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Appendix C Data Tables: Burden of Disease and Variation of Care As discussed in Chapter 3, the committee selected published data tables to use in the voting process to provide proxy indicators for burden of dis- ease and variation in care. The Medical Expenditure Panel Survey (MEPS) provided information on prevalence (Table C-1), morbidity (Table C-3) and cost (Table C-4), and the National Vital Statistics Report on mortal- ity (Table C-2). The Dartmouth Institute for Health Policy and Clinical Practice analyzed clinical practice data according to variation in treatment for surgical procedures (Table C-5) and medical conditions (Table C-6) at the Institute of Medicineâs request. Data sources were chosen based on their year of production (with preference given to the most recent reports), representativeness of the nationâs entire population, and ability to provide age stratification. 189
190 INITIAL NATIONAL PRIORITIES FOR CER TABLE C-1 Number of People Receiving Care for Selected Conditions in the U.S. Civilian Noninstitutionalized Population in 2006 Total Persons Conditions (in thousands) People of all ages Chronic Obstructive Pulmonary Disease (COPD), asthma 48,455 Hypertension 45,795 Mental disorders 36,246 Trauma-related disorders 34,899 Acute Bronchitis and URI 33,869 Hyperlipidemia 29,884 Skin disorders 22,700 Disorders of the upper GI 21,602 Osteoarthritis and other non-traumatic joint disorders 21,491 Back problems 20,487 Heart conditions 19,711 Residual Codes 19,149 Diabetes mellitus 18,268 Other eye disorders 16,403 Infectious diseases 16,254 Systemic lupus and connective tissues disorders 15,113 Female genital disorders, and contraception 14,998 Other CNS disorders 14,540 Cancer 11,114 Otitis media 10,951 Other bone and musculoskeletal disease 10,069 People ages <1 year Otitis media 1,893 Acute Bronchitis and URI 1,641 COPD, asthma 1,063 Infectious diseases 820 Other eye disorders 591
APPENDIX C 191 TABLE C-1 Continued Total Persons Conditions (in thousands) People ages 1-17 years COPD, asthma 12,588 Acute Bronchitis and URI 12,221 Otitis media 7,595 Trauma-related disorders 6,687 Mental disorders 4,570 Infectious diseases 4,222 Skin disorders 4,067 Other eye disorders 3,469 Intestinal infection 2,899 Other CNS disorders 1,853 Allergic reactions 1,783 People ages 65+ years Hypertension 19,844 Hyperlipidemia 13,201 Heart conditions 10,242 COPD, asthma 9,002 Osteoarthritis and other non-traumatic joint disorders 8,881 Diabetes mellitus 7,436 Mental disorders 7,393 Disorders of the upper GI 7,044 SOURCE: AHRQ (2009c).
192 INITIAL NATIONAL PRIORITIES FOR CER TABLE C-2 Number of Deaths for People in the United States by Age in 2005 Cause of Death Number of Deaths People of all ages Ischemic heart diseases 445,687 Malignant neoplasms of trachea, bronchus and lung 159,292 Acute myocardial infarction 151,004 Cerebrovascular diseases 143,579 Chronic lower respiratory diseases 130,933 Accidents (unintentional injuries) 117,809 Diabetes mellitus 75,119 Alzheimerâs disease 71,599 Influenza and pneumonia 63,001 Pneumonia 61,189 Heart failure 58,933 Malignant neoplasms of lymphoid, hematopoietic and related 55,028 tissue Malignant neoplasms of colon, rectum and anus 53,252 Renal failure 42,868 Malignant neoplasm of breast 41,491 Septicemia 34,136 Malignant neoplasm of pancreas 32,760 Intentional self-harm (suicide) 32,637 Hypertensive heart disease 29,282 Malignant neoplasm of prostate 28,905 People age <1 year Congenital malformations, deformations and chromosomal 5,552 abnormalities Disorders related to length of gestation and fetal malnutrition 4,798 Sudden infant death syndrome 2,230 Other respiratory conditions originating in the perinatal period 1,160 Accidents (unintentional injuries) 1,083 Infections specific to the perinatal period 1,039 Respiratory distress of newborn 860 Bacterial sepsis of newborn 834
APPENDIX C 193 TABLE C-2 Continued Cause of Death Number of Deaths People age 1-14 years Accidents (unintentional injuries) 4079 Malignant neoplasms 1377 Congenital malformations, deformations and chromosomal 918 abnormalities Assault (homicide) 716 Major cardiovascular diseases 584 Diseases of heart 403 People age 65+ years Ischemic heart diseases 365,491 Cerebrovascular diseases 123,881 Acute myocardial infarction 119,164 Malignant neoplasms of trachea, bronchus and lung 112,826 Chronic lower respiratory diseases 112,716 Alzheimerâs disease 70,858 Influenza and pneumonia 55,453 Diabetes mellitus 55,222 Heart failure 54,740 Malignant neoplasms of lymphoid, hematopoietic and related 40,267 tissue Malignant neoplasms of colon, rectum and anus 39,100 Accidents (unintentional injuries) 36,729 Renal failure 35,642 Malignant neoplasm of prostate 26,327 Septicemia 26,243 Malignant neoplasm of breast 23,747 Malignant neoplasm of pancreas 23,397 Hypertensive heart disease 20,295 Parkinsonâs disease 19,030 SOURCE: Kung et al. (2008).
