to a great extent by the results of small-area analyses (Wennberg and Gittelsohn, 1982; Wennberg, Freeman, and Culp, 1987). However, the examination of differences in patterns of care among larger population groups can also identify important areas for further investigation. Differences among subgroups in discharge rates and changes in discharge rates over time have been attributed to differences in the incidence of disease; changes in coding practices, bed capacity, availability of long-term care facilities, and supply of physician specialists; differences in physician judgment and practice patterns; and the environments of regulation and medical insurance markets, among other factors (Barnes et al., 1985; Ghali, Cooper, and Ford, 1990; Holahan, Berenson, and Kachavos, 1990; Knickman and Foltz, 1985; Office of Surveillance and Analysis, 1989; Wennberg and Gittelsohn, 1982). Many previous studies have been limited to single payers, or they report on individual diagnoses or a restricted range of diagnoses (for example, Health Care Financing Administration, 1990; Rothberg, 1982). This report compares rates of hospital discharges by principal diagnosis for black patients and white patients based on a national sample of hospitals. It is one of a series of four publications examining variations over time in hospital discharges. Others include: e All listed procedures by race (Elixhauser, Harris, and Coffey, 1994a). o All listed procedures by region (Elixhauser, Harris, and Coffey, 1994b). ¢ Principal diagnosis by region (Elixhauser, Harris, and Coffey, 1995). This series of publications is based on observations covering an 8-year period (1980-87) that permit evaluation of changes over time among different regions and racial groups. Discharges are age- and sex-adjusted and weighted to provide national estimates of rates per 100,000 population. Point estimates and confidence intervals are presented for the rates for each subgroup in each year, along with a summary measure of trends (estimated annual percent change) and its associated confidence limits. Methods Data source This study uses data from the Hospital Cost and Utilization Project (HCUP), a national sample of hospitals that provide a census of their discharge abstracts. The second round of HCUP (HCUP-2), which spans the years 1980-87, was designed to represent short-term, general, non-Federal hospitals in the United States with 30 or more beds. Hospitals were stratified to ensure representation along several dimensions thought to be important determinants of hospital behavior. These dimensions included geographic region, urban or rural location, teaching status, type of ownership, and bed size. Within these strata, 1,005 hospitals were randomly selected from the American Hospital Association (AHA) universe in 1982. Of these sampled hospitals, 664 voluntarily provided data for HCUP-2. Because hospitals entered or dropped out of the sample over the course of the data collection period, the maximum number of hospitals contributing data to this study in any year is 539, or approximately 10 percent of the universe of U.S. hospitals. Details regarding sampling and stratification are provided in Coffey and Farley (1988). The HCUP-2 sample is not fully representative of the universe of hospitals from which the sample was drawn. HCUP-2 hospitals are, on average, larger than hospitals in the AHA universe, more likely to be teaching hospitals, less likely to be located in the South, and less likely to be investor owned. Despite these differences, HCUP-2 hospitals are not significantly different from the AHA universe in terms of expenses, staffing, length of stay, and urban or rural location (Coffey and Farley, 1988; Lemrow et al., 1990). Some conditions, such as mental disorders and congenital anomalies, which are often treated in specialty hospitals, are underrepresented in this study because the HCUP sample is restricted to short-term, general hospitals. In addition, because HCUP is limited to hospital discharge abstract data, medical care provided on an ambulatory basis is not represented. Each discharge abstract summarizes a patient’s hospital stay based on specific information compiled from medical records by trained medical records technicians. The data elements on the abstract document patient characteristics—such as age, sex, and race—and medical information, including specific diagnoses and procedures. HCUP data underwent extensive editing to ensure internal consistency and validity. Some limitations of HCUP are common to most discharge abstract data. Most discharge abstracts were not created for research purposes; hence, there may be problems with the reliability and validity of certain data elements. Generally, data on admission date, discharge date, age, and sex are most reliable; diagnosis and procedure data are less accurate (Demlo, Campbell, and Brown, 1978). However, the accuracy of diagnosis and procedure data, particularly principal diagnosis and procedure on the discharge abstract, has improved since 1983, when such information became important for determining reimbursement by Medicare and other payers (Fisher et al., 1992). Other problems inherent in discharge abstract data include inconsistent coding across respondents or over time, missing data, and underreporting of minor procedures and of socially stigmatized conditions such as alcoholism or drug abuse. The unit of analysis for HCUP data is the discharge rather than the patient because linking discharge records for a single patient across hospitalizations is currently impossible for all hospitals in HCUP. Consequently, conditions that result in repeated hospitalizations for an individual within 1 year are counted multiple times, providing an overestimate of the number of patients with these conditions (May et al., 1991). Study sample This study was based on a 20-percent random sample of discharge abstracts from HCUP-2. The study sample consists of 6,797,145 discharges from 1980 to 1987. Diagnosis categories Nearly all hospital discharge abstracts in the United States classify medical conditions and procedures using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) (Public Health Service and Health Care Financing Administration, 1980). This uniform and standardized coding system for recording diagnoses and procedures consists of more than 10,000 condition and 3,500 procedure codes. For this investigation, all principal diagnosis codes were classified into 1 of 185 mutually exclusive categories using the diagnosis section of the Clinical Classifications for Health Policy Research (CCHPR), version 1. Although many categories represent single diagnoses or a homogeneous group of diagnoses, some infrequent diagnoses are grouped according to the chapters of the ICD-9-CM classification. Appendix A lists all CCHPR diagnosis categories and their constituent ICD-9-CM codes. A complete description of the diagnosis categories can be found in Elixhauser, Andrews, and Fox (1993).! Limiting the analysis to principal diagnoses causes diagnoses that tend to appear in secondary positions, such as hypertension, osteoporosis, and Alzheimer’s disease, to be underestimated (May et al., 1991). However, ! This classification system has been revised, incorporating all ICD-9-CM coding changes through October 1994. The revised CCHPR is available from the lead author. because the goal is to estimate discharge rates for particular conditions, it is necessary to use only principal diagnoses to avoid double-counting of discharges. Furthermore, the principal diagnosis should represent the major reason for the hospitalization. Calculation of discharge rates To derive national estimates of discharge rates per 100,000 population, it was necessary to weight HCUP-2 discharges. Appendix B provides a detailed description of the development of the discharge weights and compares national estimates using HCUP-2 data with those from the National Hospital Discharge Survey. When the morbidity experience of different population groups is compared, it is possible for underlying differences in characteristics between the populations to bias the comparisons. Standardization (or adjustment) of rates can be used to control for possible differences between populations that are due to variations in the distribution of certain underlying characteristics, such as age and sex. This study minimizes the influence of age and sex on discharge rates through direct standardization, using the 1970 U.S. population as the standard. It should be noted that the choice of the standard population does not affect relative comparisons between subgroups within an analysis. The age groups used in this study are under 15 years, 15-44 years, 45-64 years, and 65 years and over. Direct standardization applies the observed discharge rate for each age-sex group in the study population to the corresponding age-sex group in the standard population to derive uniformly weighted summary rates for comparison purposes. Because adjusted rates are not invariant to the choice of the standard population, it is inappropriate to compare the rates reported here with unadjusted rates or rates adjusted using a different standard population. Appendix C provides a detailed description of the standardization methodology along with an example. Calculation of confidence intervals for discharge rates To compare discharge rates for black patients ‘and white patients in a given year, an estimate of the variance for each rate was calculated and used to derive a 95-percent confidence interval estimate (CIE). Confidence intervals were then compared between races to identify important differences. Confidence limits that did not overlap were considered indicative of a statistically significant difference and were used to characterize the nature of that difference. Consider the following hypothetical example, in which the estimated discharge rate for diagnosis X per 100,000 population among black patients is 260 (95-percent CIE = 245, 275), compared with a discharge rate for white patients of 300 (95-percent CIE = 280, 320). These confidence intervals do not overlap, indicating that the point estimates for the two groups differ significantly (p < 0.05). In addition, the upper limit of the interval for black patients is less than the lower limit for white patients, indicating that the discharge rate for diagnosis X is significantly lower among black patients. It may have been preferable to test the hypothesis that the calculated difference in rates was equal to zero because such a test would have provided a more precise determination of the significance of the observed differences. However, the comparison of 95-percent confidence limits is a more conservative test, and it provides a practical means for easily and quickly assessing important differences in this exploratory investigation. The reader is urged to use caution when interpreting statistical differences reported in this study. Comparisons involving large samples permit small differences to be detected as statistically significant; thus, the clinical importance of any differences must be considered. In addition, multiple statistical tests increase the risk of committing a Type I error (detecting a significant difference that is due to chance alone). Although a smaller alpha level for constructing the confidence intervals would have reduced the risk of committing a Type I error, a 0.05 level was considered reasonable given the exploratory nature of the investigation. Moreover, sufficient information is provided in the tables to reconstruct confidence intervals for a particular diagnosis using a more stringent significance level. Appendix D provides guidance for performing such calculations. Calculation of estimated annual percent change The overall nature of the observed trends in discharge rates is summarized using the estimated annual percent change, or EAPC (Miller et al., 1992). The EAPC is derived by fitting a regression line to the natural logarithm of the discharge rates, using calendar year as the independent variable. The EAPC is equal to 100(e™ — 1), where m is the slope of the regression line. A negative EAPC indicates that the discharge rate is declining over time; a positive EAPC indicates that the rate is increasing. The standard error of the slope of the regression line was used to generate CIEs that were compared, as described above, to identify trends in discharge rates that differ between races. Interpreting detailed graphs and tables For each diagnosis category, a graph illustrates the point estimates and trends for discharges in both racial groups. Note that the scale for the vertical axis of each graph will differ according to the magnitude of the rate of discharges. Thus, caution must be exercised in making temporal comparisons across diagnosis categories based on the graphs alone. Below each graph is a table that provides the details required for assessing the significance of apparent differences. The table contains point estimates of the discharge rate for each year and for each racial group. CIEs appear below each point estimate; these allow assessment of differences from year to year within a racial group and between races for a given year. The EAPC provides a summary measure of the rate of change over time within each group. The confidence interval formed about the EAPC can be used to determine whether the annual rate of change is significantly different from zero. In addition, comparing the confidence intervals for the EAPCs allows the reader to determine whether the annual rate of change differs significantly between races. A number of diagnosis categories had discharge rates that were extremely low, yielding unstable estimates. Examples include 1—tuberculosis; 4—mycoses and actinomycoses; 5—HIV (human immunodeficiency virus) infection; 7—other infections, including parasitic; 8—sexually transmitted diseases (not HIV or hepatitis); 13—hepatobiliary cancer; 15—cancer of other gastrointestinal organs, peritoneum, 17— 6 © £3 oO 2 Q 4 2 ®-Black # White 0 ee si 1 1 l 1 I 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 0 0 0 1.8 3.3 59 9.2 12.9 — = — (—, (0.6, (1.1, (3.3, (4.8, (7.6, (—, —-) -) —) 2.9) 5.4) 8.5) 13.6) 18.1) wi White 0 0 0 0.6 1.1 2.0 13 3.3 — (—, {om (=, (0.3, (0.5, (1 4, (1 2, (2.4, (—, wel} ws) =) 0.9) 1.6) 2.6) 2.7) 4.1) i Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 23 100 80 oO o S S 60 @ QQ [0] © [) o> 8 40 Q £2 0 20 0 6. Viral infections 1 1 1 1 1 1 ®-Black #White L 1 1980 1981 1982 1983 1984 1985 and confidence interval in parentheses 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), Race 1981 1982 1983 1984 1985 1986 1987 EAPC Black 71.9 59.0 66.5 54.1 60.3 535 56.6 28 (58.8, (486, (56.0, (448, (493, (415 ~~ (450, (-5., 85.0) 69.3) 76.9) 63.4) 71.3) 65.5) 68.2) -0.3) White 89.8 89.1 90.7 77.7 67.8 65.4 60.3 6.3 (833, (821, (847, (721, (622, (602, (554, (-8., 96.4) 96.1) 96.8) 83.3) 73.4) 70.6) 65.2) -4.5) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 24 7. Other infections, including parasitic 12 10 OC 8 8 g [o) © «© 10 <= p— + O 2 Oo 5 Black #White 0 ] 1 1 1 ] ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 17.2 20.1 16.2 20.7 17.8 13.7 13.2 12.8 -5.6 (11.7, (15.4, (9.4, (13.6, (11.9, (9.2, (9.0, (7.6, (-9.2, 22.7) 24.8) 23.0) 27.8) 23.1) 18.3) 17.3) 18.0) 1.7) White 16.9 18.2 16.7 17.0 14.1 10.9 9.5 9.7 -9.7 (14.9, (15.9, (14.7, (14.8, 023, (9.4, (8.0, (8.0, (-127, 18.8) 20.5) 18.7) 19.1) 15.8) 12.4) 11.0) 11.4) -6.6) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 28 11. Cancer of stomach and esophagus 50 10 f—\ o o O 2 oO 20 10 ®-Black #White 0 : 1 ] 1 ] 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 52.2 52.5 57.6 49.9 45.4 44.0 40.5 38.1 -5.1 (41.7, (40.9, (45.2, (39.6, (36.3, (35.4, (30.9, (29.2, (-6.9, 62.7) 64.2) 70.0) 60.1) 54.6) 52.6) 50.1) 47.0) -3.3) White 64.8 64.9 65.0 62.9 56.9 56.2 57.4 58.3 -2.2 (59.0, (59.7, (60.0, (58.7, (53.0, (51.9, (52.5, (54.3, (-3.3, 70.5) 70.1) 69.9) 67.2) 60.9) 60.4) 61.8) 62.4) 4.