12. Morbidity and Hospitalizations
Table 12‑1: Morbidity and Hospitalizations Summary Table
|
Chronic Disease Measure |
County Data |
Recent Change |
U.S. Comparison |
IN Comparison |
HP 2010 |
||||
|
yrs |
% Change |
DC |
U.S. Data |
DC |
IN Data |
DC |
|||
|
Positive Indicators for Marion County |
|||||||||
|
Total CHF Discharges / 100,000 persons |
374.2 (2005) |
5 |
-10.4% (2000-2005) |
C |
373.0 (2004) |
DC
|
NA |
|
12-64.
|
|
Total Asthma Hospital Discharges/ 100,000 persons |
155.1 (2005) |
5 |
-6.1% (2000-2005) |
C |
170 (2004) |
D |
NA |
|
NA |
|
Neutral Indicators for Marion County |
|||||||||
|
% Adults Lifetime Asthma Diagnosis |
11.0 (2005) |
3 |
-18.5% (2002-2005) |
C |
12.6% (2005) |
DC
|
12.7% (2005) |
DC
|
2.5% |
|
Diabetes-mortality/ 100,000 persons |
27 (2005) |
1 |
+6.3% (2004-2005) |
D |
24.4 (2004) |
DC
|
NA |
|
5-5 46 |
|
% C-Sections/ all deliveries |
26.6% (2005) |
5 |
+32% (2000-2005) |
D |
30.2% (2005) |
C |
NA |
|
16-9 15%1 |
|
Negative Indicators for Marion County |
|||||||||
|
% Self-Reported Diabetes Diagnosis
|
10.6% (2005) |
4 |
+11.6% (2001-2005) |
C |
7.3% (2005) |
DC
|
8.3% (2005) |
DC
|
5-3 2.5% |
|
Diabetes in Adults 25 years+: Blacks versus White Disparity |
OR 1.6 (2005) |
NA |
|
|
1.7 (2005) |
DC
|
1.3 (2005) |
DC
|
NA |
|
Diabetes Discharges/ 100,000 Persons |
191 (2005) |
5 |
+12.9% (2000-2005) |
D |
205 (2004) |
D |
-- |
|
NA |
|
% Lower Limb Amputations per 100,000 |
46.9 (2005) |
1 |
+8.3 (2004-2005) |
D |
422 (2000) |
|
NA |
|
5-10 5003 |
|
Asthma Hospital Discharges Age 65+ per 100,000 persons |
324.7 (2005) |
NA |
|
|
287 (2004) |
D |
NA |
|
24-2c 110 |
|
All sites, Cancer Incidence 5 2000-2002 per 100,000 persons |
506.9 (2000-2002) |
NA |
|
|
462.2 (2002) |
D |
469.2 (2000-2002) |
D |
NA |
|
Lung-Bronchus Cancer Incidence 5 2000-2002 per 100,000 persons |
95.7 (2000-2002) |
NA |
|
|
67.5 (2002) |
D |
79.5 (2000-2002) |
D |
NA |
|
Female Breast Cancer Incidence5 2000-2002 / 100,000 persons |
137.2 (2000-2002) |
NA |
|
|
124.9 (2002) |
D |
123.2 (2000-2002) |
D |
NA |
1 HP 2010 objective for Cesarean section procedures is for first (primapara) births only. Objective for pediatric asthma hospitalizations is for children under 5 years of age. [445]
2 Most recent U.S. data found was from 2000. HCUP Fact Book No. 5: Preventable Hospitalization: Window into primary and preventative care 2000. Agency for Health Research and Quality. www.ahrq.gov/data/hcup/factbk5/hfb5fig7.htm
3 HP 2010 objective 5-10 for lower limb amputations is per 100,000 persons with diabetes. Marion County lower limb amputation rate could only be calculated per 100,000 total population, and the rate among persons with diabetes would necessarily be larger.
4 HP 2010 objective 24-2a-c are for specific age groups. http://www.healthypeople.gov/Document/HTML/Volume2/24Respiratory.htm#_Toc48970483
5 CDC/National Cancer Institute' State Cancer Profiles from the National Program of Cancer Registries Cancer Surveillance System (NPCR-CSS) http://www.statecancerprofiles.cancer.gov/incidencerates/index.php?stateFIPS=18&cancer=055&race=00&age=001&type=incd&sortVariableName=rate http://www.statecancerprofiles.cancer.gov/cgi-bin/quickprofiles/profile.pl?18&047 No current HP 2010 objectives are defined for cancer incidence.