194 INITIAL NATIONAL PRIORITIES FOR CER TABLE C-3 The Number of Events for People in the U.S. Civilian Noninstitutionalized Population in 2006 Number of Events Condition (in thousands) People of all ages Hypertension 246,722 Mental disorders 244,543 COPD, asthma 225,990 Trauma-related disorders 186,155 Diabetes mellitus 162,113 Back problems 160,397 Heart conditions 129,160 Osteoarthritis and other non-traumatic joint disorders 121,942 Acute Bronchitis and URI 94,124 Systemic lupus and connective tissues disorders 83,307 Cancer 74,611 Skin disorders 70,517 People ages 0-17 years COPD, asthma 54,354 Mental disorders 42,212 Acute Bronchitis and URI 33,931 Otitis media 24,568 Trauma-related disorders 18,899 Skin disorders 11,339 Infectious diseases 10,425 Other eye disorders 7,887 Other CNS disorders 7,010 Intestinal infection 5,798 Other endocrine, nutritional, and immune disorder 4,835 Allergic reactions 4,828 SOURCE: AHRQ (2009b).
APPENDIX C 195 TABLE C-4 Total Expenses for People for Selected Conditions in the U.S. Civilian Noninstitutionalized Population in 2006 Total Expenses Condition (in millions) People of all ages Heart conditions $ 78,032 Trauma-related disorders $ 68,142 Cancer $ 57,501 Mental disorders $ 57,452 COPD, asthma $ 51,320 Hypertension $ 48,507 Diabetes mellitus $ 48,341 Osteoarthritis and other non-traumatic joint disorders $ 37,538 Normal birth/live born $ 37,499 Back problems $ 35,015 People age <1 year Perinatal conditions $ 3,727 COPD, Asthma $ 1,227 Congenital anomalies $ 1,035 Otitis media $ ââ883 Acute Bronchitis and URI $ ââ743 Infectious diseases $ ââ716 Disorders of the upper GI $ ââ510 Gallbladder, pancreatic, and liver disease $ ââ393 Intestinal infection $ ââ383 Trauma-related disorders $ ââ310 People ages 1-17 years Mental disorders $ 8,834 COPD, asthma $ 7,080 Trauma-related disorders $ 5,890 Acute Bronchitis and URI $ 2,730 Infectious diseases $ 2,720 Otitis media $ 2,451 Skin disorders $ 1,305 Other eye disorders $ 1,197 Tonsillitis $ 1,119 Epilepsy and convulsions $ 985
196 INITIAL NATIONAL PRIORITIES FOR CER TABLE C-4 Continued Total Expenses Condition (in millions) People age 65+ years Heart conditions $ 46,151 Diabetes mellitus $ 21,420 Cancer $ 21,299 Hypertension $ 20,432 Trauma-related disorders $ 20,327 COPD, asthma $ 20,295 Osteoarthritis and other non-traumatic joint disorders $ 17,217 Mental disorders $ 13,598 Kidney disease $ 13,331 Back problems $ 10,462 SOURCE: AHRQ (2009a). TABLE C-5â Pattern of Variation in Admissions for Procedures Among Hospital Referral Regions Condition Coefficient of Variation Septicemia 34.1 COPD 34.0 Back Surgery 32.8 Congestive Heart Failure 27.3 Gastroenteritis 27.0 Simple Pneumonia 24.1 Knee Replacement 21.4 Cardiac Arrhythmia 20.6 Gastrointestinal Hemorrhage 16.3 Stroke 16.0 Hip Fracture Discharge 14.4 NOTE: Coefficient of variation is calculated as the ratio of the standard deviation to the mean (multiplied by 100, so expressed as a percent) across geographic units in the United States. SOURCE: Wennberg (2009).
APPENDIX C 197 TABLE C-6 Pattern of Variation in Admission for Treatment of Conditions Among Hospital Referral Regions Coefficient of Procedure Variation Percutaneous Interventions (PCI) 34.0 Lower Extremity Bypass 33.6 Carotid Endarterectomy 33.2 Back Surgery 32.8 TURP for BPH 31.7 Mastectomy for Cancer 30.4 CABG 26.7 Hip Replacement 26.4 Cholecystectomy 21.5 Knee Replacement 21.4 Hip Fracture discharge 14.4 NOTE: Coefficient of variation is calculated as the ratio of the standard deviation to the mean (multiplied by 100, so expressed as a percent) across geographic units in the United States. SOURCE: Wennberg (2009). References AHRQ (Agency for Healthcare Research and Quality). 2009a. Medical Expenditure Panel Survey: Total expenses for conditions by site of service: United States http://www.meps. ahrq.gov/mepsweb/ (accessed March 10, 2009). âââ. 2009b. Total number of events accounting for expenditures by site of service: United States, 2006. In Medical Expenditure Panel Survey Component Data. âââ. 2009c. Total number of people accounting for expenditures (deduplicated) by site of service: United States, 2006. In Medical Expenditure Panel Survey Component Data. Kung, H.-C., D. L. Hoyert, J. Xu, S. L. Murphy, and Division of Vital Statistics. 2008. Deaths: Final data for 2005. National Vital Statistics Reports National Center for Health Statistics. Wennberg, J. E. 2009 (unpublished). Recommendations to the Institute of Medicine on com- parative effectiveness research priorities. Submitted in response to a request from the Institute of Medicine Committee on Comparative Effectiveness Research Prioritization. The Dartmouth Institute for Health Policy and Clinical Practice.