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 38 21. Cancer of uterus 25 o 5 <3 o © 15 o £1 o g [o) e © 10 £ Oo 2 Oo 5 -®-Black #White 0 1 1 ] 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 14.0 10.2 12.0 Nn.7 8.9 9.2 8.9 7.4 -71 (9.8, (6.8, (8.3, (7.3, (5.9, (6.2, (5.0, (46, (-10.0, 18.2) 13.5) 15.7) 16.1) 12.0) 12.2) 12.7) 10.3) -4.2) White 20.0 19.6 18.8 18.2 16.1 14.6 12.7 12.2 -7.5 (17.6, (17.4, (17.0, (16.4, (14.2, (13.1, (11.3, (10.8, (-8.9, 22.4) 21.8) 20.6) 20.0) 18.0) 16.0) 14.0) 13.6) -6.1) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national astimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 22. Cancer of cervix 35 30 25 20 15 i Discharge rate per 100,000 10 @-Black #White 0 1 1 ] 1 1 ] 1 ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 29.9 26.6 23.8 24.0 18.7 13.5 12.4 10.8 4.2 (21.4, (199, (165, ~~ (165, (137, 9.2, 73, (6.7, (-168, 38.4) 33.3) 31.2) 31.5) 237) 17.9) 17.4) 149) -11.8) White 16.3 14.7 13.5 27 10.2 7.7 6.4 5.8 -14.7 (37, (22 (11.5, (105, 77, (6.3, (5.4, (48, (-16.9, 18.9) 17.1) 15.5) 15.0) 12.6) 9.0) 7.4) 6.8) -12.5) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 40 Discharge rate per 100,000 23. Cancer of ovary 25 20 15 10 |_| 5 @-Black #White 0 1 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 15.1 122 14.8 11.6 5.8 5.6 5.9 5.4 -15.8 (9.5, (70, (10.3, (7.9, (3.8, (37, (35, (34, (-21.1, 20.8) 17.4) 19.3) 15.3) 7.9) 7.5) 8.3) 73) -10.2) White 19.6 20.6 19.8 18.4 13.1 10.7 9.8 9.8 -12.0 (16.4, (174, (170, (155, (107, (9.3, (8.6, 8.4, (-15.2, 22.8) 23.8) 22.5) 21.3) 15.5) 12.1) 11.0) 11.1) -8.7) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 41 Discharge rate per 100,000 24. Cancer of other female genital organs -@-Black White 1 ] ] ] 1 ] 1 ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 2.2 3.7 3.4 22 2.9 17 2.1 2.4 -4.8 (0.8, (1.6, (13, (0.8, (15, (0.8, (0.4, (1.1, (119, 3.7) 5.7) 5.6) 3.5) 4.3) 2.5) 3.9) 3.7) 3.0) White 3.3 3.8 3.0 2.6 2.5 2.6 2.4 1.8 -8.1 (2.6, (3.0, (22, (1.9, (2.0, (2.0, (18, (13, (-109, 4.0) 4.7) 3.8) 3.4) 3.1) 3.2) 3.0) 2.3) -5.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 42 25. Cancer of prostate 80 70 60 50 40 30 Discharge rate per 100,000 20 10 ®-Black White 0 1 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 67.9 65.3 62.7 63.7 60.8 45.5 47.4 44.4 6.4 (546, (53.1, (49.0, (507, (458, (355, (35.9, (33.9, (-8.6, 81.1) 77.6) 76.4) 76.8) 75.9) 55.5) 58.9) 55.0) -4.2) White 45.6 45.4 45.0 47.0 39.1 37.1 36.8 36.8 -3.9 (41.4, 41.4, (415, (433, (35.9, (339, (33.0, (33.4, (-5.5, 49.9) 49.4) 48.5) 50.7) 42.3) 40.3) 40.6) 40.1) -2.3) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 43 26. Cancer of other male genital organs 5 ®-Black #White 4 et o oS < 8 3 @ Q 2 5 o E © 2 £ Oo 2 0 | J 0 ] ] ] 1 1 1 ed 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 25 2.0 15 1.5 1.1 0.3 1.1 0.8 -17.3 (0.7, (0.5, (0.4, (0.4, (0.3, (0.0, (0.3, (0.0, (-28.0, 4.3) 3.5) 2.6) 2.6) 2.0) 0.7) 2.0) 1.5) -5.1) White 4.2 3.8 3.3 38 2.8 25 25 22 -9.0 (3.3, (3.0, 27, (8.1, 22, (2.0, (2.0, (1.7, 11.4, 5.1) 4.5) 4.0) 4.4) 3.4) 3.0) 3.0) 2.6) -6.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 27. Cancer of bladder 50 40 30 Discharge rate per 100,000 10 ®-Black White 0 1 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 179 19.8 21.6 16.6 16.9 130 15.8 9.6 -7.9 (13.3, (14.6, (15.3, (11.0, (12.3, (9.2, (10.6, (6.4, (-12.4, 22.5) 25.0) 27.9) 22.1) 21.5) 16.8) 20.9) 12.9) -3.3) White 449 46.9 43.9 41.7 35.7 30.0 29.1 26.8 -8.3 (40.4, (42.9, (39.9, (38.5, (32.8, (27.4, (26.2, (24.1, (-10.2, 49.3) 50.9) 47.9) 45.0) 38.6) 32.5) 31.9) 29.4) -6.5) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 45 Discharge rate per 100,000 12 10 28. Cancer of kidney -@-Black #&White 1 1 ] ] ] 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 8.2 75 8.2 10.0 8.5 6.5 6.2 4.2 75 4.7, (5.2, (5.0, (6.6, (5.1, 4.3, (3.8, 23, (-129, 11.8) 9.9) 11.3) 13.3) 11.9) 8.8) 8.6) 6.1) =1.7) White 9.9 10.2 10.8 9.9 8.7 8.8 9.6 8.4 26 (8.7, (9.0, (9.6, 8.9, 77, G7, (8.5, (72, (45, 11.2) 11.4) 12.0) 11.0) 9.8) 9.9) 10.6) 9.5) -0.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 46 29. Cancer of other urinary organs 2 5 —\ o o ) 8 g 2 1 g [) E © = Oo 2 0 0.5 @®-Black White 0 1 1 ] 1 ] ] ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 1.1 1.9 1.2 1.6 1.8 0.5 0.4 0.9 -13.0 (0.4, (0.3, (0.0, (0.7, (0.5, (0.0, (0.0, (0.1, (-24.7, 1.8) 3.5) 2.6) 2.6) 3.1) 1.2) 0.9) 1.6) 0.6) White 1.6 1.3 1.2 1.1 1.2 1.1 1.2 1.3 -1.6 (1.2, (0.8, (0.9, (0.8, (0.9, (0.8, (0.8, {1.0, (5.7, 2.0) 1.4) 1.6) 1.4) 1.6) 1.3) 1.5) 1.7) 2.7) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 47 30. Cancer of brain and nervous system 14 ow 10 o S Q o oO = 8 © a > g S 6 © ee QO 2 4 v 2 ®-Black #White 0 1 1 1 1 ] 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 3.8 52 4.6 4.9 8.0 3.8 4.6 52 1.7 (1.9, (3.1, (2.7, (2.9, (4.8, (2.2, (1.9, (2.4, (-5.8, 5.7) 7.2) 6.6) 6.9) 11.3) 5.3) 7.2) 8.0) 9.7) White 122 12.7 11.7 13.1 13.1 11.6 10.7 11.7 -14 (9.9, (10.1, (9.7, (1.1, (10.9, (9.4, (8.7, (9.6, {-34, 14.6) 15.3) 13.7) 15.0) 15.3) 13.8) 12.7) 13.7) 0.5) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 48 31. Cancer of thyroid Discharge rate per 100,000 w LA NL ® Black White 0 1 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 1.9 2.6 3.9 15 17 1.0 27 1.0 9.6 (0.8, (1.4, 22, (0.5, (0.5, (0.3, (1.4, 02, (-209, 3.0) 3.9) 5.6) 2.5) 2.9) 1.7) 3.9) 1.8) 3.4) White 49 5.0 43 43 4.1 3.8 3.9 4.0 37 (4.1, 4.1, (3.6, (3.6, (3.4, (3.0, 2, (3.3, (-5.1, 5.7) 5.9) 5.0) 5.1) 4.8) 4.6) 4.6) 4.7) -2.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 49 32. Hodgkin's disease Discharge rate per 100,000 Ho ®-Black White 0 L 1 1 1 1 | 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 5.7 5.1 4.0 5.8 3.7 3.6 2.0 19 -143 (3.7, (32, (2.0, (3.3, (2.0, (2.0, (0.8, (06, (-197, 7.6) 6.9) 6.1) 8.2) 5.3) 5.1) 3.2) 3.3) -8.5) White 75 7.0 7.7 6.9 5.2 5.1 3.9 34 11.3 (6.3, (5.8, (6.4, (5.9, 4.3, @.1, (3.1, (28, (-14.3, 8.7) 8.1) 8.9) 7.9) 6.1) 6.0) 4.6) 4.0) 3.1) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 50 33. Non-Hodgkin’s lymphoma 14 12 ” A o SS <) oO = 8 oO : V o © S 6 0s Oo <5 0 4 2 -®-Black #White 0 ] 1 1 ] 1 ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 49 9.8 7.1 10.7 6.9 52 4.4 5.9 -4.7 (2.6, (6.4, (4.5, (6.3, (4.3, (3.1, (2.5, (3.7, (-135, 7.2) 13.2) 9.7) 15.2) 9.5) 7.2) 6.4) 8.1) 5.0) White 12.9 13.1 12.6 13.5 10.7 10.2 9.6 9.4 -5.4 (11.0, (11.8, (11.1, (11.9, (9.3, (8.9, (8.2, (8.1, (73, 14.8) 14.6) 14.2) 15.0) 12.0) 11.6) 10.9) 10.7) -3.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 51 Discharge rate per 100,000 34. Lymphosarcoma and reticulosarcoma 14 12 10 “ @-Black White 0 1 ] 1 ] 1 L. ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 8.4 7.1 6.2 7.0 48 5.1 3.9 2.3 -14.3 (4.9, (4.6, (38, (4.1, (2.8, (3.2, 07 (1.1, (-188, 11.8) 9.7) 8.7) 10.0) 6.7) 7.0) 6.1) 3.5) -9.5) White 23 ¥23 12.4 11.9 10.2 8.8 6.5 49 12.2 (103, (104, (106, (10.3, (8.7, (7.5, (5.5, (4.0, (-16.4, 14.4) 14.2) 14.2) 13.6) 11.6) 10.1) 7.4) 5.7) -7.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 52 Discharge rate per 100,000 25 20 10 35. Leukemia ay - @-Black White 0 1 1 ] 1 L 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 14.0 16.8 21.4 17.1 14.1 1.7 12.6 11.1 5.9 (9.1, (118, (150, (11.9, (9.8, 8.1, (7.6, (66, (-10.8, 19.0) 21.8) 27.8) 22.4) 18.4) 15.3) 17.5) 15.5) -0.8) White 22.1 21.3 20.5 20.7 15.4 14.7 13.1 1.7 9.3 (185, (172, (175, (17.7, (134, (126, (11.3, (9.9, (11.4, 25.8) 25.4) 23.5) 23.7) 17.4) 16.8) 15.0) 13.5) 7.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 53 36. Multiple myeloma 25 20 oO & < o S 15 @ 5. 8 g (0) E « 10 £ Q 2 2 TN 5 ~—H Black # White 0 1 ] 1 1 1 LL 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 15.0 15.9 22.3 15.6 13.6 11.1 12.3 7.4 -9.6 (10.6, (11.1, (16.5, (11.7, (9.8, (7.5, (7.4, (48, (-154, 19.3) 20.8) 28.2) 19.5) 17.4) 14.7) 17.3) 10.0) -3.3) White 9.0 8.3 9.7 8.8 7.2 55 4.7 4.7 -10.5 (7.9, z1, (8.4, (7.6, (6.2, (4.6, (3.9, (4.0, (-14.1, 10.1) 9.4) 11.1) 9.9) 8.1) 6.3) 5.5) 5.4) -6.6) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 54 37. Cancer, other primary 16 14 12 te o o oS o 10 © @ a o 8 © oy [) Es 2 S 6 2 a 4 2 -®-Black White 0 1 ] 1 1 ] 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 12.4 11.8 14.1 116 11.4 72 79 71 -9.1 (8.9, (8.6, (9.1, (7.8, (7.9, (5.1, (5.3, “1, (139, 16.0) 15.0) 19.2) 15.4) 15.0) 9.4) 10.6) 10.1) 4.9) White 15.3 15.4 14.0 11.8 14 8.7 8.6 74 -10.7 (13.2, (13.7, (12.1, (10.3, (9.4, (7.3, (7.1, (6.2, (-12.3, 17.4) 17.1) 16.0) 13.3) 12.8) 10.1) 10.1) 8.5) -9.1) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 55 38. Secondary malignancies 100 80 a - o © <> 3 e 60 . > @ Q 2 g (0) E © 40 = O 2 o 20 -®-Black White 0 1 ] 1 ] ] Le ] ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 58.0 57.8 65.4 728 92.3 90.1 79.3 79.8 6.1 (44.2, (45.2, (51.0, (58.2, (75.9, (73.8, (60.9, (61.7, (2.4, 71.8) 70.4) 79.7) 87.6) 108.8) 106.5) 97.7) 98.0) 10.0) White 75.5 79.1 82.1 88.7 93.3 89.4 88.2 84.8 2.0 (68.0, (69.7, (71.4, (79.9, (85.4, (80.8, (81.0, (77.0, (0.3, 83.0) 88.5) 92.8) 97.6) 101.2) 98.0) 95.4) 92.6) 3.7) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 56 Discharge rate per 100,000 60 50 40 30 20 10 39. Neoplasms of unspecified site or uncertain behavior @- Black White 1 ] 1 1 ] 1 1 ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 49.2 54.8 484 415 37.5 82. 26.8 23.3 11.4 (38.5, (42.4, (379, (330, (29.1, (252, (20.1, (153, (-138, 59.8) 67.1) 58.8) 50.0) 45.9) 39.0) 33.5) 31.3) -9.0) White 50.4 50.2 49.2 45.0 37.5 29.7 24.5 19.8 -184 (46.4, (45.7, 43.7, (41.1, (34.5, (27.2, 23, (178, (16.2, 54.5) 54.8) 54.7) 48.8) 40.4) 32.2) 26.7) 21.8) -10.0) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 57 40. Maintenance chemotherapy, radiotherapy 160 120 > a oO o oc 100 2 o a Q t 80 () e 2 G 60 2 0 40 _— 20 Black #White 0 1 1 ] ] 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 26.9 27.2 421 63.8 81.1 98.3 108.2 110.8 26.3 (16.1, (17.3, (27.4, (48.0, (59.9, (76.3, (82.9, (80.7, (20.0, 37.8) 37.0) 56.8) 79.6) 102.3) 120.2) 133.4) 140.9) 32.9) White 41.8 53.0 71.9 89.6 116.3 127.8 130.8 137.3 19.3 (32.0, (41.6, (57.6, (737, (98.3, (1052, (111.2, (116.8, (14.4, 51.7) 64.4) 86.3) 105.4) 134.3) 150.4) 150.4) 157.8) 24.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 58 41. Benign neoplasm, uterus 160 140 120 © i, oO o 100 oO o 5 2 80 g [o) E 8 eR alia eo 5 60 2 o 40 20 ®-Black # White 0 1 1 ] 1 ] ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 141.9 139.3 133.6 135.6 128.9 121.9 120.4 130.6 -1.9 (114.2, (114.4, (109.8, (1159, (108.9, (100.8, (96.2, (103.1, (-3.0, 169.7) 164.3) 157.5) 155.3) 148.8) 143.2) 144.6) 158.2) -0.8) White 62.0 63.9 61.6 60.5 62.1 57.7 54.7 54.8 -2.1 (57.0, (58.3, (56.0, {65.2, (57.0, (52.4, (49.5, (49.6, (-3.0, 67.0) 69.5) 67.2) 65.7) 67.2) 63.0) 59.8) 60.0) =1.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 59 42. Other benign neoplasms 140 100 2, o © o oO ai tw 80 oO a a g o o 60 © = Oo 2 0 40 20 Black White 0 1 ] 1 1 1 1 ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 115.8 99.8 98.2 94.0 86.7 65.3 56.7 46.7 -11.7 (96.9, (85.5, (84.4, (78.7, (69.9, (53.6, (45.8, (376, (-14.2, 134.7) 114.1) 112.0) 109.4) 103.4) 77.1) 67.6) 55.8) -9.2) White 126.9 124.7 114.5 105.5 96.6 80.5 68.9 63.0 -10.2 (1182, (1158, (105.7, (96.6, (88.9, 724, (60.8, (54.0, (-11.7, 135.7) 1337) 123.3) 114.4) 104.4) 88.9) 77.0) 72.0) -8.6) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 60 Discharge rate per 100,000 43. Carcinoma in situ, cervix 14 EA 10 v @- Black #White 0 1 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 12 13.1 °.7 11.6 7.8 8.1 8.5 55 -9.2 7 (9.5, 72, (8.6, (5.3, (4.6, (5.4, (31, (134, 14.7) 16.7) 12.2) 14.7) 10.4) 11.5) 11.6) 7.8) -4.8) White 12.6 12.3 127 11.6 11.8 8.9 73 6.7 -9.1 (10.9, (10.3, (10.8, (10.0, (9.3, 77, (6.2, (5.7, (-12.3, 14.3) 14.3) 14.6) 13.2) 14.2) 10.2) 8.4) 7.8) -5.