Table notes: County data: Is for most recent year available. Recent Change: Percent change of most recent measurement from a measurement the noted number of years prior. Changes of more than 5 percent in either direction are denoted by thumbs up or thumbs down symbols. Neutral thumbs indicate no change, even though no change may be a negative outcome; U.S. or IN population data: Is for most recent year available; U.S. (or IN) Comparison: Comparison of most recent data using thumbs up or thumbs down symbolsthumbs up or thumbs down to denote differences that are statistically significant or deemed to be noteworthy from the analysts’ professional perspective. Note: When there is no public health implication associated with a measure, directional arrows replace thumb icons to indicate the direction of change or the relationship of the Marion County measure (higher/lower/not different) to the U.S./IN measure.
Table 12‑2: Morbidity and Hospitalizations Summary Table - Health Screenings
|
Screening Measures |
County Data |
Recent Change |
U.S. Comparison |
IN Comparison |
HP 2010 |
||||
|
yrs |
% Change |
DC |
U.S. Data |
DC |
IN Data |
DC |
|||
|
Positive Indicators for Marion County |
|||||||||
|
%Women 40+ with Mammogram |
75% (2005) |
3 |
-8.5% (2002-2005) |
D |
76.5% (2005) |
DC |
71.6% (2005) |
DC |
3-13 70% |
|
Neutral Indicators for Marion County |
|||||||||
|
% Adults 50+ w/ FOBT / prior 2 years |
22.3% (2006) |
NA |
|
|
24.1% (2006) |
|
21.1% (2006) |
|
3-12a 33% |
|
%Adults 50+ w/ Colonoscopy |
62.3% (2006) |
NA |
|
|
57.1% (2006) |
|
56.4% (2006) |
|
3-12b. 50% |
|
Negative Indicators for Marion County |
|||||||||
|
% Women 18+ w/ Pap Exam |
86.6% (2004) |
4 |
-8.8% (2000-2004) |
D |
85.9 (2005) |
DC |
82.5 (2005) |
DC |
3-11a 97% |
Table notes: County data: Is for most recent year available. Recent Change: Percent change of most recent measurement from a measurement the noted number of years prior. Changes of more than 5 percent in either direction are denoted by thumbs up or thumbs down symbols. Neutral thumbs indicate no change, even though no change may be a negative outcome; U.S. or IN population data: Is for most recent year available; U.S. (or IN) Comparison: Comparison of most recent data using thumbs up or thumbs down symbols to denote differences that are statistically significant or deemed to be noteworthy from the analysts’ professional perspective. Note: When there is no public health implication associated with a measure, directional arrows replace thumb icons to indicate the direction of change or the relationship of the Marion County measure (higher/lower/not different) to the U.S./IN measure.
Diabetes
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia (high blood sugar) resulting from defects in insulin secretion, insulin action, or both. Diabetes can alter the way fats and carbohydrates are metabolized, leading to high levels of cholesterol. Prolonged duration of high blood sugar levels damages the small arteries that are essential to healthy eyes, kidneys, heart, and nerves. Persons with diabetes become more susceptible to other diseases and may be hospitalized for diagnoses such as heart attacks, kidney failure, heart failure, skin ulceration and infection, diabetic blindness, and lower extremity amputations.[446]
Over 90 percent of diabetes cases are type 2 (“adult-onset”), another 5 to 10 percent are type 1 (“insulin-dependent diabetes” or “juvenile onset”).[447] While type 2 diabetes is more common among older individuals, some minority populations and persons who are obese, the onset of type 2 diabetes may be prevented or delayed by healthful behaviors, including maintaining a healthy body weight, normal blood pressure level, and keeping physically active.[448] The American Diabetes Association estimates that only one-third of persons with diabetes are diagnosed.[449] Therefore, the true prevalence of diabetes is likely to be underestimated in statistics based on self-report.
In 2001, a Marion County sample of adults over 18 years estimated the prevalence of medically recognized diabetes[450] to be 9.5 percent (Figure 12‑1)[451]. In 2000 the Behavioral Risk Factor Surveillance System telephone survey found national and Indiana adult prevalence rates were 6.1 percent and 6.0 percent, respectively, both significantly lower than Marion County’s rate (10.6 percent overall).
Between 2000 and 2005, both the national and state prevalence of diabetes have risen (Table 12‑3). Averaging rates of the prior 4 years (2001 to 2004: 8.8 percent) the 2005 prevalence has increased over 20 percent.
The 2005 diabetes prevalence among Marion County Whites was significantly higher than national, but not state, self-reported prevalence rates for adults (Table 12‑3). Significant race/ethnicity differences emerge between Blacks and the two other ethnic groups after the age of 25, where Black adults have twice the prevalence of diabetes than similarly aged adults of other ethnicities. Prevalence among all ages of Marion County Blacks is 60 percent higher than Marion County Whites and Hispanics, and higher compared to state and national total Black populations.
The Black-to-White differences in prevalence are similar in Marion County and the nation, Odds Ratios 1.61 and 1.67 respectively, (See Table 12‑4). Diabetes prevalence among Marion County Hispanics is not statistically different than the state or national Hispanic prevalence, or Marion County’s White population (Table 12‑3).[452]
By gender there were no statistically significant male to female prevalence differences for any ethnic group.
Figure 12‑1: Lifetime Prevalence of Diabetes, Marion County, Indiana, and the U.S., 2000-2005
Source: Marion County Diabetes Study, Indiana State Department of Health, 2001; BRFSS data 2002-05; Indiana Behavioral Risk Factor Surveillance System Data, Indiana State Department of Health (2000-2005); National Behavioral Risk Factor Surveillance System Data, CDC(2000-2005), Marion County Community Health Assessment Telephone Survey (2005);
Table 12‑3: Diabetes Prevalence In the U.S., Indiana, and Marion County by Age group, Race and Gender, 2005
|
Category |
U.S. 2005 |
Indiana 2005 |
Marion County, 2005 |
|
Male |
7.7% |
9.0% |
10.1% |
|
Female |
7.2% |
7.8% |
11.1% |
|
White |
6.8% |
7.8% |
9.3% |
|
Black |
11.4% |
10.4% |
15.0% |
|
Hispanic |
6.6% |
10.0% |
7.0% |
|
Ages: 18-24 |
0.8% |
0.6% |
1.9% |
|
Age 65+ |
16.9% |
20.5% |
23.9% |
|
Total |
7.3% |
8.3% |
10.6% |
Source: Marion County Community Health Assessment Telephone Survey (2005); Indiana Behavioral Risk Factor Surveillance System Data, Indiana State Department of Health (2005); National Behavioral Risk Factor Surveillance System Data, CDC (2005).
Table 12‑4: Black and White Adult Disparity in Self Reported Diabetes Prevalence: Marion County, Indiana and U.S., 2005
|
|
Marion County 2005 |
Indiana 2005 |
U.S. 2005 |
|
Black:White Diabetes Odds Ratio |
1.61 |
1.33 |
1.67 |
The estimated prevalence of diabetes among 18 to 24 year olds in Marion County decreased from 3.6 percent in 2001 to 1.9 percent in 2005, and there were no significant differences among the three major ethnicities in under-24 year-olds. Nevertheless, Marion County’s 2005 prevalence in this age group is 2 to 3 times greater than the same age group in the state and nation (Table 12‑3).[453] Prevalence among persons over 65 years of age is also significantly higher in Marion County elders than that seen for the state or nation (Figure 12‑2).
Indiana BRFSS and Marion County SMART BRFSS surveys also estimate the prevalence of the different types and stages of diabetes. Differences between national, state and Marion County figures for diabetes and gestational-onset diabetes are not statistically significant, though the prevalence in Marion County and in Indiana tended to be higher than the national prevalence (Table 12‑5).