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 61 44. Other carcinoma in situ Discharge rate per 100,000 SH 2 v -®-Black White 0 1 ] ] ] 1 ] 1 1 1980 1981 1082 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black Za 4.1 34 29 3.8 1.8 32 3.6 87 (8.9, (2.0, (2.0, (1.5, (1.7, (0.5, (1.4, (2.0, (176, 10.3) 6.3) 4.7) 4.3) 5.8) 3.1) 4.9) 5.3) 1.1) White 53 49 6.2 6.1 6.2 5.7 6.0 5.2 0.8 (4.6, (4.1, (5.3, (5.1, (5.3, (4.8, (4.9, (4.5, {(-2.0, 6.1) 5.7) 7.9) 7.0) 7.2) 6.7) 7.0) 6.0) 3.6) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 62 45. Thyroid disorders 35 25 a & ~~ oS Q = 20 2 oO £ 2 gS & 15 «© Ve Oo LP ao 10 5 Black ##White 0 1 ] ] 1 1 ] 1 ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 31.1 27.8 24.2 26.9 20.5 17.9 15.5 21.0 -7.8 (25.2, (21.7, (18.9, (21.0, (16.2, (12.2, (11.4, (15.5, (-11.6, 37.1) 33.9) 29.5) 32.9) 24.9) 23.5) 19.7) 26.4) -4.0) White 26.3 25.8 22.0 19.8 17.4 13.7 13.3 11.9 -11.7 (23.7, (23.5, (19.9, (17.8, (15.8, (12.1, (11.5, (10.5, (-13.0, 28.9) 28.1) 24.0) 21.8) 19.0) 15.3) 15.2) 132 10.93 Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 63 46. Diabetes mellitus 400 300 228 3 QS o o a o a 2 200 g o t © = Oo 2 a 100 Black #White 0 1 ] ] 1 ] | ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 370.2 363.7 338.2 353.5 313.1 288.1 289.1 310.8 -3.5 (308.8, (313.1, (290.6, (305.5, (270.8, (246.8, (246.4, (256.7, (-5.0, 431.5) 4142) 3859) 401.5) 3554) 329.4) 331.8) 364.8) -1.9) White 170.4 166.7 172.3 163.0 140.5 126.7 124.0 112.4 -6.3 (161.3, (157.6, (162.0, (152.9, (131.9, (1182, (116.3, (105.0, (-7.9, 179.4) 175.8) 1827) 1732) 149.2) 1352) 131.6) 119.9) -4.6) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 64 47. Other endocrine disorders 35 30 25 - J oS © o oS T 20 SS oO & > g & 15 © £ oO 2 Qa 10 5 -®-Black #White 0 ] 1 1 ] 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 24.2 29.1 27.7 27.8 32.9 30.2 27.6 28.2 15 (19.3, (22.6, 1.7, (21.8, (26.6, (23.7, (21.0, (22.2, -1.2, 29.1) 35.7) 33.7) 33.7) 39.2) 36.6) 34.2) 34.2) 4.2) White 23.1 20.6 226 21.1 20.0 170 16.1 15.1 -5.9 (20.4, (18.5, (19.9, (19.0, (17.9, (15.2, (14.6, (13.4, 7.7, 25.7) 22.7) 25.2) 23.3) 22.1) 18.8) 17.7) 16.7) 4.1) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 65 48. Nutritional deficiencies 12 0 7X 7 AX o oS 8 S 3 IN ¥ 2 @ & JO) © 6 (0) o © and 3 BE 4 - 2 -®-Black #White 0 1 1 ] 1 1 1 l ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 7.9 78 7.0 10.2 10.9 7.6 10.8 8.8 3.4 (4.9, (4.9, (4.7, (6.9, (7.7, (5.1, (6.4, (5.2, (-1.6, 10.8) 10.6) 9.4) 13.4) 14.1) 10.0) 15.2) 12.5) 8.6) White 4.8 5.1 50 5.1 5.5 5.0 53 4.2 -0.7 4.1, (4.4, (4.3, (4.4, 4.7, (4.3, (4.4, (3.5, (-3.1, 5.5) 5.8) 5.8) 5.7) 6.2) 5.7) 6.2) 5.0) 1.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 66 49. Fluid and electrolyte disorders 160 140 f 120 o & oS o 100 2 @ & 2 80 g o) E 2 © 60 @ 2 a 40 — 20 ®-Black White 0 1 l 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 59.8 63.4 75.7 87.7 112.2 150.0 152.9 152.7 17.1 (48.3, (53.0, (64.1, (72.1, (925, (122.3, (126.1, (1219, (13.7, 71.2) 73.7) 87.2) 103.3) 131.8) 177.7) 179.7) 183.5) 20.6) White 38.9 43.5 46.5 53.4 81.0 102.2 112.0 108.1 19.1 (36.3, (40.5, (43.4, (49.7, (75.2, (94.9, (103.0, (98.3, (14.6, 41.6) 46.6) 49.7) 57.1) 86.8) 109.5) 121.0) 117.8) 23.7) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 67 50. Other metabolic and immunity disorders 50 40 A o o © we a a 10 5 0 Black White 0 1 1 1 1 | 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 26.7 26.9 26.7 26.6 28.9 275 26.4 24.2 07 (187, (198, (196, (193, (205 ~~ (210, (198, ~~ (174, 22, 34.7) 34.0) 33.8) 33.9) 37.2) 34.0) 33.0) 31.1) 0.8) White 155 175 15.6 V3 16.9 17.8 15.7 16.9 0.5 (135, (155, (136, (152, (146, (151, (134, (141, 13, 17.6) 19.6) 17.5) 19.5) 19.2) 20.6) 18.1) 19.6) 2.3) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 78 Discharge rate per 100,000 61. Depression and affective disorders 200 150 100 50 Black #White 0 I I l 1 l 1 I ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 83.6 78.0 86.0 88.7 88.6 92.1 93.7 98.9 28 (65.1, (62.1, (68.9, (70.1, (71.6, (71.8, (69.7, (75.2, (18, 102.1) 940) 1030) 107.3) 1056) 1126) 117.6) 122.6) 3.7) White 159.6 163.6 162.4 158.4 160.2 163.3 167.3 176.7 1.0 (1411, (1450, (1434, (1403, (1404, (1425, (1456, (1515, (02, 178.1) 1822) 181.4) 1766) 180.1) 1840) 189.0) 201.9) 1.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 72 62. Anxiety and personality disorders 70 60 50 SC CS © S oO T= 40 Q QQ QQ © S 30 © oh Oo 2 i 20 = 10 #0 Black #White 0 1 1 1 1 l 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 38.8 38.8 35.5 30.4 25.2 20.1 21.7 17.4 11.7 (312, (320, (281, (242, (195 ~~ (157, (164, (122, (138, 46.4) 45.6) 43.0) 36.7) 30.9) 24.5) 27.0) 22.6) -9.5) White 66.8 59.6 54.9 50.3 425 36.9 34.1 32.7 -10.3 (602, (544, (499, (460, (387, (330, (302, (28.1, (-113, 73.5) 64.7) 59.9) 54.5) 46.2) 40.8) 38.0) 37.2) -9.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 80 63. Eating disorders and obesity 20 15 10 — Discharge rate per 100,000 5 -®-Black #White 0 1 ] ] 1 1 1 l 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 9.8 9.4 12.3 9.8 7.8 6.6 7.4 7.9 -5.6 (6.7, 6.2, (9.1, (6.9, (5.5, (3.6, (3.4, (4.5, (-9.8, 12.9) 12.7) 15.4) 12.7) 10.1) 9.6) 11.5) 4.2) =1.2) White 17.4 15.6 15.0 13.7 11.6 11.8 10.6 11.5 -6.6 (13.8, (13.0, (12.5, (11.4, (9.8, (9.5, (8.2, (8.5, (-8.4, 20.9) 18.3) 17.4) 15.9) 13.4) 13.7) 12.9) 14.5) -4.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 64. Adjustment reaction 20 15 o S S o =) ® 5 2 10 g (0) Oo © we O 0 0 5 ®-Black #White 0 1 1 1 1 1 1 ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 8.0 7.8 10.0 9.1 7.4 9.0 9.6 8.3 0.9 (4.8, (5.2, (6.7, (6.3, (4.8, (5.3, (5.2, (4.4, (-2.5, 11.1) 10.3) 13.4) 11.9) 10.0) 12.7) 14.0) 12.1) 4.5) White 14.0 14.2 13.6 150 14.2 13.1 14.6 17.7 19 (1.2 (11.3, (10.9, (11.8, (11.2, (10.6, (11.4, (13.3, (-0.6, 16.7) 17.2) 16.4) 18.2) 17.3) 15.6) 17.8) 22.1) 4.5) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 82 65. Developmental disorders [/ A Discharge rate per 100,000 nN -@ Black White 0 1 ] 1 1 ] 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 2.8 3.8 35 1.8 0.7 15 1.0 1.4 -16.6 (14, (1.5, (1.9, (0.9, (0.1, (0.6, (0.3, (0.4, (-26.9, 4.2) 6.1) 5.1) 2.8) 1.3) 2.5) 1.6) 2.3) 4.8) White 1.9 2.4 15 1.7 1.2 0.8 1.0 0.8 -14.4 (A, (1.7, (1.1, (1.2, (0.8, (0.5, (0.5, (0.4, (-19.0, 2.4) 3.1) 1.9) 2.2) 1.6) 1.1) 1.4) 1.1) -9.5) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 83 66. Other mental disorders (not psychoses) 20 15 A o o <3 S 2 @ a Q g No (0) © © £ O 2 a 5 -®-Black White 0 1 1 1 1 ] 1 ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 15.5 12.8 12.2 10.9 11.5 9.4 11.1 14.0 -2.5 (11.5, (8.8, (8.5, (7.5, (7.8, (5.4, (7.5, (9.0, (-6.9, 19.5) 16.8) 15.9) 14.2) 15.3) 13.4) 14.8) 19.0) 2.2) White 18.0 16.8 17.7 16.8 15.2 16.4 16.1 16.3 -15 (15.9, (14.7, (14.7, (13.9, (11.8, (11.4, (27, (13.0, +27, 20.1) 19.0) 20.7) 19.7) 18.6) 21.3) 19.5) 19.6) -0.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 84 67. Central nervous system infection 35 30 25 ~ S oO Q 2 Soo 20 Q a 2 g S 15 © Hon Oo £2 oO 10 5 -®-Black White 0 ] 1 1 1 1 ] ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 26.5 24.2 21.3 21.2 20.8 26.5 27.5 30.1 26 (19.5, (19.1, (16.1, (16.9, (16.1, (19.9, (21.3, (21.6, 14, 33.5) 29.3) 26.6) 25.5) 25.6) 33.2) 33.7) 38.7) 6.9) White 19.8 23.0 23.1 25.3 22.1 215 225 22.7 0.6 (17.5, (20.4, (20.2, (22.5, (19.9, (19.3, (19.9, (20.2, (-1.8, 22.2) 25.6) 25.9) 28.1) 24.4) 23.8) 25.0) 25.2) 2.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 85 68. Other inflammatory diseases of the central nervous system 3.5 2.5 Cc o Oo S oO py 2 Q 5 QQ © S 1.5 2 A a Q 2 0 1 - EB 0.5 @ Black #White 0 ] 1 1 ] 1 L 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 16 1.9 12 1.1 15 14 3.2 13 2.9 (0.3, 0.7, (0.4, 0.3, (0.6, (0.4, (15, 06, (77, 2.8) 3.2) 2.0) 1.8) 2.3) 2.5) 5.0) 2.1) 14.8) White 1.0 #4 13 1.1 v2 15 1.0 1.0 0.3 (0.7, (0.8, (1.0, (0.8, (0.9, (1.1, (0.7, (0.7, (4.4, 1.3) 1.4) 1.7) 1.5) 1.5) 1.9) 1.3) 1.4) 5.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 86 69. Parkinson’s disease 12 10 “~~ \ 8 8 Black White 0 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 35 6.5 74 72 3.9 35 3.9 1.7 -11.6 (1.8, 3.7, (4.8, (4.1, (2.4, 0.2, 32 (05, (-21.8, 5.3) 9.2) 9.4) 10.3) 5.5) 5.2) 6.5) 2.9) 0.0) White 11.1 10.3 11.3 9.2 73 6.1 5.1 4.6 -13.1 (9.5, (9.1, (10.1, (8.1, (6.4, (52, (4.4, (8.9, (-15.7, 12.7) 11.6) 12.4) 10.2) 8.2) 6.9) 5.9) 5.3) -10.3) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 87 Discharge rate per 100,000 70. Multiple sclerosis 12 10 J -# Black #White 0 1 ] ] 1 1 Le ] ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 4.8 6.4 6.6 5.0 5.4 6.6 4.8 4.9 -1.3 (2.6, (3.9, (4.1, (3.0, (2.9, (3.9, (3.1, (2.8, (-5.8, 6.9) 8.8) 9.0) 7.0) 7.8) 9.3) 6.5) 7.0) 3.4) White 8.9 8.8 9.1 9.9 79 75 6.4 5.6 -6.5 (7.6, (7.6, G7, (8.4, (6.7, (6.4, (5.2, (4.6, (-9.6, 10.3) 9.9) 10.5) 11.4) 9.1) 8.6) 7.6) 6.5) -3.3) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 88 71. Other hereditary and degenerative central nervous system diseases 25 on ZI 5 o Ee] < o © 15 2 Se @ a 2 © = ® > < gs 10 o 2 0 5 ® Black # White 0 1 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 18.0 11.8 140 20.7 19.3 16.0 11.8 12.9 23 (13.7, (8.3, (10.1, (153, (14.5, (11.9, (8.1, (8.8, (-8.9, 22.2) 15.3) 17.9) 26.0) 24.1) 20.0) 15.5) 17.0) 4.7) White 18.7 19.2 20.8 18.4 17.8 14.7 13.7 12.1 6.6 (16.8, (17.0, (18.6, (16.6, (15.8, (12.9, (12.0, (10.3, 92, 20.6) 21.4) 23.1) 20.2) 19.9) 16.6) 15.4) 14.0) -4.0) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 89 72. Paralysis 25 20 o © o S 150 © a 2 g (0) ~ E S 100 : Wu Oo 2 a 50 ®-Black ##White 0 ] ] 1 1 ] ] l ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 137.1 125.8 117.3 111.0 98.4 84.6 76.4 62.8 -10.2 (115.9, (106.8, (100.5, (93.5, (82.6, (71.7, (63.4, (50.8, (-11.6, 158.3) 144.8) 134.0) 128.4) 114.2) 97.5) 89.3) 74.8) -8.8) White 205.7 201.5 189.8 179.5 169.7 139.1 116.3 96.7 -10.2 (193.7, (189.9, (178.0, (168.9, (160.2, (130.0, (107.5, (88.8, (-12.6, 217.7) 213.1) 201.6) 190.2) 179.2) 148.2) 125.0) 104.7) ~77) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Provider Studies. Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of 136 119. Other abdominal hernia 120 100 8 80 © o 2 Ee © a 2 60 S (0) 2 © £ 3 a 40 20 -#-Black #White 0 1 ] 1 ] 1 1980 1981 1982 1983 1984 1985 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1987 EAPC Black 95.1 86.6 78.3 77.3 63.3 54.6 45.6 -10.9 (80.4, (72.8, (65.1, (65.5, (51.9, (44.5, 35.3, (-125, 109.8) 100.3) 91.5) 89.1) 74.7) 64.8) 55.9) -9.2) White 102.4 100.0 96.0 89.2 74.4 67.6 54.8 -9.5 (95.7, (92.8, (89.8, (83.6, (69.5, (62.6, (50.6, (-11.0, 109.0) 107.1) 102.3) 94.8) 79.3) 72.6) 58.9) -7.9) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Proj estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: ect, 1980-87, weighted to obtain national Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 137 Discharge rate per 100,000 300 250 200 150 100 50 120. Noninfectious enteritis and colitis Lo Black White 1 1 1 1 | 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 157.4 164.8 165.5 157.9 153.2 122.0 113.0 89.4 -7.8 (129.9, (1357, (139.0, (130.1, (12563, (95.3, (91.0, (73.1, (109, 184.8) 1939) 1920) 1857) 181.0) 1487) 1349) 1056) -4.5) White 256.4 255.1 2477 2368 212.7 176.8 156.1 135.5 -9.1 (238.0, (238.1, (229.4, (222.1, (200.0, (163.9, (142.1, (1246, (-113, 074.8) 2722) 2659) 251.5) 2255) 189.7) 1702) 146.4) -6.9) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 138 121. Intestinal obstruction without hernia 100 80 ) 60 7 Discharge rate per 100,000 40 20 Black #White 0 ] 1 1 ] l 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 56.1 63.9 62.1 77.8 74.9 68.8 81.5 76.1 44 (46.3, (53.1, (52.5, (65.0, (62.7, (57.2, (66.9, (63.1, (1.9, 65.9) 74.8) 71.7) 90.5) 87.1) 80.3) 96.1) 89.1) 7.0) White 58.2 62.5 61.0 66.2 728 71.1 69.9 70.7 3.0 (54.8, (58.5, (57.3, (62.3, (68.7, (66.8, (65.6, (66.3, (1.6, 61.6) 66.6) 64.7) 70.1) 77.0) 75.4) 74.2) 75.2) 4.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 139 Discharge rate per 100,000 122. Diverticulosis and diverticulitis 100 60 gg 20 ®-Black White 0 1 1 1 l 1 1 1] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 45.6 471 54.5 51.6 46.8 36.5 421 42.9 -2.7 (38.1, (37.2, (44.6, (43.0, (36.9, (29.1, (31.9, (34.3, (-6.0, 55.0) 57.0) 64.3) 60.3) 56.6) 43.9) 52.2) 51.5) 0.7) White 81.7 81.6 80.6 81.0 69.0 62.9 59.2 60.7 -5.3 (76.5, (76.7, (75.9, (76.1, (64.7, (58.8, (54.9, (55.8, (-7.0, 86.8) 86.5) 85.3) 85.9) 73.3) 66.9) 63.4) 65.5) -3.6) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 140 123. Anal and rectal conditions 80 60 o SS Q o © = @ a o 40 S Q © [vo] < Oo 2 0 20 ®-Black White 0 1 ] 1 ] ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 73.1 75.4 69.8 68.7 60.9 51.7 50.7 45.0 -7.3 (59.0, (62.9, (57.5, (57.7, (50.6, (42.1, (39.1, (34.9, (-9.0, 87.2) 87.9) 82.0) 79.6) 71.3) 61.3) 62.3) 55.0) -5.7) White 66.2 62.5 59.4 57.5 50.4 43.7 39.6 31.6 -9.6 (60.8, (57.8, (54.7, (53.3, (46.7, (40.2, (35.6, (28.4, (-11.5, 71.6) 67.2) 64.1) 61.6) 54.1) 47.2) 43.6) 34.8) -7.7) Note: Based on 20 percent of discharges from the Hospital Cost and Utiliza estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Provider Studies. tion Project, 1980-87, weighted to obtain national Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of 141 124. Peritonitis, intestinal abscess, and other disorders of peritoneum 20 18 oO o QQ o Oo @ a £2 10 g (0) ES © er O 2 Oo 5 ®-Black #White 0 ] 1 1 1 1 ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 11.5 1.1 12.6 14.6 155 17.4 14.9 14.4 5.0 (7.9, (8.1, (8.9, (10.8, (11.1, (12.8, (10.7, (9.9, (1.7, 15.1) 14.0) 16.3) 18.4) 19.9) 22.1) 19.0) 19.0) 8.5) White 12.6 12.3 11.9 12.4 13.3 12.8 11.4 10.7 -1.5 (11.3, (via, (10.8, (11.0, (11.9, (11.5, (9.9, (9.5, (34, 13.9) 13.6) 13.1) 13.8) 14.8) 14.2) 12.9) 11.9) 0.5) Note: estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 142 125. Biliary tract disease 250 200 eS oS Q Oo oS 150 o a 2 E [) © © 100 , 5) 2 o 50 ®-Black #White 0 1 ] ] 1 1 1 ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 136.2 150.5 131.4 131.5 135.4 114.0 119.7 115.8 -3.1 (114.4, (129.8, (1114, (1135 ~~ (116.2, (97.7, (101.5, (98.1, (-4.8, 158.1) 171.2) 151.5) 149.5) 154.6) 130.2) 137.8) 133.5) -1.5) White 239.3 239.6 232.2 233.6 220.7 214.6 206.8 207.7 -2.4 (226.2, (2272, (218.8, (221.8, (2094, (202.6, (194.8, (195.0, (-2.9, 2505) 252.1) 2456) 2455) 232.0) 226.) 218.7) 220.3) -1.9) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 143 Discharge rate per 100,000 60 50 40 30 20 10 126. Liver disease, not alcohol related ®-Black #White 1 1 1 ] ! I ad 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 51.1 47.0 491 42.7 40.4 43.5 41.3 36.5 -4.0 (41.9, (37.2, (39.4, (33.8, (33.0, (34.9, (31.6, (28.6, (-5.5, 60.3) 56.8) 58.9) 51.7) 47.8) 52.2) 51.0) 44.3) -2.5) White 44.3 42.8 43.8 39.6 36.2 38.2 31.6 30.3 -5.6 (40.8, (39.5, (40.9, (36.8, (33.86, (33.6, (29.3, (27.6, (-6.7, 47.8) 46.1) 46.6) 42.4) 38.8) 38.8) 33.9) 33.0) —4.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 144 Discharge rate per 100,000 127. Pancreas disorders (not diabetes) 140 120 ————— 100 80 60 40 —— 20 #®-Black #White 0 1 1 1 1 1 1 ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 128.0 132.5 132.3 114.7 118.8 120.2 122.1 118.3 -14 (105.0, (107.7, (109.1, (97.1, (99.0, (100.1, (98.9, (97.9, (-2.8, 151.0) 157.2) 155.5) 132.3) 138.7) 140.3) 145.2) 138.7) -0.1) White 3741 37.9 378 40.0 39.6 37.2 36.7 36.7 -0.3 (34.3, (35.2, (35.1, (36.9, (36.8, (34.4, (34.0, (33.9, (-1.4, 39.9) 40.6) 40.5) 43.1) 42.5) 39.9) 39.4) 39.6) 0.7) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 145 128. Gastrointestinal hemorrhage 80 60 o oS ) o o D a Q L 40 [) 2 © £ Oo 2 Q 20 ®-Black White 0 ] ] 1 1 l i ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 65.8 64.9 71.8 70.2 725 75.1 77.5 70.2 1.8 (52.5, (51.7, (59.3, (55.7, (60.6, (60.8, (60.9, (55.9, (0.4, 79.1) 78.2) 84.3) 84.7) 84.4) 89.3) 94.1) 84.5) 3.2) White 54.6 52.6 54.5 59.3 57.9 56.3 54.1 0.7 (50.5, (50.9, (49.1, (51.0, (55.4, (54.0, (52.4, (50.0, (-0.5, 57.4) 58.2) 56.1) 57.9) 63.1) 61.8) 60.3) 58.2) 1.9) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 146 129. Other gastrointestinal disorders 60 50 40 30 Discharge rate per 100,000 20 10 -®- Black #White 0 ] 1 ] 1 ] ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 47.3 453 47.1 51.0 36.4 35.9 34.4 38.0 47 (389, (37.0, (39.3, (42.3, (288, (294, (26.0, (25.5, +77, 55.7) 53.7) 54.9) 59.7) 43.9) 42.5) 42.8) 50.5) -1.6) White 52.4 52.8 49.7 49.9 43.9 36.4 35.4 33.1 J2 (486, (49.3, (46.1, (462, 40.3, (337, (323, (30.4, (-8.9, 56.3) 56.3) 53.4) 53.5) 47.4) 39.1) 38.5) 35.8) 5.5) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 147 130. Abdominal pain 140 120 100 80 60 Discharge rate per 100,000 40 20 @-Black #White 0 1 ] 1 l 1 L ] ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 119.1 111.8 107.5 98.3 86.1 78.2 65.9 65.0 -9.1 (99.7, (94.9, (90.5, (82.4, (71.9, (6586, (54.2, (49.6, (10.2, 138.5) 128.7) 1246) 1142) 100.3) 90.9) 77.6) 80.4) -7.9) White 133.7 128.9 129.4 110.4 96.4 84.7 79.6 73.7 -9.1 (122.7, (119.1, (119.7, (1015, (88.1, (78.4, (730, (67.3, (-105, 1447) 1387) 139.4) 119.3) 104.8) 91.0) 86.2) 80.2) -7.6) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. ‘Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 148 131. Nephritis, nephrosis 20 15 o as, a . OQ LQ a 50 #-Black #White 0 1 1 ] 1 1 L. ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 1738 166.3 1482 1575 155.0 159.7 171.1 153.9 0.6 (1470, (1416, (125.7, (1356, (1315, (1349, (1422, (1278, (-23, 2007) 191.1) 1707) 179.4) 1786) 184.4) 200.1) 180.) 1.2) White 1770 161.3 1514 150.1 1379 131.7 1286 122.9 -4.9 (1637, (149.8, (142.1, (1421, (1295, (1234, (1208, (115.2, (-5.5, 190.2) 1727) 160.7) 1582) 146.2) 140.0) 136.3) 130.6) -4.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 152 135. Calculus of urinary tract 180 160 140 8 120 Q o Oo o 100 S ho g [ 80 E © 5 o«_ 8 60 a 40 20 Black ##White 0 1 ] ] 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1983 1984 1985 1986 1987 EAPC Black 64.8 54.1 49.0 47.0 41.5 43.4 41.1 -6.1 (52.4, (44.8, (47.1, (39.5, (38.8, (34.2, (34.9, (30.5, (-7.8, 77.4} 63.4) 58.4) 55.3) 48.7) 51.9) 51.8) 4.4) White 159.0 148.4 143.9 144.5 142.3 137.9 139.5 132.8 -2.0 (1485, (137.9, (134.1, (1362, (1338, (127.8, (127.1, (1225, (-2.8, 169.5) 159.0) 153.6) 152.9) 150.8) 147.9) 152.0) 143.1) -1.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 153 136. Other genitourinary disorders 160 140 120 o 3 co 100 o @ a 2 80 g [) cs 2 S 60 2 0 40 20 Black #White 0 1 1 1 ] ] ] ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 131.3 132.4 106.8 101.6 99.0 68.7 58.8 60.6 -12.1 (105.1, (109.2, (89.2, (84.7, (83.7, (57.3, (46.8, - (48.3, (-14.7, 157.4) 155.7) 124.5) 118.5) 114.2) 80.0) 70.9) 72.9) -9.4) White 138.2 125.8 1n29 103.9 90.7 75.4 61.9 56.3 -12.5 (127.7, (1154, (104.7, (96.0, (83.7, (68.3, (56.5, (50.8, (-13.7, 148.7) 136.2) 121.1) 111.9) 97.7) 82.6) 67.4) 61.7) -11.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilizati estimates, and age- and sex-adjusted to the 1970 resident U.S. population. on Project, 1980-87, weighted to obtain national Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 1 54 137. Hyperplasia of prostate 120 100 NS. o Gg, a S 80 Ql o NS SL 2 @ & 5 60 8 [0 E © £ 3 a 40 20 ®-Black White 0 1 1 ] ] 1 ] ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 83.3 81.8 69.2 81.9 72.7 65.8 66.1 65.9 -3.5 (65.7, (63.7, (54.1, (68.1, (55.2, (52.0, (51.86, (51.5, (-5.3, 100.9) 99.9) 84.3) 95.8) 90.2) 79.5) 80.7) 80.4) -1.6) White 105.7 109.3 101.8 103.6 96.0 94.4 93.2 101.0 -1.7 (96.4, (99.4, (94.3, (96.5, (89.4, (87.3, (85.1, (92.3, (-2.9, 114.9) 119.2) 109.2) 110.6) 102.6) 101.5) 101.3) 109.6) -0.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 155 138. Other male genital disorders 140 120 100 o o © 100 = oO 0 a 50 #-Black ##White 0 1 1 ] 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 189.3 176.0 146.7 130.4 116.1 96.8 78.4 53.3 -15.6 (149.1, (137.8, (116.3, (108.0, (91.9, (72.0, (59.9, (42.8, (-18.1, 2295) 2142) 177.1) 1528) 140.3) 121.6) 96.9) 639) -13.1) White 202.1 181.1 156.6 140.8 120.2 99.8 86.2 77.8 ABZ (186.6, (167.7, (1447, (130.8, (1107, (91.1, (786, (69.9, (-139, 217.6) 194.4) 168.4) 150.8) 129.7) 108.4) 93.8) 85.8) -12.5) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 161 Discharge rate per 100,000 144. Menopausal disorders 35 NE 25 20 15 10 0 l | l 1 1 1 | 1 @- Black White 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 81.7 241 239 23.1 17.2 18.1 9.4 9.4 -16.7 (23.7, (19.2, (18.6, (7.2 (12.8, (8.1, (6.0, (34, (-19.7, 39.6) 29.1) 29.3) 28.9) 21.6) 18.0) 12.7) 15.4) -13.5) White 32.1 30.7 24.5 222 17.4 10.3 8.2 6.1 -22.2 (29.1, (27.9, (22.0, (19.7, (15.4, (8.8, (6.6, 41, (-257, 35.2) 33.6) 27.0) 24.7) 19.4) 11.9) 9.8) 8.0) -18.7) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 162 145. Infertility 16 14 ~~ 12 o 3 oc 10 2 o a 2 8 g (0) E s SS 6 2 a 4 2 ®-Black White 0 1 1 1 1 1 ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 15.2 13.4 12.2 8.4 7.8 5.7 4.6 4.8 -17.2 (10.7, (9.5, (8.8, (5.7, (4.9, (3.4, (2.6, (3.0, (-195, 19.8) 17.4) 15.6) 11.0) 10.7) 7.9) 6.7) 6.5) -14.8) White 11.2 11.9 9.9 7.7 6.1 3.9 3.3 -17.6 9.2, (9.8, (8.3, (6.3, (4.8, (3.9, (3.0, (2.4, (-19.9, 13.1) 14.0) 11.6) 9.2) 7.3) 6.3) 4.9) 4.2) -15.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 163 250 200 o oO S 8 150 © Q [4b] © [0] © Ss 100 = O 0D 2 50 0 146. Other female genital disorders mn @-Black ##White ] 1 1 1 1 1 1 ] 1980 1981 1982 1983 1984 1985 1986 1987 and confidence interval in parentheses Discharge rate per 100,000, estimated annual percent change (EAPC), Race 1981 1982 1983 1984 1985 1986 1987 EAPC Black 158.2 144.4 118.7 94.8 76.2 55.8 50.9 =172 (1352, (1226, (1005, (775, (61.6, (431, (380, (-193, 181.1) 166.1) 137.0) 112.2) 90.7) 68.5) 639) -15.2) White 186.2 154.6 128.2 108.0 87.7 77.1 69.9 -15.2 (171.8, (1432, (1187, (99.7, (80.8, (70.4, (63.3, (16.1, 200.6) 166.0) 137.7) 116.3) 94.6) 83.8) 76.5) -14.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 164 147. Pregnancy with abortive outcome 350 300 *. 250 oe © Q oO S T 200 0 Q Bo g S150 © = Oo 2 Q 100 50 Black White 0 1 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1981 1982 1983 1984 1985 1986 1987 EAPC Black 280.8 250.3 242.2 234.3 192.7 183.3 165.6 -8.2 (211.3, (189.5, (176.0, (1732, (1428, (134.2, (1187, (-9.3, 350.3) 311.1) 308.3) 295.5) 2425) 2324) 2125) -1.2) White 119.7 110.1 104.7 101.2 89.3 74.9 66.3 -9.1 (1105, (101.4, (94.9, (92.5, (80.9, (67.7, (59.1, (-10.5, 128.9) 118.9) 114.6) 109.9) 97.6) 82.0) 73.5) 7.7) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 165 148. Complications during pregnancy 500 400 oS oS QQ o S 300 o a 5 g (0) eS a 200 il Oo 2 Q 100 @-Black #White 0 1 ] 1 ] 1 ] ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 372.2 355.6 378.1 377.8 414.0 410.4 427.7 457.4 33 (305.1, (294.9, (308.1, (3115, (3367, (3264, (328.7, (351.5, (2.3, 439.3) 416.3) 448.1) 444.1) 491.2) 494.5) 526.7) 563.2) 4.3) White 198.8 204.1 210.4 216.9 233.5 252.1 247.3 252.5 39 (180.3, (183.7, (190.1, (194.8, (211.4, (2240, (222.4, (224.7, (3.1, 217.3) 2245) 2306) 238.9) 2557) 2802) 2722) 280.2) 4.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 166 149. Complications of birth, puerperium 1,000 800 2” ® : A oO S 8 600 o ja 1 QQ © (0) o © 400 I sal OQ 0 a 200 @- Black White 0 1 1 1 1 | 1 1 | 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 730.9 699.9 705.5 7350 737.3 7598 795.3 826.2 2.1 (5935, (575.1, (571.4, (5983, (592.0, (599.2, (614.8, (634.1, (1.2, 868.3) 824.8) 840.0) 871.6) 8826) 9204) 9758) 1,018.3) 3.0) White 645.3 637.3 6376 6363 667.8 690.0 659.4 657.6 0.7 (578.1, (5730, (5762, (580.1, (610.2, (6269, (5982, (5944, (-0.0, 712.4) 7015) 699.1) 692.5) 7254) 7530) 720.7) 7207) 1.5) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 167 150. Normal delivery/liveborn 2,500 2,000 cS Co Qo 8 1,500 o QQ. QQ © QQ > © 1,000 Fl oO 0 a 500 Black White 0 1 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 21103 2,058.1 2,056.8 1,980.0 19022 19165 2027.9 2040.8 0.7 (1761.4, (1,741.0, (1,700.5, (1,661.4, (15796, (1,551.5, (1,600.7, (16102, 17, 2.4593) 2,375.1) 2.4132) 2,208.5) 2224.8) 22815) 24550) 2471.4) 0.4) White 21477 21167 2,088.4 20064 20168 20172 1877.7 18777 -1.9 (1970.9, (1.9357, (1,902.9, (1,844.9, (18526, (1.8447, (1,7240, (1.7240, 24, 03245) 2297.6) 22738) 2,167.9) 2,180.9) 2,189.8) 20314) 2,031.5) -1.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 168 151. Skin and subcutaneous infections 140 120 -— yy = = 100 5—8 oO < oO o 2s i 80 QQ QQ © S 60 [+] te oO @ a 40 20 -@-Black White 0 ] 1 1 1 1 ! 1 ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 125.2 134.7 123.6 124.4 121.7 126.4 133.1 129.7 0.3 (99.9, (1088, (1039, (1024, (1032, (104.6, (1038, (103.4, (-0.9, 150.6) 160.6) 143.3) 146.3) 140.3) 1483) 162.3) 156.0) 1.5) White 105.4 102.3 102.9 100.4 104.1 105.8 97.2 100.6 -0.5 (99.7, (967, (97.4, (953, (983, (999, (91.3, (944, (-1.4, 111.4) 107.9) 108.3) 1054) 109.9) 111.8) 103.1) 106.8) 0.3) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 169 152. Other inflammatory conditions of skin 12 10 3S 3 8 oS oO @ a Q © 6 (0) E © £ 9 a 4 2 ®-Black #White 0 ] ] l ] ] ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 10.0 8.0 8.0 10.0 5.8 6.8 8.0 9.3 -1.9 (6.5, (5.0, (5.8, (6.9, 37, (4.5, (5.5, (3.1, 75, 13.6) 11.0) 10.3) 13.2) 8.0) 9.1) 10.5) 15.4) 4.1) White 10.0 8.8 9.9 8.0 6.5 5.4 50 4.5 -11.8 (8.4, (7.3, (8.1, (6.6, (5.4, (4.1, (4.2, (2.9, (-14.5, 11.6) 10.4) 1.7) 9.4) 7.6) 6.0) 5.9) 6.1) -9.1) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 170 60 50 40 30 Discharge rate per 100,000 20 10 153. Chronic ulcer of skin i ee 1 1 1 1 l 1 ® Black White 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 40.3 46.0 46.0 45.7 46.9 43.1 42.8 48.7 0.9 (32.4, (380, (368, (369, (37.7, (336, (331, (347, (-0.9, 48.2) 54.0) 55.1) 54.5) 56.1) 52.5) 52.5) 62.7) 2.8) White 22.9 21.0 226 22.3 20.2 21.8 21.9 19.6 <2 @10, (192, (206, (20.4, (204, (204, (202, (178, (-2.4, 24.8) 22.7) 24.5) 24.1) 23.9) 23.5) 23.7) 21.4) 0.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 171 154. Other skin disorders 50 40 > , o S 3 @ Q 2 © 0) 2 :F i Oo R04 a 10 Black #White 0 ] 1 ] ] 1 ] “d | 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 46.6 42.9 34.5 36.8 28.2 25.3 20.8 16.8 -13.3 37.1, (34.9, (27.7, (28.6, (21.6, (19.0, (15.7, (12.5, (-15.3, 56.1) 50.9) 41.3) 45.0) 34.7) 31.6) 25.9) 21.0) ~11.3) White 48.3 43.0 36.1 34.6 26.0 19.9 16.1 13.7 -17.2 (43.0, (39.3, (32.5, (29.1, (224, (15.6, (1.4, (95, (-19.1, 53.6) 46.8) 39.6) 40.1) 30.0) 24.2) 21.0) 18.0) -15.2) Nete: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Provider Studies. Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of 172 155. Auto-immune and connective tissue disease 50 40 . o oO oS o 2 @ a 8 g Q °o x 20 Oo Oo 0 nu ®- Black #White 0 1 1 1 | l 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 36.7 36.4 40.4 37.1 28.5 24.6 27.2 23.5 783 (27.6, (29.2, (32.8, (30.1, (23.0, (19.3, (20.5, (16.7, (-10.3, 45.8) 43.6) 48.1) 44.1) 34.1) 29.9) 33.9) 30.2) -4.1) White 13.4 12.8 13.6 14.6 12.9 114 9.2 8.9 -6.1 (12.0, (114, (12.1, (13.0, (11.3, (9.6, 8.1, (7.6, (-9.2, 14.9) 14.3) 15.0) 16.2) 14.5) 12.6) 10.4) 10.1) -2.9) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 173 156. Acquired foot deformities 50 40 H- « oO © o @ Q e g 0) E Oo 2 0 10 Black #White 0 ] 1 1 ] ] 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 38.1 27.8 28.8 30.1 29.4 18.9 18.2 16.4 -10.5 (27.5, (20.3, (20.7, (21.2, (22.1, (13.5, (13.3, (11.8, (-14.1, 48.6) 35.2) 36.9) 39.0) 36.7) 24.2) 23.1) 20.9) -8.7) White 39.5 42.2 43.9 42.7 43.1 34.9 27.5 22.4 -7.8 (35.0, (37.9, (39.2, (38.3, (38.1, (30.8, (24.3, (19.0, (-122, 43.9) 46.6) 48.6) 47.1) 48.1) 39.0) 30.7) 25.8) -3.1) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 174 157. Infective arthritis and osteomyelitis 35 30 o 2 » o oO SS a o g > 15 © ci Oo L 0 10 5 ®-Black White 0 ] 1 1 1 1 1 ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1982 1983 1984 1985 1986 1987 EAPC Black 18.3 20.2 22.3 26.4 29.9 24.3 6.0 (14.7, (14.2, {15.0, (17.4, (19.8, (20.4, (23.3, {17.5, (3.1, 24.3) 22.3) 25.5) 27.1) 30.4) 32.3) 36.5) 31.2) 9.1) White 17.2 19.7 20.1 19.9 4.4 (13.6, (14.6, (15.5, (15.8, (17.4, (17.9, (18.3, (18.0, (3.4, 16.4) 17.6) 18.7) 18.7) 20.9) 21.5) 21.9) 21.9) 5.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national ‘estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 175 120 100 80 60 Discharge rate per 100,000 40 20 158. Other joint disorders (not trauma) a tens ® Black ## White 1 1 1 1 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 86.7 78.7 64.0 59.9 48.0 37.0 326 202 -152 (722, (659, (519, (502, (404, (298, (252, (225, (-166, 101.2) 91.6) 76.2) 69.5) 55.9) 44.2) 40.0) 36.0) -13.9) White 106.1 103.2 94.3 87.8 75.2 61.2 52.9 47.4 “1.7 (982, (959, (870, (81.0, (68.8, (548, (463, (405, (-134, 114.1) 1106) 101.7) 94.6) 81.7) 67.6) 59.5) 54.4) -9.9) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 176 Discharge rate per 100,000 159. Rheumatoid arthritis and related conditions 35 30 oni ® 25 ” A 15 10 ®-Black #White 0 1 I 1 1 1 I I 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 24.4 17.9 19.5 22.2 142 14.3 13.1 104 10.1 (189, (134, (138, (176, (108, (108, (9.1, 73 (137, 29.9) 22.5) 25.2) 26.9) 17.6) 17.9) 17.1) 13.6) -6.3) White 31.0 28.9 29.6 27.8 24.7 20.8 17.5 15.3 9.8 (26.2, (24.4, (25.4, (237, (207, (17.2, (140, (11.3, (-122, 35.9) 33.4) 33.8) 31.9) 28.7) 24.4) 21.0) 19.2) 7.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 177 160. Osteoarthritis 80 60 o o Q oO 2 @ Q fo) © 40 [) © © i Oo 2 Oo 20 ®-Black #White 0 1 ] l 1 l L | l 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 42.3 49.3 49.2 48.0 43.0 32.7 35.9 375 -4.4 (33.7, (40.0, (40.5, (87.9, (35.7, (25.4, (28.1, (29.6, (-7.8, 50.9) 58.7) 57.9) 58.1) 50.3) 40.1) 43.6) 45.3) -0.9) White 65.3 68.9 78.2 76.0 73.2 69.3 73.8 72.0 0.9 (59.1, (62.8, (69.2, (69.8, (66.9, (62.6, (65.3, (64.0, (-0.6, 71.5) 75.0) 81.2) 82.1) 79.4) 76.0) 82.3) 79.9) 2.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 178 161. Spondylosis, intervertebral disc disorders, cervical disorders, other back pain 350 300 250 200 te "—. 