Table 12‑5: Prevalence of Diabetes, Gestational Diabetes, and Pre-Diabetes, Marion County: BRFSS 2005
|
|
Diabetes |
Gestational DM |
Pre-Diabetes |
No Diabetes |
|
Marion County Total[454] |
8.2% |
1.0% |
0.6% |
89.8% |
|
White[455] |
9.3% |
-- |
-- |
-- |
|
Black |
15% |
-- |
-- |
-- |
|
Hispanic |
7% |
-- |
-- |
-- |
|
Other |
|
-- |
-- |
-- |
|
Indiana: Total |
8.3% |
1.3% |
0.7% |
90.7% |
|
White |
7.8% |
1.0% |
1.0% |
90.35 |
|
Black |
10.4% |
1.2% |
1.4% |
87.0% |
|
Hispanic |
10.0% |
.07% |
1.3% |
88.1% |
|
Other |
16.5% |
N/A |
2.3% |
1.4% |
|
U.S. (median percentage) |
7.3% |
.08% |
0.8% |
90.9% |
Source: CDC BRFSS survey, SMART Marion County; BRFSS state of Indiana 2005.
Figure 12‑2: All-Diabetes Prevalence, Indiana[456] and National Population,[457] by Age group 2005
Source: Indiana BRFSS data (2005), Indiana National BRFSS data (2005) CDC.
A 2005 survey of adult obesity and related risk factors in Marion County showed a two-fold increase in diabetes prevalence among Black adults over age 25 compared to similarly aged Whites, and emerging diabetes among young women (Table 12‑6).
Table 12‑6: Marion County with Physician recognized Diabetes, 2005
|
Race/Gender Group |
Total |
18-24 |
25-64 |
65+ |
|
White, non-Hispanic Total |
9.3 |
2.1 |
7.6 |
20.2 |
|
White Males |
8.4 |
1.6 |
6.5 |
23.8 |
|
White Females |
10.2 |
2.6 |
8.7 |
17.9 |
|
Black non-Hispanic Total |
15 |
1 |
13.6 |
39.9 |
|
Black Males |
15.9 |
0 |
16.5 |
39.4 |
|
Black Females |
14.2 |
2.6 |
11.3 |
40.2 |
|
Hispanic Total |
7 |
1.4 |
7.2 |
27.7 |
|
Hispanic Males |
5.7 |
0 |
5.7 |
40 |
|
Hispanic Females |
9.1 |
3.8 |
9.6 |
16.7 |
|
Other Race/Ethnicity Total |
13.2 |
15.4 |
10.1 |
26 |
|
Other Race/Ethnicity Males |
15.1 |
0 |
12.6 |
22.2 |
|
Other Race/Ethnicity Females |
10.9 |
20 |
7.1 |
33.3 |
|
All Males |
10.1 |
0.9 |
8.7 |
26.7 |
|
All Females |
11.1 |
3.3 |
9.3 |
22.1 |
|
Marion County Total |
10.6 |
1.9 |
9 |
23.9 |
Source: 2005 Marion County Adult Obesity Needs Assessment Survey 02/23/07 (DR0502)
Adverse Outcomes and Diabetes
Diabetes represents one of the four most common, potentially avoidable reasons for hospitalization in Marion County (Table 12‑17 under the Potentially Preventable Hospitalizations heading). From 2005 to 2006, overall rates of hospitalization for diabetes-related conditions has held stable at 191 per 100,000 for all ages, but is showed a tendency to increase among adults 45 to 64 years old (Table 12‑7).
As of 2005 Marion County diabetes-related mortality was less than 27 per100,000 persons (Table 12‑7), slightly higher than the 2004 U.S. diabetes mortality rate of 24.4 per 100,000.[458]
Rates of diabetes-related admissions, amputations (43 to 47 per 100,000) and death (25 to 27 per 100,000) were stable between 1999 and 2005. In-patient dialysis rose for residents age 15 to 64 years, and total dialysis rose from 100 cases per 100,000 in 1999 to 182 per 100,000 in 2005. Note that small numbers of cases among 15 to 24 year olds may make these estimates of change between 2004 and 2005 unreliable.
Diabetic patients in the United States are 15 times more likely to have a lower extremity amputation than persons without diabetes. Amputation of the lower extremities in persons with diabetes is considered to be preventable through proper management of blood sugar and appropriate foot care.[459]
The CDC has set an objective 5-10 to reduce the rate of lower extremity amputations in persons with diabetes to no more than 500 per 100,000 persons.[460] In 2004 and 2005, Marion County had a lower limb diabetes amputation rate of 43.3 and 46.9 per 100,000 total population, respectively. It was not possible to determine a rate per 100,000 persons with diabetes and thus our rate cannot be compared to the HP 2010 objective(Table 12‑7). Renal failure and dialysis increased from 2004 to 2005 among adults under 64 years of age.