150 Discharge rate per 100,000 100 50 ®-Black Hl White 0 ] ] 1 1 ] ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 214.6 2122 204.1 211.1 204.8 181.6 173.0 131.7 5.6 (172.8, (171.6, (170.4, (1782, (172.5, (151.2, (141.9, (106.8, (-8.3, 256.3) 252.8) 237.7) 244.0) 237.0) 211.9) 2042) 156.6) 2.8) White 324.1 3240 3303 3329 3359 304.3 287.9 252.8 -3.0 (297.4, (299.3, (305.1, (309.0, (311.5, (280.2, (261.7, (228.2, (-5.0, 350.9) 3487) 3555) 356.8) 360.3) 328.3) 3142) 277.4) -1.0) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 179 162. Osteoporosis and other disorders of bone and cartilage 70 60 50 40 Discharge rate per 100,000 + — 20 10 ®-Black #White 0 ] 1 ] ] ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 31.6 314 208 27.8 30.3 32.8 30.7 27.8 -0.7 (24.4, (25.1, (23.0, (22.1, (24.2, (26.2, (23.8, (20.9, (-2.6, 38.8) 37.6) 36.1) 33.6) 36.4) 39.5) 37.8) 34.6) 1.1) White 55.0 57.1 58.5 55.3 56.7 538 49.7 48.0 2.2 (50.9, (53.3, (54.6, (51.8, {63.1, (49.3, (45.8, (44.1, (-3.8, 59.0) 60.9) 62.4) 58.7) 60.4) 58.5) 53.7) 51.8) -0.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 180 163. Other acquired deformities 12 3 8 ~ oo o ® Q jo} g © VY 0) 2 © ns 3 a 4 2 ®- Black White 0 ] 1 ] 1 1 ] ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 8.5 7.4 53 8.0 53 5.8 45 5.2 -7.0 (5.4, (5.1, (3.4, (5.5, (3.3, (4.0, (2.9, (32, (-115, 11.6) 9.6) 7.2) 10.6) 7.3) 7.6) 6.0) 7.3) ~2.2) White 10.5 10.8 9.9 10.4 2.6 8.7 9.1 8.0 -3.8 (9.0, (9.3, (8.6, (9.0, (8.3, (7.5, (7.8, (6.6, (-5.2, 11.9) 12.3) 11.3) 11.7) 10.9) 9.9) 10.4) 9.4) -2.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 181 Discharge rate per 100,000 164. Other muscle, bone, connective tissue disease 100 40 20 © Black ## White 0 I 1 ] I l I I I 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 62.3 57.6 61.4 56.5 49.3 42.9 42.4 30.7 -8.8 (51.8, (47.8, (51.7, (489, (41.2, (35.3, (33.8, (249, (-11.5, 72.8) 67.4) 71.1) 64.1) 57.4) 50.4) 50.9) 36.5) -6.0) White 83.0 81.4 76.8 72.1 59.1 49.3 39.9 335 “27 (77.0, (759, (715, (669, (540, (440, (345, ~~ (283, (-152 89.0) 86.9) 82.1) 77.3) 64.2) 54.5) 45.3) 38.8) -10.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 182 165. Congenital anomalies 120 100 80 60 40 Discharge rate per 100,000 20 Black # White 0 ] 1 1 1 ] 1 ] ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 79.6 62.5 64.3 57.5 47.3 47.7 41.0 35.3 -10.0 (62.4, (51.8, (51.0, (449, (357, (36.4, (30.9, (27.4, (-11.6, 96.9) 73.2) 77.7) 70.0) 59.0) 59.1) 51.2) 432) -8.4) White 111.4 106.2 94.1 88.9 79.0 69.9 66.3 62.4 -8.5 (97.3, (93.7, ®1.1, (77.7, (68.1, (59.6, (55.8, (52.0, (8.1, 1255) 118.7) 107.1) 100.0) 89.8) 80.2) 76.9) 72.9) -7.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 183 166. Perinatal conditions 60 50 a _ 8 40 cS o ae @ oN JO) © 30 [) PD © <= 3 a 20 10 ® Black #White 0 1 1 1 ] L 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 50.4 42.9 44.2 41.0 44.3 44.4 49.3 51.6 14 (34.5, (32.3, (29.6, (32.1, (34.1, (327, (36.0, (37.8, 14, 66.3) 53.6) 58.7) 49.8) 54.5) 56.2) 62.7) 65.5) 3.8) White 41.3 41.0 42.9 45.4 44.5 52.7 50.1 50.5 3.7 (34.6, (34.5, (36.5, (38.3, (37.8, (44.7, (42.5, (42.9, (2.3, 48.0) 47 4) 49.4) 52.5) 51.2) 60.8) 57.7) 58.2) 5.1) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 184 Discharge rate per 100,000 160 140 | ea 120 100 167. Joint disorders, trauma related 80 60 40 - 20 0 1 1 1 1 1 1 1 1 ®-Black White 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 77.8 79.9 772 787 66.1 46.4 38.3 31.1 -13.0 (65.3, (67.9, (66.8, (60.2, (53.4, (382, (30.9, (236, (-16.9, 90.3) 92.0) 87.7) 87.1) 79.0) 54.7) 45.8) 38.5) -9.0) White 142.5 145.0 134.6 27.4 104.3 81.7 64.2 54.8 -13.8 (1289, (1330, (1222, (1152, (939, (71.4, (54.0, (45.4, (-16.9, 156.1) 157.0) 147.0) 139.1) 114.7) 91.9) 74.4) 64.2) -10.6) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 185 168. Fracture of neck of femur (hip) 100 80 60 45 AT Discharge rate per 100,000 20 @-Black #White 0 ] 1 ] 1 ] 1 1 1 1980 1981 1982 1983 1 984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 32.0 30.7 41.1 35.6 42.0 37.8 375 39.3 2.8 (24.9, (24.2, (33.5, (27.8, (34.3, (30.3, (30.0, (30.1, (-0.1, 39.2) 37.2) 48.6) 43.4) 49.6) 45.3) 44.9) 48.6) 5.9) White 88.9 89.5 86.9 89.9 93.3 94.7 90.6 85.2 0.1 (82.3, (84.1, (81.6, (84.6, (87.5, (88.6, (84.6, (79.6, 1.4, 95.6) 94.8) 92.2) 95.2) 99.2) 100.8) 96.6) 90.7) 1.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 186 Discharge rate per 100,000 169. Spinal cord injury, including fracture @®-Black # White 1 ] 1 ] 1 ] ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 6.1 4.1 41 46 43 25 47 6.2 0.9 (4.0, (2.3, (2.4, (2.7, (2.7, 0.2. (2.9, (3.4, (-9.7, 8.3) 5.8) 5.8) 6.4) 6.0) 3.7) 6.5) 8.9) 8.7) White 5.1 4.7 4.8 4.5 4.4 4.2 49 4.8 -0.9 (4.2, (3.7, (4.1, (3.8, 32, {3.3 (3.9, 37, (-2.7, 6.1) 5.6) 5.6) 5.3) 5.7) 5.1) 5.8) 5.8) 1.0) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 187 Discharge rate per 100,000 400 300 200 100 170. Other fractures, not hip ®- Black White 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 267.1 265.1 25502 2304 2422 0256 ~~ 2323 230.7 24 2182, (2190, (2125, (193.1, (2045, (187.3, (182.9 (184.5, (-3.4, 3160) 3112) 2980) 267.7) 2799) 2639) 2817) 277.0) -1.3) White 385.1 3746 357.5 3546 3412 322.1 296.1 279.5 4.4 (360.8, (3527, (337.6, (336.4, (3222, (3022, (277.6, (2632, (-5.2, 4094) 3966) 377.3) 3737) 3602) 3421) 3146) 295.9) -3.6) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 188 171. Sprains and strains 160 140 120 i QO oS o gS 100 © I 92 80 © © Su io S 5 60 0 a No 40 20 @- Black ## White 0 1 I 1 1 1 ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 124.5 118.9 121 104.2 107.8 87.6 715 51.3 -10.7 (1036, (916, (87.6, (854, (84.8, (69.9, (59.2, (40.8, (14.2, 1455) 146.2) 1365) 123.0) 130.9) 105.2) 83.8) 61.7) -6.9) White 137.2 127.6 1238 122.7 113.8 99.6 83.4 72.4 -8.4 (125.1, (117.2, (1150, (1140, (1053, (91.6, (75.4, (64.1, (-10.5, 149.3) 138.1) 1327) 131.3) 1223) 107.7) 91.4) 80.7) -6.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 189 Discharge rate per 100,000 172. Intracranial injury (not fracture) 120 100 60 40 20 -®- Black # White 0 1 | l ! 1 ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 87.7 87.4 85.9 853 88.9 75.5 81.9 71.8 -24 (66.0, (59.0, (60.0, (64.2, (68.3, (56.3, (63.9, (53.6, (-4.0, 109.5) 115.9) 111.9) 106.5) 109.5) 94.8) 99.9) 90.0) -0.9) White 113.4 107.5 100.4 96.9 94.5 90.8 86.1 77.3 -4.8 (104.9, (99.4, (93.0, (89.3, (87.2, (82.9, (78.2, (69.9, (-5.5, 121.9) 115.5) 107.8) 104.6) 101.8) 98.7) 94.1) 84.7) -4.1) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 190 173. Internal injury to viscera or vessels, crushing injury 70 60 50 40 Discharge rate per 100,000 20 10 ®-Black # White 0 1 1 l 1 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 43.3 44.3 40.2 40.9 45.0 49.1 56.0 59.0 4.9 (31.5, (33.8, (30.1, (29.5, (34.3, (37.2, (40.8, (41.5, 23, 55.0) 54.8) 50.3) 52.4) 55.7) 60.9) 71.4) 76.4) 7.6) White 31.6 32.0 28.4 28.5 31.0 31.8 32.8 33.4 1.3 (28.9, (29.3, (26.0, (26.2, (28.2, (29.0, (29.9, (30.1, (-0.6, 34.3) 34.8) 30.8) 30.8) 33.8) 34.6) 35.8) 36.7) 2.9) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 191 174. Open wounds 250 200 Wom o S oS S SA ——e © 150 @ ~~ 8. 2 g [o) 2 3 100 Oo LD Oo 50 -@-Black White 0 1 1 ] ] 1 1 ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 203.3 195.5 194.0 185.2 153.8 137.6 155.4 152.3 -5.1 (153.3, (153.3, (153.4, (1480, (123.0, (1085, (113.0, (104.0, {-73, 2533) 237.7) 2346) 2223) 1847) 166.7) 197.8) 200.6) -2.8) White 114.9 108.8 101.9 97.5 87.0 78.5 745 68.8 -7.3 (107.6, (101.2, (94.9, (90.5, (80.7, (72.5, (68.8, (62.1, (-7.9, 122.1) 116.4) 108.9) 104.4) 93.2) 84.6) 80.2) 75.4) -6.7) Note: estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 192 175. Complication of device or procedure 200 150 B= o o QS oO > @ £2 Q L 100 (0) E © £ Oo 2 0o 50 ®-Black White 0 1 ] ] 1 ] ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 99.9 113.4 117.4 144.0 145.0 157.6 183.0 181.7 9.3 (81.0, (94.2, (95.8, (119.5, (119.0, (126.6, (142.3, (146.1, (7.8, 118.7) 132.7) 139.0) 168.5) 171.0) 188.5) 223.7) 217.3) 10.8) White 122.5 125.5 130.7 140.5 146.7 146.0 162.8 171.4 49 (112.8, (116.1, (121.1, (1307, (1362, (1346, (150.3, (157.6, (4.2, 132.3) 135.0) 140.4) 150.3) 157.2) 157.5) 175.4) 185.2) 5.7) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 193 176. Superficial injury, contusion 100 80 oO | oO > a 2 60 o 0M Q © o o S 40 Q 0 0 20 ® Black White 0 1 ] 1 1 I 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 65.6 62.7 57.8 48.6 46.0 39.0 40.2 29.6 =10.2 (50.3, (45.4, 418, (385, (37.0, (30.4, (309, (232, (-120, 80.9) 79.9) 73.8) 58.7) 55.0) 47.5) 49.4) 36.0) -8.4) White 79.3 725 67.3 58.7 50.8 43.1 38.0 35.5 -11.6 (74.0, 67.1, (629, (55.2, (47.3, (39.9, (349, (321, (-125, 84.5) 77.8) 71.6) 62.2) 54.3) 46.4) 41.0) 39.0) -10.6) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 194 177. Burns 60 40 30 Discharge rate per 100,000 20 py — 10 ®-Black #8 White 0 1 ] ] 1 l I 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 47.3 49.2 45.0 43.8 432 37.7 34.6 33.2 55 (338, (36.0, (340, (339, (325, (288, (259, (231, (-6.8, 60.8) 62.4) 56.0) 53.6) 54.0) 46.7) 43.3) 43.3) 4.2) White 28.7 28.0 25.6 23.8 23.1 21.7 19.1 18.9 6.2 (256, (243, (226, (210, (20.4, (18.7, (16.1, (152, (-6.9, 31.8) 31.7) 28.5) 26.5) 25.8) 24.8) 22.1) 22.7) 5.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 195 178. Poisoning 120 100 S S 80 =] 2 @ c. QQ © 60 E © = 3 a 40 20 ® Black # White 0 1 ] 1 I I 1 ] ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 101.0 98.4 96.5 99.7 97.8 92.0 101.9 97.0 £03 (76.4, (76.8, (742, (77.38, (77.8, (745, (816, (77.4, +13, 1257) 119.9) 118.8) 1217) 117.7) 1096) 1222) 116.6) 0.7) White 98.3 101.9 96.5 93.6 88.9 91.5 85.4 83.6 2.6 (91.5, (92.9, (88.9, (86.4, (832, (85.1, (79.9, (77.9, (33, 105.1) 110.9) 104.2) 100.9) 94.5) 98.0) 90.9) 89.3) -1.9) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 196 Discharge rate per 100,000 80 60 40 20 179. Other external injury ® Black # White ] 1 1 1 I ] 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 71.4 72.3 66.5 70.4 72.8 66.0 68.1 62.8 1.4 (59.7, (60.0, (53.4, (58.5, (60.0, (53.7, (55.0, (48.9, (-2.6, 83.1) 84.7) 79.7) 82.3) 85.7) 78.3) 81.2) 76.7) 0.2) White 63.2 62.9 63.2 64.1 61.2 58.3 53.5 478 -3.6 (58.7, (58.1, (59.1, (59.8, (56.8, (54.1, (49.4, (43.7, (-5.2, 67.7) 67.6) 67.2) 68.4) 65.7) 62.6) 57.6) 52.0) -1.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 197 180. Indications for plastic surgery 100 80 o SS < QS 2 60 @ Q 2 $ 0) 2 S 40 Oo 0 0 -®-Black # White 0 1 1 ] 1 1 ] l 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 275 25.4 249 24.2 232 19.1 17.2 12.0 -9.8 (20.8, (18.1, (16.8, (18.3, (17.5, (14.7, (12.7, (9.1, (-13., 34.3) 32.7) 33.0) 30.0) 29.0) 23.5) 21.6) 14.9) -6.4) White 81.2 80.4 77.6 74.7 72.1 59.3 45.9 41.7 -9.4 (69.6, (70.1, (67.2, (65.7, (63.0, (52.4, (39.6, (34.5, (-124, 92.8) 90.7) 87.9) 83.8) 81.3) 66.2) 52.2) 48.9) -6.4) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 198 181. Allergic reactions 16 14 12 10 Discharge rate per 100,000 o ®- Black # White 0 1 I ] I 1 I 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 10.4 10.3 8.8 9.3 1.4 105 10.0 6.7 -3.0 6.9, (7.3, (6.2, (6.6, (7.9, (7.5, (6.6, 4.2, 74, 14.0) 13.3) 11.4) 12.0) 14.2) 13.5) 13.3) 9.3) 1.6) White 13.7 137 12.8 12.3 1.4 9.0 7.8 63 -105 (122, (122, (11.4, (109, (10.1, (7.8, (6.8, (5.4, (-13.2, 15.3) 15.2) 14.2) 13.6) 12.7) 10.1) 8.9) 7.2) -7.8) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 199 182. Rehabilitation care and fitting of prostheses 35 30 2 rf / 15 Discharge rate per 100,000 A / @- Black White 0 I I 1 I I ] I 1 1080 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 45 8.6 8.6 6.8 8.8 9.1 19.4 25.0 21.7 (2.8, (5.8, (4.7, (3.6, (5.0, (5.1, iz, (14.8, (11.5, 6.2) 11.5) 12.6) 10.1) 12.6) 13.1) 27.6) 35.2) 32.9) White 7.8 8.3 6.8 10.4 10.8 228 29.0 31.4 26.4 (5.9, (6.2, (5.0, {72 (7.5, (15.5, (21.2, (23.2, (16.9, 9.7) 10.4) 8.6) 13.7) 14.0) 30.0) 36.8) 39.6) 36.6) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 200 183. Administrative/social admission 40 ®-Black #White 30 SS o Q o S - 1 [o) eS. 0} ® 20 0) 2 © = oO 0 0 10 0 ] 1 1 ] ] 1 ] 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 36.9 27.4 271 11.9 110 11.0 37 3.2 -29.9 (22.4, (17.6, (id, (7.4, (5.9, (5.8, (1.9, (1.6, (-354, 51.4) 36.7) 43.0) 16.3) 16.0) 16.2) 5.4) 4.8) -24.0) White 17.9 13.9 10.1 6.8 4.0 29 2.6 2.0 -28.1 (12.3, (9.6, (7.4, (5.5, (2.8, (2.1, (1.9, (12, (-30., 23.5) 18.2) 12.8) 8.0) 5.1) 3.7) 3.3) 29) -25.3) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 201 Discharge rate per 100,000 184. Medical examination, evaluation 20 15 10 5 -®-Black #&White 0 I I 1 | l I 1 ] 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 9.0 1.4 9.9 9.2 10.1 10.9 18.2 14.1 7.2 (5.9, 8.1, (6.8, 4.8, (5.3, 4.8, (7.5, 6.2, (15, 12.2) 14.7) 13.0) 13.7) 14.8) 17.0) 29.0) 22.1) 13.3) White 12.4 1.9 13.8 125 9.8 1.2 13.1 11.4 “1.1 (10.3, 9.8, (10.9, (9.6, (7.2, 8.6, (9.5, (7.9, (-4.4, 14.5) 13.9) 16.7) 15.4) 12.4) 13.9) 16.7) 14.8) 2.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 202 185. Other aftercare 35 30 2s | ~g— lo} o Q oe! o i 20 Q 2 S Q @ a = OQ £2 0 10 5 ®- Black ##White 0 1 ] ] ] ] 1 1 1 1980 1981 1982 1983 1984 1985 1986 1987 Discharge rate per 100,000, estimated annual percent change (EAPC), and confidence interval in parentheses Race 1980 1981 1982 1983 1984 1985 1986 1987 EAPC Black 133 15.7 13.2 122 12.2 15.2 15.5 15.2 1.6 (9.4, (11.4, (9.6, (8.4, (9.0, (8.7, (10.1, (10.3, 3.7, 17.2) 20.0) 16.8) 16.1) 15.3) 21.7) 21.0) 20.1) 4.9) White 25.8 27.0 29.6 27.3 26.3 24.1 24.6 23.9 -1.9 (21.2, (22.7, (23.2, (22.6, (20.4, (16.8, (18.3, 74, (-3.6, 30.4) 31.2) 36.0) 32.0) 32.1) 31.5) 30.9) 30.7) 0.2) Note: Based on 20 percent of discharges from the Hospital Cost and Utilization Project, 1980-87, weighted to obtain national estimates, and age- and sex-adjusted to the 1970 resident U.S. population. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 203 Appendix A Summary diagnosis categories and ICD-9-CM codes Category number Diagnosis category ICD-9-CM codes’ Infectious and Parasitic Diseases 1. Tuberculosis 010-018, 137, 795.5, V01.1, V03.2, V71.2, V74.1 2. Septicemia 038 3. Other bacterial infections 020-037, 040-041, 790.7, V02.4-V02.5, V03.3-V03.9, V74.2-V74.4,V74.6,V74.8-V74.9 4. Mycoses and actinomycoses 039, 110-118, V75.4 B. HIV (human immunodeficiency virus) infection 042-044, 279.10, 279.19, 795.8 8. Viral infections 050-079, 138, 139.1-139.8, 790.8, V01.2-V01.5, V01.7, V02.6, V04, V05.1, V73 7. Other infections, including parasitic 080-088, 100-104, 120-134, 136, 795.3, V01.8-V01.9, V05.2, V06.1-V06.9, V07.0, V07.3-V07.9, V12.0, V75.0-V75.3, V75.5-V75.9 8. Sexually transmitted infections (not HIV or hepatitis) 090-099, 795.6, V01.6, V02.7-V02.8, V74.5 9. Fever of unknown origin 780.6 Neoplasms and Carcinoma in Situ 10. Cancer of head and neck 140-149, 195.0 11. Cancer of stomach and esophagus 150-151, V10.04 12. Cancer of colon-rectum 153-154, V10.05, V10.06, V76.41 13. Hepatobiliary cancer 155-156, V10.07 14. Cancer of pancreas 157 15. Cancer of other gastrointestinal organs, peritoneum 152, 158-159, V10.00-V10.03, V10.09, V76.42 16. Cancer of bronchus, lung, trachea, larynx 161, 162 17. Cancer, other respiratory and intrathoracic 160, 163, 165, V10.1, V10.2, V76.0 18. Melanoma 172,V10.82 19. Other cancer of skin (not melanoma) 173,V10.83,V76.43 20. Cancer of breast 174-175, 793.8, V10.3, V52.4, V76.1 21. Cancer of uterus 179, 182,V10.42 22. Cancer of cervix 180, 795.0, V76.2, V10.41 23. Cancer of ovary 183.0, V10.43 24. Cancer of other female genital organs 181, 183.2-183.9, 184, V10.40, V10.44 25. Cancer of prostate 185, V10.46 26. Cancer of other male genital organs 186-187, V10.45, V10.47-V10.49 27. Cancer of bladder 188, V10.51,V76.3 28. Cancer of kidney 189.0-189.1, V10.52 29. Cancer of other urinary organs 189.2-189.9, V10.50, V10.59 30. Cancer of brain and nervous system 191-192,V10.85 31. Cancer of thyroid 193, V10.87 32. Hodgkin's disease 201,V10.72 33. Non-Hodgkin's lymphoma 202,V10.79 34. Lymphosarcoma and reticulosarcoma 200, V10.71 35. Leukemia 203.1, 204-208, V10.6 36. Multiple myeloma 203.0 37. Cancer, other primary 164, 170-171, 190, 194, 195.1-195.9, 203.8, 795.1, V10.81, V10.84, V10.86, V10.88-V10.99, V76.49, V76.8-V76.9 38. Secondary malignancies 196-198 39. Neoplasms of unspecified site or uncertain behavior 199, 235-239 40. Maintenance chemotherapy, radiotherapy V58.0-V58.1, V66.1-V66.2, V67.1-V67.2 41. Benign neoplasm, uterus 218-219 42. Other benign neoplasms 210-217, 220-229, V71.1 43. Carcinoma in situ, cervix 233.1 44. Other carcinoma in situ 230-233.0, 233.2-234 See note at end of table. Source: AHCPR, Division of Provider Studies. 205 Appendix A—Continued Summary diagnosis categories and ICD-9-CM codes Category : number Diagnosis category ICD-9-CM codes’ Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders 45, Thyroid disorders 240-246, 794.5, V77.0 46. Diabetes mellitus 250, 251.0, 790.2, 791.5-791.6, V77.1 47. Other endocrine disorders 251.1-259, 794.6 48. Nutritional deficiencies 260-269, 799.4, V12.1, V77.2 49. Fluid and electrolyte disorders 276 50. Other metabolic and immunity disorders 270-275, 277, 278.1-279.0, 279.11-279.13, 279.2-279.9, 783.1-783.5, 783.7-783.9, 794.7, 795.7, V07.2,V12.2, V77.3-V77.9 Diseases of the Blood and Blood-Forming Organs 51. Anemias 280-285, V78.0-V78.2 52. Coagulation and hemorrhagic disorders 286, 287, V78.3 53. Diseases of white blood cells 288 54. Other hematologic conditions 289, 785.6, 790.0, V12.3, V58.2, V78.8-V78.9 Mental Disorders 55, Organic disorders and dementias 290.0, 290.2-290.9, 293-294, 310, 331.1-331.2, 797 56. Presenile dementia, including Alzheimer's 290.1, 331.0 57. Alcohol-related disorders 291, 303, 305.0, 571.0-571.3, 790.3, V11.3, V79.1 58. Drug disorders, not alcohol related 292, 304, 305.1-305.9 59. Schizophrenic disorders 295, V1i1.0 60. Other psychoses 297, 298.1-298.9, 299 61. Depression and affective disorders 296, 298.0, 300.4, 301.12, 309.0-309.1, 311, V79.0 62. Anxiety and personality disorders 300.0-300.3, 300.5-300.9, 301.0, 301.10-301.11, 301.13-301.19, 301.2-301.9, 307.40-307.49, 307.8, 308, 309.81, 312.3, 316, V11.1, Vi1.2 63. Eating disorders and obesity 307.1, 307.5, 783.0, 783.6, 278.0 64. Adjustment reaction 309.2-309.7, 309.82-309.9 65. Developmental disorders 315, 317-319, V79.2-V79.3 66. Other mental disorders (not psychoses) 302, 306, 307.0, 307.2-307.3, 307.6-307.7, 307.9, 312.0-312.2, 312.4-312.9, 313, 314, 780.1, 780.5, 799.2, V11.8-V11.9, V15.4, V40, V66.3, V67.3, V70.1-V70.2, V71.0, V79.8-V79.9 Diseases of the Nervous System and Sense Organs 67. Central nervous system infection 045-049, 139.0, 320-323, V05.0 68. Other inflammatory diseases of the central nervous system 324-326, 781.6 69. Parkinson’s disease 332 70. Multiple sclerosis 340 71. Other hereditary and degenerative } central nervous system diseases 330, 331.3-331.9, 333-337 72. Paralysis 342-344, 781.4 73. Epilepsy, convulsions 345, 780.3 74. Headache, including migraine 346, 784.0 75, Cataract 366 76. Other eye disorders 360-365, 367-379, V41.0-V41.1, V42.5, V43.0-V43.1, V45.6, V52.2, V53.1, V72.0, : Vv80.1-V80.2 77. Otitis media and related conditions 381-383, 384.2-384.9, 385.0-385.2, 387 See note at end of table. Source: AHCPR, Division of Provider Studies. 206 Appendix A—Continued Summary diagnosis categories and ICD-9-CM codes Category number Diagnosis category ICD-9-CM codes’ Diseases of the Nervous System and Sense Organs—con. 78. Conditions associated with dizziness or vertigo 386, 780.4 79. Other ear and sense organ disorders 380, 384.0-384.1, 385.3-385.9, 388-389, V41.2-V41.3, V41.5, V563.2, V72.1, V80.3 80. Other nervous system disorders 341, 347-359, 780.0, 781.0-781.3, 781.7, 782.0, 784.3, 784.5-784.6, 792.0, 793.0, 794.0-794.1, 796.1, V12.4, V45.2, V48.4-V48.5, V49.3, V53.0, Vv80.0 Disorders of the Circulatory System 81. Acute and chronic rheumatic disease 390-398 82. Hypertension 401-405, 796.2, v81.1 83. Acute myocardial infarction 410 84. Ischemic heart disease 411-414, 786.50-786.51, 786.59, V45.81, V81.0 85. Diseases of pulmonary circulation 415-417 86. Other and ill-defined heart disease 420-423, 425, 429 87. Heart valve disorders 424, 785.2-785.3, V42.2, V43.3 88. Conduction disorders, dysrhythmias 426-427, 785.0-785.1, V45.0, V53.3 89. Congestive heart failure 428 90. Cerebrovascular disease 430-438 91. Atherosclerosis (not heart or brain) 440, 443.9, 557 92. Aneurysm and disorders of arteries 441-442, 447 93. Peripheral arterial embolism 444 94. Other circulatory disease 443.0-443.8, 448, 785.4-785.5, 785.9, 793.2, 794.3, 796.3, V12.5, V15.1, V42.1, V43.2, V43.4, V47 2, V71.7,V81.2 95. Syncope 780.2 96. Thrombophlebitis and thromboembolism 451, 453 97. Varicose veins of lower extremity 454 98. Hemorrhoids 455 99. Other diseases of veins and lymphatics 452, 456.1, 456.21, 456.3-459 Diseases of the Respiratory System 100. Pneumonia and influenza 480-487 101. Other respiratory infections (not tuberculosis) 460-466, 472-476, 510, 511.1, 513 102. Chronic obstructive pulmonary disease and allied conditions 490-492, 494, 496, 781.5, V81.3 103. Asthma 493 104. Aspiration pneumonitis, food/vomitus 507.0 105. Pleurisy, pneumothorax, pulmonary collapse 511.0, 511.8-511.9, 512, 518.0-518.2, 786.52 106. Respiratory failure/insufficiency (adult) 518.5, 518.81-518.82, 799.1, V46.1 107. Other lower respiratory diseases 495, 500-506, 507.1-508, 514-517, 518.3-518.4, 518.89, 519.4-519.9, 782.5, 786.0, 786.2-786.4, 786.6-786.9, 793.1, 794.2, V12.6, V42.6, V81.4 108. Other upper respiratory diseases 471, 477-478, 519.0-519.3, 784.1, 784.4, 784.7-784.9, 786.1, V41.4, V44.0, V55.0 Diseases of the Digestive System 109. Intestinal infections 001-009, V01.0, V02.0-V02.3, V03.0-V03.1, V06.0, V74.0 110. Disorders of teeth and jaw 520-526, V52.3, V53.4, V58.5, V72.2 i. Diseases of mouth, excluding dental 527-529, 792.4 112. Esophageal disorders 530 113. Gastric ulcer 531 114. Duodenal ulcer 532 See note at end of table. Source: AHCPR, Division of Provider Studies. 207 Appendix A—Continued Summary diagnosis categories and ICD-9-CM codes Category number Diagnosis category ICD-9-CM codes’ Diseases of the Digestive System—con. 115. Other peptic ulcer 533-534 116. Gastritis, upper gastrointestinal obstruction, nausea 535-537, 787.0 17. Appendicitis 540-543 118. Inguinal hernia 550 119. Other abdominal hernia 551-553 120. Noninfectious enteritis and colitis 555-556, 558, 564.1, 564.5 12%. Intestinal obstruction without hernia 560, 564.7 122. Diverticulosis and diverticulitis 562 123. Anal and rectal conditions 564.6, 565-566, 569.0-569.4 124. Peritonitis, intestinal abscess, and other disorders of peritoneum 567-568, 569.5 125. Biliary tract disease 574-576, 793.3 126. Liver disease, not alcohol related 570, 571.4-573, 782.4, 789.1, 789.5, 790.4-790.5, 794.8,V42.7 127. Pancreas disorders (not diabetes) 577.579.4 128. Gastrointestinal hemorrhage 456.0, 456.20, 578 129. Other gastrointestinal disorders 564.0, 564.2-564.4, 564.8-564.9, 569.6-569.9, 579.0-579.3, 579.5-579.9, 787.1-787.9, 789.2-789.4, 789.9, 792.1, 793.4, 793.6, V12.7, V44.1-V44.4,V45.3,V47.3, V53.5, V55.1-V55.4 130. Abdominal pain 789.0 Diseases of the Genitourinary System 131. Nephritis, nephrosis 580-583, 587-588 132. Acute and unspecified renal failure 584, 586 133. Chronic renal failure 585, V42.0, V45.1, V56 134. Urinary tract infection 590, 595, 597, 598.0, 599.0, 788.1 135. Calculus of urinary tract 592, 594, 788.0 1386. Other genitourinary disorders 589, 591, 593, 596, 598.1-598.9, 599.1-599.9, 788.2-788.9, 791.0-791.4, 791.7-791.9, 793.5, 794.4,V13.0, V41.7,V43.5,V44.5-V44 6, V47.4-V47.5,V53.6, V55.5-V55.6, V81.6 137. Hyperplasia of prostate 600 138. Other male genital disorders 601-608, 792.2 139. Nonmalignant breast conditions 610-611.0, 611.2-611.3, 611.5-611.9 140. Inflammation of female pelvic organs 614-616 141. Endometriosis 617 142. Prolapse of female genital organs 618 143. Menstrual disorders and ovarian cyst 620.0-620.2, 625.3, 626 144. Menopausal disorders 627 145. Infertility 628 146. Other female genital disorders 619, 620.3-620.9, 621-624, 625.0-625.2, 625.4-625.9, 629, V13.2, V15.7, V25-26, V45.5, V55.7,V72.3 Complications of Pregnancy, Childbirth, and the Puerperium 147. Pregnancy with abortive outcome 630-639, V13.1 148. Complications during pregnancy 640-649, 760-761, 771.0-771.2, 775.0-775.3, 792.3, V23, Vas, V72.4 149. Complications of birth, puerperium 652-676, 762-763, 767-768 150. Normal delivery/liveborn 650-651, V22, V24, V27,V30-V37, V39 See note at end of table. Source: AHCPR, Division of Provider Studies. 208 Appendix A—Continued Summary diagnosis categories and ICD-9-CM codes Category number Diagnosis category ICD-9-CM codes’ Diseases of the Skin and Subcutaneous Tissue 151. Skin and subcutaneous infections 680-686 152. Other inflammatory conditions of skin 690, 694-695.3, 695.5-698 153. Chronic ulcer of skin 707 154. Other skin disorders 701.1-706, 709, 780.8, 782.1-782.3, 782.6-782.9, V13.3, V42.3, V82.0 Diseases of the Musculoskeletal System and Connective Tissue 155. Auto-immune and connective tissue disease 135, 446, 695.4, 701.0, 710.0, 720 156. Acquired foot deformities 700, 727.1, 734-735, 736.7 157. Infective arthritis and osteomyelitis 711, 730 158. Other joint disorders (not trauma) 712-713, 716.0, 716.2-716.9, 718.1-718.2, 718.5-718.9, 719.1-719.9, 726, 727.2-727.9 159. Rheumatoid arthritis and related conditions 714,V82.1-V82.2 160. Osteoarthritis 715, V13.4 161. Spondylosis, intervertebral disc disorders, cervical disorders, other back pain 721-724 162. Osteoporosis and other disorders of bone and cartilage 733 163. Other acquired deformities 736.0-736.6, 736.8-736.9, 737.0-737.2, 737.33-737.4, 737.8-737.9, 738.1-738.9 164. Other muscle, bone, connective tissue disease 710.1-710.9, 725, 727.0, 728-729, 731-732, 737.30-737.32, 739, 781.9, 793.7, V13.5, V42.4, V43.6-V43.7, V45.4, V48.1-V48.3, V48.6-V48.7, V49.0-V49.2, V49.4-V49.5, V53.7 Congenital Anomalies 165. Congenital anomalies 740-759, V13.6, V82.3-V82.4, 795.2 Certain Conditions Originating in the Perinatal Period 166. Perinatal conditions 764-766, 769-770, 771.3-771.9, 772-774, 775.4-775.9, 776-779, V13.7 Injury and Poisoning 167. Joint disorders, trauma related 716.1, 717,718.0, 718.3, 719.0, 830-839, 905.6 168. Fracture of neck of femur (hip) 820, 905.3 169. Spinal cord injury, including fracture 806, 952, 907.2 170. Other fractures, not hip 800-805, 807-819, 821-829, 905.0-905.2, 905.4-905.5, V66.4, V67.4 171. Sprains and strains 840-848, 905.7 172. Intracranial injury (not fracture) 850-854, 907.0 173. Internal injury to viscera or vessels, crushing injury 860-869, 900-904, 906.4, 908.0-908.4, 925-929 174. Open wounds 870-897, 905.8-905.9, 906.0-906.1 175. Complication of device or procedure 909.3, 996-999, V54.0 176. Superficial injury, contusion 910-919, 906.2-906.3, 920-924 177. Burns 940-949, 906.5-906.9 178. Poisoning 960-989, 909.0-909.1, 796.0, V15.6, V82.5 179. Other external injury 907.1, 907.3-907.9, 908.5-908.9, 909.2, See note at end of table. Source: AHCPR, Division of Provider Studies. 209 909.4-909.9, 930-939, 950-951, 953-959, 990-994, 995.1-995.9, 799.0, V15.5, V71.3-V71.6 Appendix A—Continued Summary diagnosis categories and ICD-9-CM codes Category number Diagnosis category ICD-9-CM codes’ Other and Cross-Cutting Conditions 180. Indications for plastic surgery 470,611.1, 611.4, 738.0, V50, V51 181. Allergic reactions 691-693, 708, 995.0, V07.1, V14,V15.0, V72.7 182. Rehabilitation care and fitting of prostheses 718.4, V52.0-V52.1, V52.5-V52.9, V57 183. Administrative/social admission V20, V60-63, V65, VE8 184. Medical examination, evaluation V70.0, V70.3, V70.5, V70.7-V70.8, V71.8-V71.9, V72.5, 185. Other aftercare V53.9, V54.8-V54.9, V55.8, V58.3-V58.4, V58.8-V58.9, V66.0, V66.5-V66.6, V66.9, V67.0, V67.51,V67.59, V67.6, V67.9 1 Codes reflect valid ICD-9-CM codes as of October 1987. Source: Agency for Health Care Policy and Research, Center for General Health Services Intramural Research, Division of Provider Studies. 