Table 12‑7: Rates of Diabetes-related Mortality, Admissions, and Amputations, Marion County Residents by Age, 2004-2005
|
|
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total |
|
Diabetic Deaths |
||||||
|
2004 |
0 |
0 |
4.1 |
26.9 |
144.1 |
25.2 |
|
2005 |
0 |
0 |
4.2 |
27.5 |
157.0 |
26.8 |
|
Diabetic Hospital Admissions |
||||||
|
2004 |
34.5 |
112.7 |
142.9 |
305.8 |
507.6 |
190.8 |
|
2005 |
32.8 |
118.5 |
145.8 |
324.9 |
445.7 |
190.6 |
|
Lower Limb Amputations |
||||||
|
2004 |
0.5 |
2.7 |
12.8 |
88.3 |
173.8 |
43.3 |
|
2005 |
0.5 |
1.8 |
15.6 |
82.6 |
208.0 |
46.9 |
|
Inpatient Dialysis |
||||||
|
2004 |
2.5 |
54.1 |
75.2 |
300.6 |
557.4 |
159.3 |
|
2005 |
0 |
212.2 |
85.1 |
319.4 |
512.5 |
182.5 |
Source: Marion County Death Data;Marion County Hospital Discharge Data (DR0490-T20); Marion County Inpatient Hospital Procedures. Rates per 100,000 total population
The age-specific death rates are crude (unadjusted) rates.
Asthma
Asthma is a condition of the lungs in which there is widespread narrowing of airways, causing varying difficulties in breathing. It is the leading chronic illness among U.S. children and the leading cause of school absenteeism due to a chronic illness. Decreases in lung function and a worsening of asthma are associated with exposure to allergens, indoor pollutants such as cigarette smoke, and ambient air pollutants such as ozone, particulate matter, and sulfur dioxide.[461]
Total Marion County asthma rates declined significantly from 2001 to 2002, and declined more slowly over the next 3 years. In 2005, 11 percent of Marion County adults self-reported having ever been diagnosed with asthma (lifetime prevalence) compared to 12.6 percent of adults in the U.S. and 12.7 percent of Indiana adults.[462] At the state and national level, the lifetime prevalence of asthma appears to be increasing, and was estimated to be about one percentage point higher than in Marion County in both 2004 and 2005 (Figure 12‑3).
Figure 12‑3: Prevalence of Asthma, Marion County, Indiana, and the U.S.
Source: Marion County Community Health Assessment Telephone Survey (2001); Indiana Behavioral Risk Factor Surveillance System Data, Indiana State Department of Health (2005); National Behavioral
Effective management of asthma can prevent many hospital admissions. Good management requires reduced exposure to factors that trigger asthma episodes, managing asthmatic bronchial response with medication, objective monitoring of lung function, and educating patients to become partners in their own care.
Hospitalization rates by age, race, and sex for Marion County residents are shown in Table 12‑8. A Healthy People 2010 objective 24-2 is to reduce asthma-related admissions among children under 18 to 250 per 100,000[463]. In 2004, the U.S. asthma hospitalization rate among children under 18 years old was 270 per 100,000.[464] Marion County’s 2005 child asthma hospitalization rate for children under 15 was 200.8 per 100,000, ranging between 87 and 443 per 100,000 (White girls and Black boys, respectively) which is considerably lower than 310 per 100,000 nationally[465]. Among elders over 65, the total discharge rates per 100,000 persons due to asthma (324.7)[466] are far higher than national rates (287 per 100,000) and the Healthy People 2010 objective 24-2 for this age-group (110 per 100,000).[467]
Overall the Marion County rate of asthma-related hospital discharges was 155.1 per 100,000 , significantly lower than the national total asthma discharge rate of (170 per 100,000 persons)[468] (See Table 12‑8).