210 Appendix B Development of discharge weights for the Hospital Cost and Utilization Project, 1980-87 Introduction To compute national estimates of hospital discharges using data from the Hospital Cost and Utilization Project, 1980-87 (HCUP-2), the number of discharges from each HCUP-2 hospital was multiplied by an appropriate weight that reflects the proportion of the universe represented by the hospital. This appendix summarizes the approach used to develop discharge weights, including the computation of weights, adjustment for reporting gaps, and investigation of and correction for individual hospital and stratum anomalies. The HCUP-2 sample of hospitals was drawn from the universe of short-term, general, non-Federal hospitals in the United States with 30 or more beds. The sample was stratified along several hospital characteristics that are thought to distinguish hospital behavior. Table B-1 summarizes these characteristics and their dimensions. (For specific statistics comparing HCUP-2 with the American Hospital Association [AHA] universe of hospitals, see Coffey and Farley [1988].) The identities of the individual hospitals were unknown to the authors; only information regarding the strata characteristics and number of discharges was required for this analysis. Definition of strata Although 108 unique strata potentially can be defined on the basis of the characteristics shown in Table B-1, not all strata actually existed in the AHA universe. With respect to the HCUP-2 database, some existing AHA strata contained no hospitals throughout the 1980-87 period; other AHA strata contained no hospitals for individual years. The method used in developing weights required that empty strata be eliminated by collapsing categories of the stratifying characteristics. Because the HCUP-2 database underrepresents investor-owned hospitals (because of difficulties in obtaining cooperation from this sector), investor-owned and voluntary hospitals were collapsed into a single category, resulting in only two dimensions of ownership: 211 public and private. In addition, it was decided that hospitals that change their stratum classification from year to year are probably more representative of their new stratum; thus, their weighting factor was altered accordingly and could vary over time. Computation of discharge weights Stratum weights were computed by dividing the number of AHA discharges from the universe of hospitals in each stratum by the number of discharges reported in the AHA survey for HCUP-2 sample hospitals. Note that the discharge weight is based on the number of discharges reported to AHA rather than the number of discharges present in the HCUP database. This approach was used to maintain consistency between the numerator and the denominator. For any hospital that did not provide discharge data to HCUP during a period that AHA data showed the hospital to be in operation, a reporting adjustment was computed to inflate the number of available discharges for purposes of deriving weights. After the reporting adjustment was computed, some hospitals had large unadjusted-to-adjusted differences in discharge weights. A zero weight was assigned to eight hospital-years (eight different hospitals, one year each) that had unadjusted-to-adjusted weight ratios of 12 or greater. For five hospital-years (three hospitals for one year each, one hospital for two years), data are available in HCUP-2 but no corresponding data are available from the AHA database. These hospital-years were given a zero weight because the number of AHA discharges, which is critical to computing the weights, cannot be imputed. In order to identify major discrepancies between the two data sources, the ratio of annual AHA-reported discharges to the number of annual discharges contributed to HCUP-2 on a hospital-by-hospital basis was examined for each year. AHA-to-HCUP ratios fell outside the range of 0.7-1.3 for 55 hospital-years. All hospitals with an AHA-to-HCUP ratio of more than 3.5 were assigned a weight of zero (10 hospital-years, representing four hospitals). When individual hospitals were given a zero weight, the weights of the remaining hospitals in the stratum were readjusted upward to represent better the universe of hospitals. Validity of HCUP discharge weights In order to evaluate the validity of discharge estimates obtained from HCUP data using the newly created discharge weights, weighted estimates of discharges from HCUP were compared with estimates from the National Hospital Discharge Survey (NHDS). Because the largest dropout of hospitals in HCUP occurred during 1987, a comparison for 1987 should provide the most conservative basis for assessing the validity of the weights. Table B-2 summarizes the differences between NHDS and HCUP in sampling and methods. For comparison purposes, both 1987 and 1988 NHDS estimates were employed. The 1987 NHDS estimates were used because they correspond temporally to the 1987 HCUP discharge estimates. NHDS estimates for 1988 were also used because the methodology for NHDS was changed in that year in an attempt to provide more representative estimates of national discharges." NHDS estimates are provided for the top 85 diagnosis categories, based on principal diagnosis. NHDS estimates were aggregated into categories using the classification system described in Elixhauser, Andrews, and Fox (1993). Table B-3 describes the total number of U.S. hospital discharges as estimated from all three sources: NHDS for 1987 and 1988, HCUP-2 for 1987. NHDS estimates in this table were derived from National Center for Health Statistics annual summaries in which newborns are reported separately from other hospital discharges (Graves, 1989a, 1991a). Ratios of NHDS to HCUP discharges are provided as an indication of how closely HCUP figures approximate NHDS figures. Values close to 1 indicate a high degree of correspondence between the data sources. Table B-4 provides this comparison on a diagnosis-specific basis using data from detailed National Center for Health Statistics publications (Graves, 1989b, 1991b). This table lists the estimated number of discharges for all three data i Despite differences in the methodologies, comparison of the 1987 and 1988 NHDS estimates revealed few statistically significant differences in the number of discharges (Haupt and Kozack, 1992). 212 sources as well as ratios of NHDS discharges to HCUP discharges. Ratios less than 1 indicate that NHDS discharge estimates are lower than HCUP estimates; ratios of more than 1 indicate that NHDS estimates are higher. In the following discussions of particular diagnosis categories, the numbers refer to the rank order among all HCUP discharges (column 1). Three diagnosis categories containing delivery and newborn codes—normal delivery/liveborn (rank 1), complications of birth, puerperium (rank 2), and complications during pregnancy (rank 4)—are higher in HCUP than in NHDS. The primary reason for this difference is that NHDS does not allow ICD-9-CM codes 640-643 and 645-676 to appear as a first-listed diagnosis when birth occurred during the hospitalization, HCUP does not impose this restriction. Acute myocardial infarction (rank 12) is higher in NHDS compared with HCUP, probably because NHDS reassigns some discharges with myocardial infarction in any diagnosis field to the principal diagnosis. Among the top 85 diagnosis categories, the following 12 additional categories showed considerable discrepancy between HCUP and NHDS estimates for both years (ratios less than 0.8 or more than 1.2): maintenance chemotherapy, radiotherapy (rank 18); diabetes mellitus (rank 19); epilepsy, convulsions (rank 32); abdominal pain (rank 40); other female genital disorders (rank 42); cancer of bronchus, lung, trachea, and larynx (rank 43); syncope (rank 50); anemias (rank 56); pleurisy, pneumothorax, pulmonary collapse (rank 63); hypertension (rank 64); other eye disorders (rank 73); and other and ill-defined heart disease (rank 82). Mean ratios of groups of disease categories are reported in Table B-5 to provide a summary measure of how closely HCUP and NHDS estimates correspond. In general, there appears to be better correspondence between HCUP and the 2 The ICD-9-CM codes are hemorrhage (640, 641), hypertension (642), and vomiting (643) in pregnancy. 3 The ICD-9-CM codes are prolonged pregnancy (645), infections (647), and other complications in pregnancy (646, 648); normal delivery (650); multiple gestation (651); malposition (652); disproportion (653); pelvic soft tissue abnormalities (654); other fetal, placental, and amniotic problems (655-658); other indications for care (659); obstructed and other abnormal labor (660-662); umbilical cord complications (663); obstetrical trauma (664, 665); postpartum hemorrhage (666); retained placenta (667); obstetrical procedure complications (668, 669); and complications of the puerperium (670-676). 1988 NHDS estimates. Because of differences in how delivery and myocardial infarction codes are handled in the two databases, mean ratios are compared both excluding the three delivery categories and excluding the delivery and myocardial infarction categories. The mean ratios for the most frequent diagnosis categories (top 50, top 25, and top 10) are also compared. In general, there is excellent correspondence between the 1987 estimates from HCUP-2 and the 1988 NHDS estimates, which were based on a sampling strategy that was revised to provide more representative estimates. Table B-1 Hospital characteristics and dimensions Characteristic Dimensions Geographic region Northeast North Central West South Location/teaching status Rural Urban/nonteaching Urban/teaching Type of control Public Investor-owned Voluntary Number of beds Urban/ Urban/ Rural nonteaching teaching Small 30-85 30-145 30-325 Medium 86-175 146-290 326-575 Large 176 or more 291 or more 576 or more Table B-2 Differences between NHDS and HCUP-2 samples and methods NHDS HCUP-2 Includes hospitals with 6 beds or more: 6,965 hospitals in sampling frame Includes some specialty hospitals: obstetrics-gynecology; ear, nose, and throat; orthopedic; and children’s Sample of discharges from each hospital: = 181,000 abstracts/year 3-stage stratified sample with sampling proportional to size: = 400 hospitals Reassigns myocardial infarction to principal diagnosis when other circulatory diagnoses are present Does not accept certain codes that are not “legal” first- listed diagnoses, e.g., ICD-9-CM codes 640-643 and 645-676 cannot be listed first when birth occurred during the hospitalization Includes hospitals with 30 beds or more: 5,050 hospitals in sampling frame No specialty hospitals included Census of discharges from each hospital: = 4 million abstracts/year Sample stratified by bed size, ownership, teaching status, and urban/rural location: =~ 664 hospitals No reassignment of any codes Accepts all codes Note: HCUP-2 is Hospital Cost and Utilization Project, 1980-87; ICD-9-CM is International Classification of Diseases, 9th Revision, Clinical Modification; NHDS is National Hospital Discharge Survey. 213 Table B-3 Estimated total U.S. hospital discharges: NHDS, 1987 and 1988, and HCUP-2, 1987 1987 NHDS: 1988 NHDS: Item 1987 NHDS 1988 NHDS 1987 HCUP-2 1987 HCUP-2 1987 HCUP-2 Discharges in thousands Ratio Discharges (except newborns) 33,387 31,146 RR — Newborns 3.971 3,733 — — — Total discharges (including newborns) 37,358 34,879 33,713 13 1.08 Note: HCUP-2 is Hospital Cost and Utilization Project, 1980-87; NHDS is National Hospital Discharge Survey. HCUP-2 estimates are compared with both 1987 and 1988 estimates from NHDS because the NHDS sample was restructured in 1988 to be more representative of the universe of U.S. hospitals. Table B-4 Comparison of national estimates of discharges based on HCUP-2, 1987, and NHDS, 1987 and 1988 1987 1988 Rank NHDS: NHDS: in 1987 1988 1987 1987 1987 HCUP Diagnosis category’ NHDS NHDS HCUP-2 HCUP-2 HCUP-2 Discharges in thousands Ratio 1 150. Normal delivery/liveborn 3,958 3,807 4,392 0.90 0.87 2 149. Complications of birth, puerperium 88 55 2,265 0.04 0.02 3 84. Ischemic heart disease 1,491 1,430 1,617 0.92 0.88 4 148. Complications during pregnancy 504 485 911 0.55 0.53 5 100. Pneumonia and influenza 953 969 879 1.08 1.40 6 90. Cerebrovascular disease 894 784 808 1.91 0.97 7 170. Other fractures, not hip 810 750 784 1.03 0.96 8 89. Congestive heart failure 629 663 685 0.92 0.97 9 101. Other respiratory infections (not tuberculosis) 769 rig 688 1.12 1.04 10 161. Spondylosis, intervertebral disc disorders, cervical disorders, other back pain 846 705 681 1.24 1.03 11 125. Biliary tract disease 636 574 581 1.09 0.99 12 83. Acute myocardial infarction 760 716 549 1.39 1.31 13 175. Complication of device or procedure 464 491 498 0.93 0.99 14 88. Conduction disorders, dysrhythmias 583 556 493 1.18 1.18 15 61. Depression and affective disorders 523 576 473 1:11 122 16 57. Alcohol-related disorders 484 359 407 1.19 0.88 17 103. Asthma 454 479 407 1.14 1.18 18 40. Maintenance chemotherapy, radiotherapy 90 180 384 0.23 0.47 19 46. Diabetes mellitus 489 467 381 1.28 1.23 20 134. Urinary tract infection 428 436 371 1.16 1.18 21 120. Noninfectious enteritis and colitis 422 367 353 1.20 1.04 22 135. Calculus of urinary tract 335 311 344 0.97 0.90 23 49. Fluid and electrolyte disorders 357 379 326 1.10 1.18 24 151. Skin and subcutaneous infections 322 311 298 1.08 1.04 25 137. Hyperplasia of prostate 274 247 285 0.96 0.87 26 168. Fracture of neck of femur (hip) 253 254 261 0.97 0.97 See note at end of table. 214 Table B-4—Continued Comparison of national estimates of discharges based on HCUP-2, 1987, and NHDS, 1987 and 1988 1987 1988 Rank NHDS: NHDS: in 1987 1988 1987 1987 1987 HCUP Diagnosis category’ NHDS NHDS HCUP-2 HCUP-2 HCUP-2 Discharges in thousands Ratio 27 118. Inguinal hernia 301 257 266 1.13 0.97 28 147. Pregnancy with abortive outcome 301 263 265 1.14 0.99 29 38. Secondary malignancies 198 234 244 0.81 0.96 30 178. Poisoning 233 193 245 0.95 0.79 31 117. Appendicitis 274 234 237 1.18 0.99 32 73. Epilepsy, convulsions 137 131 232 0.59 0.56 33 116. Gastritis, upper gastrointestinal obstruction, nausea 227 189 232 0.98 0.82 34 143. Menstrual disorders and ovarian cyst 276 234 227 1.22 1.03 35 174. Open wounds 249 196 226 1.10 0.87 36 172. Intracranial injury (not fracture) 241 202 218 1.1 0.93 37 121. Intestinal obstruction without hernia 223 201 213 1.05 0.94 38 102. Chronic obstructive pulmonary disease and allied conditions 358 235 209 1.7 1.12 39 160. Osteoarthritis 231 205 207 1.13 0.99 40 130. Abdominal pain 79 69 203 0.39 0.34 41 171. Sprains and strains 254 182 202 1.26 0.90 42 146. Other female genital disorders 275 136 193 1.43 0.71 43 16. Cancer of bronchus, lung, trachea, larynx 298 233 187 1.59 1.25 44 42. Other benign neoplasms 190 189 181 1.05 1.04 45 41. Benign neoplasm, uterus 186 190 179 1.04 1.06 46 140. Inflammation of female pelvic organs 197 164 174 133 0.94 47 128. Gastrointestinal hemorrhage 204 175 "7 1.19 1.02 48 107. Other lower respiratory diseases 190 235 165 1.15 1.43 49 59. Schizophrenic disorders 185 177 173 1.07 1.02 50 95. Syncope 21 30 164 0.13 0.18 51 122. Diverticulosis and diverticulitis 173 166 165 1.05 1.01 52 20. Cancer of breast 205 175 163 1.26 1.07 53 2. Septicemia 172 193 157 1.09 1.23 54 12. Cancer of colon-rectum 196 161 161 1.22 1.00 55 136. Other genitourinary disorders 176 134 159 1.11 0.85 56 51. Anemias 212 195 155 .37 1.26 57 119. Other abdominal hernia 175 142 152 1.15 0.93 58 6. Viral infections 176 169 152 1.18 4 59 96. Thrombophlebitis and thromboembolism 170 142 154 1.11 0.92 60 167. Joint disorders, trauma-related 169 152 154 1.10 0.99 61 58. Drug disorders, not alcohol-related 197 150 144 1.37 1.04 62 165. Congenital anomalies 238 138 145 1.65 0.96 63 105. Pleurisy, pneumothorax, pulmonary collapse 111 103 146 0.76 0.71 64 82. Hypertension 302 267 147 2.06 1.82 65 80. Other nervous system disorders 218 116 143 1.52 0.81 66 142. Prolapse of female genital organs 146 125 141 1.04 0.89 67 179. Other external injury 156 97 139 1.32 0.70 68 127. Pancreas disorders (not diabetes) 136 128 136 1.00 0.94 69 162. Osteoporosis and other disorders of bone and cartilage 190 152 135 1.41 1.13 70 158. Other joint disorders (not trauma) 130 107 134 0.97 0.80 7 109. Intestinal infections 135 144 126 1.07 1.14 72 112. Esophageal disorders 145 147 122 1.19 1.20 See note at end of table. 