Table 12‑8: Asthma-related Hospitalization Rates per 100,000 Persons by Age, Race, and Gender, 2005 Marion County Residents
|
Race/Gender Group |
Age |
|||||
|
<15 |
15-24 |
25-44 |
45-64 |
65+ |
Total |
|
|
Whites |
94.1 |
28.4 |
50.1 |
115.5 |
243.8 |
96.5 |
|
White Males |
100.1 |
36.5 |
18.7 |
36.9 |
133.9 |
54.3 |
|
White Females |
87.7 |
20.2 |
83.3 |
190.8 |
314.6 |
137.3 |
|
Blacks |
351.0 |
77.4 |
100.6 |
307.0 |
378.0 |
228.0 |
|
Black Males |
442.9 |
64.0 |
66.7 |
179.3 |
244.3 |
208.2 |
|
Black Females |
258.0 |
90.4 |
129.0 |
410.1 |
460.3 |
245.4 |
|
Males |
239.1 |
45.8 |
35.9 |
82.6 |
187.5 |
110.2 |
|
Females |
160.8 |
53.4 |
115.8 |
289.0 |
412.6 |
197.3 |
|
Total |
200.8 |
49.6 |
75.9 |
191.2 |
324.7 |
155.1 |
Source: 2005 Marion County Hospital Discharge Data (DR0490-T21-22)
There were significant disparities in rates of asthma-related hospital admissions by race and gender (Table 12‑9). Among children under age 15, Blacks were 2 to 4 times more likely to be hospitalized for asthma than Whites. This disparity by race continued, if to a lesser degree, through the life span. Overall, Blacks were more than twice as likely to have an asthma-related hospitalization than Whites. Black females had the highest prevalence of asthma-related hospitalizations among all groups.
Relative to males’ rates, females’ rates of asthma hospitalizations increased with age. By age 45 to 64 years, females were 3.5 times more likely than males to be hospitalized due to asthma. Overall, females were 1.8 times more likely to be hospitalized from this disease than males (Table 12‑9).
Table 12‑9: Ratios of Rates of Hospital Admissions Due To Asthma by Race and Sex, Marion County Residents, 2005
|
Age Group |
Black to White |
Female to Male |
|
<15 |
3.7 |
0.7 |
|
15-24 |
2.7 |
1.2 |
|
25-44 |
2.0 |
3.2 |
|
45-64 |
2.7 |
3.5 |
|
65+ |
1.6 |
2.2 |
|
Total |
2.4 |
1.8 |
Source: 2005 Marion County Hospital Discharge Data (DR0 490; T21-22)
Cancer Incidence
Four cancers cause the greatest numbers of new cancer cases in the U.S., Indiana, and Marion County: lung-bronchus, colorectal (in both sexes) and prostate and breast cancers. Marion County exceeds both state and national total lung-bronchus and breast cancer incidence rates for 2000-2002, and U.S. colorectal rates, while its prostate cancer rate is similar or lower than the state and nation (Table 12‑10.).
The National Cancer Institute, CDC, and states with cancer registries like Indiana gather data on new (incident) cancer cases as they are diagnosed in the general population, allowing estimates of the likelihood or residents’ risk of developing each type of cancer (incidence rate). The most recent data for Marion County and the state are from 2000-2002.
Table 12‑10: Marion County, Indiana and U.S. Leading Cancers’ Incidence per 100,000 for All Ages: 2000-2002
|
|
MC Total Incidence 2000-02 |
Indiana Incidence 2000-2002 |
U.S. Incidence 2002 |
Significant MC difference? |
|
All sites |
506.9 (497.8, 516.1) |
469.2 (466.1, 472.4) |
462.2 (461.4, 463.0) |
Higher than both |
|
Lung-Bronchus |
95.7 (91.7, 99.8) |
79.5 (78.2, 80.8) |
67.5 (67.2, 67.8) |
Higher than both |
|
Colon-Rectal |
55.0 (53.9, 60.1) |
56.5 (56.2, 58.4) |
52.0 (51.7, 52.3) |
Higher than U.S. |
|
Female Breast |
137.2 (131.0, 143.7) |
123.2 124.0, 128.5) |
124.9 (124.4, 125.5) |
Higher than both |
|
Prostate |
148.8 (141.1, 156.9) |
140.5 (137.8, 143.2) |
161.2 (160.4, 161.9) |
Same as IN Lower than U.S. |
Incidence rates (cases per 100,000 persons per year) are age-adjusted to the 2000 U.S. standard population (19 age groups: <1, 1-4, 5-9, ... , 80-84, 85+). NCI State Cancer Profiles
Source: CDC/National Cancer Institute' State Cancer Profiles from the National Program of Cancer Registries Cancer Surveillance System (NPCR-CSS) http://www.statecancerprofiles.cancer.gov/incidencerates/index.php?stateFIPS=18&cancer=055&race=00&age=001&type=incd&sortVariableName=rate http://www.statecancerprofiles.cancer.gov/cgi-bin/quickprofiles/profile.pl?18&047
Colon cancer incidence rates show both Marion County and Indiana rates to be significantly higher than those for the nation in 2000 through 2002. Marion County’s rate however is not significantly different from the state’s or the nation’s (Table 12‑10). Some 440 cases of colon-rectal cancer were reported among Marion County residents from 2000 through 2002.
While 13 other metropolitan counties surpass Marion County’s breast cancer incidence rate, the Marion County rate is statistically greater than the state or nation (e.g. confidence intervals for the 3 estimates do not overlap). Over 600 new cases of breast cancer were detected in Marion County from 2000 through 2002.
Health Screenings for Early Detection
Breast Cancer Screening
Mammography detects breast cancer about 1.7 years earlier than by clinical or self-breast exam alone. However, almost one-third of Indiana women aged 40 and older reported in BRFSS surveys that they had not had a mammogram in the past two years. From 1995 to 2001, 64 percent of all U.S. breast cancer cases were diagnosed early (in situ or at a local stage). Five-year survival rates for early diagnosed cases were 98 percent in this period, with 90 percent in remission 10 years after diagnosis. In 2000 through 2003, 69 percent of breast cancers were diagnosed at early stages.[469]
Nationally breast cancer screening rates have met the HP 2010 objective3-13 that 70 percent of women 40 years and older having had screening mammography within the past 2 years[470]. Marion County rates of screening have also met that objective as of 2004. Trends in women getting screening mammography have been rising until 2000 then stabilizing for Whites while continuing to rise for other racial-groups.[471]
|
|
Marion County 2005 |
Indiana 2005 |
U.S. Average 2005 |
HP 2010 Objective |
|
% Women 40+ Screened in the past 2 years (95% CI) |
75 |
71.6 |
76.5 |
70% |
National, Indiana, and Marion County screening mammography rates among women over age 40 have all declined since 2000. In 2002, mammography rates were notably better in Marion County than in the state overall (82% verses 69%). But, by 2005, the Marion County rate had declined to 75 percent while the state rate had increased to 73.5 percent. The Marion County, Indiana, and U.S. mammography rates all exceeded Health People 2010 objective of 70 percent screening rates among women over 40 (Figure 12‑4).[472]
Figure 12‑4: Percentage of Marion County Women Older than 40 Having A Mammogram in Past 2 Years
Source: Marion County BRFSS_SMART Surveys (2000, 2002, 2004); Indiana BRFSS Data, (2000, 2002 2004); National BRFSS Data, CDC (2000, 2002, 2004); Healthy People 2010, U.S. Department of Health and Human Services.
Colon Cancer Screening
In 2006, the BRFSS included questions on whether respondents over age 50 had a fecal occult blood test (FOBT) within the past two years or have ever had a screening “sigmoidoscopy or colonoscopy”.
In 2006 22.3 percent of Marion County residents over age 50 had a fecal occult blood test (FOBT) within the past 2 years, and 62.3 percent had at least one flexible sigmoidoscopy or colonoscopy examination. Rates were similar to the one in five Indiana residents over 50 and 24 percent of adults nationally who reported having a FOBT. Rates were higher among Marion county residents however than the over 50 percent of Hoosiers who had a colonoscopy in the previous 2 years, and the 57% percent of U.S. adults with this screening test.