215 Table B-4—Continued Comparison of national estimates of discharges based on HCUP-2, 1987, and NHDS, 1987 and 1988 1987 1988 Rank NHDS: NHDS: in 1987 1988 1987 1987 1987 HCUP Diagnosis category’ NHDS NHDS HCUP-2 HCUP-2 HCUP-2 Discharges in thousands Ratio 73 76. Other eye disorders 163 162 122 1.33 1.32 74 113. Gastric ulcer 111 114 114 0.98 1.00 75 25. Cancer of prostate 128 123 112 1.14 1.10 76 141. Endometriosis 108 99 113 0.96 0.88 77 166. Perinatal conditions 107 138 110 0.97 1.25 78 91. Atherosclerosis (not heart or brain) 120 129 115 1.05 1.43 79 114. Duodenal ulcer 109 99 109 1.00 0.91 80 180. Indications for plastic surgery 111 96 108 1.03 0.89 81 173. Internal injury to viscera or vessels, crushing injury 106 74 108 0.98 0.69 82 86. Other and ill-defined heart disease 126 122 102 1.24 1.20 83 108. Other upper respiratory diseases 87 83 101 0.86 0.82 84 176. Superficial injury, contusion 106 85 98 1.08 0.87 85 138. Other male genital disorders 120 85 97 1.23 0.87 ! For a description of diagnosis codes comprising each diagnosis category, refer to Elixhauser, Andrews, and Fox (1993). Note: HCUP-2 is Hospital Cost and Utilization Project, 1980-87; NHDS is National Hospital Discharge Survey. Table B-5 Correspondence between NHDS and HCUP-2 estimates for discharges from U.S. hospitals 1987 NHDS: 1988 NHDS: Estimate 1987 HCUP-2 1987 HCUP-2 Ratio All diagnosis categories 1.10 0.96 All categories excluding delivery categories 1.12 0.98 All categories excluding delivery categories and myocardial infarction 1.12 0.97 Top 50 categories excluding delivery categories and myocardial infarction 1.06 0.96 Top 25 categories excluding delivery categories and myocardial infarction 1.05 1.01 Top 10 categories excluding delivery categories and myocardial infarction 1.06 0.99 Note: HCUP-2 is Hospital Cost and Utilization Project, 1980-87; NHDS is National Hospital Discharge Survey. Delivery categories are normal delivery/livebom; complications during pregnancy; and complications of birth, puerperium. 216 Appendix C Standardization When comparing the morbidity or mortality experience of different population groups, it is possible for comparisons to be biased by differences among the populations in the distribution of certain underlying characteristics. For example, because age and sex are important determinants of morbidity and mortality, variations in the age or sex composition of different populations can dramatically influence comparisons of these rates. Therefore, when comparing morbidity or mortality experience among population groups, it is advisable to control for the potential influence of such factors in either the design or the analysis of the study. Among the options available for controlling for extraneous factors at the time of the analysis is standardization of rates (Mausner and Kramer, 1985). With the direct method of standardization, the observed data from each comparison group (e.g., black patients and white patients) are initially stratified on the basis of different categories of the characteristics that are to be controlled (e.g., age and sex). The observed stratum-specific rates for the outcome of interest (e.g., the discharge rate) are then determined. For each comparison group, the observed stratum-specific rates are then multiplied by the total number of individuals within similarly defined strata of a standard population. The results of these calculations represent the expected number of occurrences of the outcome in the standard population, had the observed stratum-specific rates of the comparison groups prevailed. Typically, for each comparison group, the expected number of occurrences of the outcome is summed over all strata and divided by the total number of subjects in the standard population to yield an overall “adjusted” rate. The adjusted rate is expressed in units comparable with the original 217 measure (e.g., procedures per 100,000 population or discharges per 100,000 population). Because the observed stratum-specific rates for each comparison group have been applied to the same standard population, variations in the composition of the comparison groups relative to the stratification variables do not influence the comparison of the overall adjusted rates. The choice of the standard population is not critical. It could represent the combination of the comparison groups; or it could be derived from U.S. or State vital statistics data; or it could, for that matter, be artificially constructed. However, it is important to note that the magnitude of the adjusted rates is not invariant to the choice of population standard; therefore, one set of adjusted rates should not be compared with another set of rates adjusted on the basis of a different standard population. In this investigation, U.S. Bureau of the Census data for 1970 were used as the standard in computing all adjusted rates. An example of age standardization of rates is provided in Table C-1, illustrating the potential impact of this methodology. This hypothetical example demonstrates how it is possible for substantial differences between groups based on a comparison of crude overall rates (3,327 versus 737 deaths per 100,000 population) to disappear when the comparison is based on adjusted rates (908 versus 908 deaths per 100,000 population). When the observed stratum-specific rates for each comparison group were applied to the same standard population, variations in the composition of the comparison groups relative to age did not influence the comparison of the overall adjusted rates. It is also possible for true differences between populations to be masked when comparisons are based solely on crude rates. In this case, only after adjustment do the differences become apparent. Table C-1 Hypothetical example of standardization of mortality rates by age Observed population A Observed population B Expected deaths Number Number of Population Death of Population Death Standard Population Population Age group deaths size rate’ deaths size rate’ population A B 5 years and under 75 3,000 2,500 2,000 80,000 2,500 10,000 250 250 6-10 years 85 17,000 500 850 170,000 500 30,000 150 150 11-20 years 50 50,000 100 180 180,000 100 80,000 80 80 21-30 years 160 80,000 200 320 160,000 200 160,000 320 320 31-40 years 480 120,000 400 560 140,000 400 220,000 880 880 41-50 years 840 140,000 600 720 120,000 600 220,000 1,320 1,320 51-60 years 1,280 160,000 800 640 80,000 800 160,000 1,280 1,280 61-70 years 1,800 180,000 1,000 500 50,000 1,000 80,000 800 800 71-80 years 8,500 170,000 5,000 850 17,000 5,000 30,000 1,500 1,500 81 years and over 20,000 80,000 25,000 750 3,000 25,000 10,000 2,500 2,500 Total population — 1,000,000 — — 1,000,000 — 1,000,000 — —_ Total observed deaths 33,270 et —_— 7.370 —_ _ — — — Observed rate’ —_ — 3327 — — 737 sn _— — Total expected deaths se go — —_ —_— — —_ 9,080 9,080 Adjusted rate’ _- —_ we — se ss = 908 908 ! Rate per 100,000 population. 218 Appendix D Recalculation of confidence interval estimates The large number of statistical comparisons made possible by the data included in this report increases the likelihood of identifying significant differences that are due to chance alone. This could have been mitigated by using a more conservative alpha level. However, in light of the exploratory nature of this investigation, a 0.05 alpha level was used in constructing confidence intervals about the point estimates shown in the tables. This appendix provides information necessary to construct more restrictive confidence interval estimates (CIEs) for assessing differences in particular procedure categories. Standard error for a rate The CIEs reported for discharge rates were based on the usual method of computation: Lower limit CIE = rate — 1.96 x SE (rate) Upper limit CIE = rate + 1.96 x SE (rate) where SE (rate) is the standard error of the rate. The tables provide sufficient information to enable confidence intervals to be recalculated using different levels of significance. The value of the rates may be obtained directly from the tables, but the standard error must be derived from the information provided. To do so, simply set the above equation equal to the lower limit of the CIE and solve for the SE as shown below. (lower limit CIE ) — (rate) SE (rate) = 19% Standard error for EAPC The estimated annual percent change (EAPC) is derived by fitting a regression line to the natural logarithm of the discharge rates, using calendar year as the independent variable. The equation for calculating the EAPC is given below, where m is the slope of the regression line: EAPC = 100 x (exp™ — 1) The value of the slope may therefore be obtained as the solution to the following equation: = ln) 1 + EAPC La 100 The lower limit (I) of the confidence interval is calculated in the following manner: Lower limit CIE = 100 x (ex m =1.96 (SE (m)) _ 1) The standard error of the slope can be derived from the above equation as follows: In[1 4 lower limit CIE) 100 -1.96 SE(m) = Example These equations could easily be programmed into a spreadsheet software package to quickly and easily recalculate CIEs for a number of different diagnoses. An example of the steps necessary to recalculate the confidence interval is given below, using the EAPC and associated confidence interval for diagnosis category 2 (septicemia) among black patients (EAPC = 20.1; 95-percent CIE = 14.9, 25.5). EAPC 20.17 m=tn[ 1+ 100 Jl 1+ oa |-01832 lle %4SEY i 100 SEGnys= ~1.96 14.9 E [1+ 0 | ~ 01852 I ~1.96 Substitution of the derived values of the slope (m) and its SE, along with a different alpha level, into the equation below enables a more restrictive confidence interval to be calculated. An example is provided for constructing a confidence interval corresponding to a two-tailed test with alpha equal to 0.005: 220 CIE = 100 X (exp m2 (SE) _ ) = 100 x (exp 0.1832% (2.81 x 0.0226) _ 1 =(12.7, 28.0) Provider Studies Research Notes No. Title (Author) and Order Number Date i Project Overview (Hornbrook) NTIS Accession No. PB84-111566 June 1983 2 Patients in Public General Hospitals: Who Pays, How Sick? (Coffey) PHS Pub. No. 83-3344 Sept. 1983 3 Characteristics of Financially Distressed Hospitals (Kelly and O’Brien) NTIS Accession No. PB84-111574 June 1983 4 Who Receives Cesareans: Patient and Hospital Characteristics (Goldfarb) Sept. 1984 NTIS Accession No. PB85-124766 5 Sole Community Hospitals: Are They Different? (Farley) PHS Pub. No. 85-3348 Mar. 1985 6 Utilization of Hospital Inpatient Services by Elderly Americans (Garnick and Short) PHS Pub. No. 85-3351 June 1985 7 Competition Among Hospitals: Market Structure and Its Relation to Utilization, Costs, and Financial Position (Farley) PHS Pub. No. 85-3353 Aug. 1985 8 Use of Short-Term General Hospitals by Patients With Psychiatric Diagnoses (Wallen) PHS Pub. No. 86-3395 Oct. 1985 9 Case Mix and Treatment Patterns of Medicaid and Privately Insured Psychiatric Patients in Short-Term General Hospitals (Wallen) PHS Pub. No. 87-3402 Oct. 1986 10 HCUP-2 Project Overview (Coffey and Farley) PHS Pub. No. 88-3428 July 1988 11 Trends in Hospital Average Lengths of Stay, Casemix, and Discharge Rates, 1980-85 (Farley) PHS Pub. No. 88-3420 Apr. 1988 12 Urban and Rural Hospital Costs: 1981-85 (Hogan) PHS Pub. No. 88-3419 Apr. 1988 13 The 50 Most Frequent Diagnosis-Related Groups (DRGs), Diagnoses, and Procedures: Statistics by Hospital Size and Location (Lemrow and others) PHS Pub. No. 90-3465 Sept. 1990 14 Financially Distressed Hospitals: A Profile of Behavior Before and After PPS (Rizzo) PHS Pub. No. 90-3467 Sept. 1990 15 AIDS in U.S. Hospitals, 1986-87: A National Perspective (Ball and Turner) AHCPR Pub. No. 91-0015 July 1991 16 Pediatric AIDS-Related Discharges in a Sample of U.S. Hospitals: Demographics, Diagnoses, and Resource Use (Ball and Thaul) AHCPR Pub. No. 92-0031 Feb. 1992 17 Clinical Classifications for Health Policy Research: Discharge Statistics by Principal Diagnosis and Procedure (Elixhauser and others) AHCPR Pub. No. 93-0043 Aug. 1993 18 Intermittent Positive Pressure Breathing: Old Technologies Rarely Die (Duffy and Farley) AHCPR Pub. No. 94-0001 Dec. 1993 19 The National Bill for Diseases Treated in U.S. Hospitals: 1987 (Andrews and others) AHCPR Pub. No. 94-0002 Feb. 1994 20 Trends in Hospital Procedures Performed on Black Patients and White Patients: 1980-87 (Elixhauser and others) AHCPR Pub. No. 94-0003 Apr. 1994 21 Are Contract-Managed Hospitals More Efficient? (Dor) AHCPR Pub. No. 94-0004 Apr. 1994 2 Trends in Hospital Procedures: Regional Variations, 1980-87 (Elixhauser and others) AHCPR Pub. No. 95-0002 Dec. 1994 23 Trends in Hospital Diagnoses: Regional Variations, 1980-87 (Elixhauser and others) AHCPR Pub. No. 95-0003 Feb. 1995 24 Trends in Hospital Diagnoses for Black Patients and White Patients: June 1995 1980-87 (Elixhauser and others) AHCPR Pub. No. 95-0048 Research Notes 1, 3, and 4 are available from the National Technical Information Service (NTIS), Springfield, VA 22161; telephone (703) 487-4650. Single copies of all other publications are available from the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907; telephone 800-358-9295. * |J.5. G.P.0.:1995-386-974:20 221 PUBLIC HFAITH LIBRARY SEP 1 8 1995 Department of Health and Human Services Donna E. Shalala, Ph.D., Secretary Public Health Service Philip R. Lee, M.D., Assistant Secretary for Health Agency for Health Care Policy and Research Clifton R. Gaus, Sc.D., Administrator Center for General Health Services Intramural Research Donald Goldstone, M.D., Director Division of Provider Studies Rosanna M. Coffey, Ph.D., Director U. C. BERKELEY LIBRARIES Co47277690 U.S. Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research Executive Office Center, Suite 501 2101 East Jefferson Street Rockville, MD 20852 AHCPR AHCPR Pub. No. 95-0048 June 1995