The Healthy People 2010 objective 3-12b is that 50 percent of adults over 50 who have ever had screening colonoscopies.[473] Use of fecal occult testing in Indiana still falls significantly short of state FOBT screening prevalence and of the Healthy People 2010 objective 3-12a that 33 percent of adults have a FOBT.[474]
Between 2000 and 2003, less than half (41%) of Indiana colorectal cancers were diagnosed early. Survival exceeds 90 percent when the cancer is diagnosed before it has extended beyond the intestinal wall, compared to 75 percent for prostate and 69 percent for breast cancer.[475]
|
% Marion County adults: FOBT |
% IN adults: FOBT |
% U.S. adults: FOBT |
% Marion County adults: Colonoscopy |
% IN adults: Colonoscopy |
% U.S. adults: Colonoscopy |
HP 2010 FOBT |
HP 2010 Colonoscopy |
|
22.3 |
21.1 |
24.1 |
62.3 |
56.4 |
57.1 |
33 |
50% |
|
(18.3-26.2) |
(19.5-22.7) |
(N/A) |
(57.7-66.8) |
(54.5-58.3) |
(N/A) |
|
|
Source: NCI http://www.statecancerprofiles.cancer.gov/risk/risk.html
http://apps.nccd.cdc.gov/brfss-smart/MMSACtyRiskChart.asp?yr2=2006&CtyCode=38&cat=CC&MMSA=39&qkey=4425&grp=0
Cervical Cancer Screening
Nationally, from 1995 to 2000, 55 percent of cervical cancer cases were diagnosed early and the five-year survival rate for these women was 92 percent. In Indiana, from 2000 through 2003, 85 percent of cervical cancers were diagnosed in early stages, but African American women were more likely to be diagnosed at a later stage than were White women.[476]
The Marion County, Indiana, and U.S. rates of cervical cancer screening Pap exams all declined from over 94 percent in 2000 to under 87 percent in 2004 (Figure 12‑5). In 2004, a slightly higher proportion of Marion County women reported having pap tests (86.6%) than Indiana women overall (82.5%). All levels fail to meet Healthy People 2010 objective 3-11a. that 97 percent of women over age 18 have had a Pap exam[477] (Table 12‑13.).
Figure 12‑5: Percentage of Marion County Women Having A Pap Test
Source: Marion County BRFSS_SMART Surveys (2000, 2002, 2004); Indiana BRFSS Data, (2000, 2002 2004); National BRFSS Data, CDC (2000, 2002, 2004); Healthy People 2010, U.S. DHHS.
Table 12‑13: Women 18+ Reporting Annual Pap in Past Year: Marion County, Indiana and U.S, 2004 and 2005
|
|
Marion County 2004 |
Indiana 2005 |
U.S. Average 2005 |
HP 2010 Objective |
|
% Women 18+ with Pap Exam |
86.6 |
82.5 |
85.9 |
97 |
Source: Marion County BRFSS_SMART Surveys (2004); Indiana BRFSS Data, (2005); National BRFSS Data, CDC (2005); Healthy People 2010, U.S. DHHS
Other Cancers
Prostate cancer is the most commonly diagnosed cancer among Indiana males, accounting for over 42 percent of all new cancer cases in men. Having annual Digital Rectal Exams (DRE) and Prostate-Specific Antigen (PSA) tests is recommended for all men over age 50 for early cancer detection. In 2006, while 85 percent of all Indiana men were diagnosed in early stages, Black men had both a higher incidence rate and a higher mortality rate than their White counterparts (214.7 and 64.7 per 100,000).[478]
Screening tests for lung cancer include chest x-rays, sputum analyses, or fiber optic bronchial exams. Five-year lung cancer survival is highest if diagnosed when lung cancer is confined within the lung. In Indiana only 18 percent of lung cancers were diagnosed at the local stage between 2000 and 2003.[479] Even when diagnosed early, lung cancer has a 45 percent five-year mortality rate.
Late-Stage Diagnosis of Cancer
Cancer diagnosis includes information about the cancer’s stage of development, which may be expressed numerically (I, II, III, or IV) or by terms such as "localized," "regional," and "distant." The earlier the detection in the cancer’s stage of development, the lower the enumerated “stage”, the more localized to the original tissue, and the better likelihood that treatment will be effective. Tracking late-detected cancers is one way to monitor the impact of cancer screening.[480]
As people become more aware of the value of cancer screening, late-detected stages of cancer rates have been falling nationally for some cancers since the 1990s, especially for prostate cancer, since the introduction of the prostate-specific antigen (PSA) test. However, late stage detection in breast cancer has changed little over the past 15 years. In 2003 in the U.S., seven cases of late stage diagnosis per 100,000 persons occurred for each of prostate, colon, and female breast cancer – those with available and effective screening tests. In the same year, 0.7 cases of cervical cancer per 100,000 women were detected in their late stages.[481] Persons most at risk for late stage cancer diagnosis are those without health insurance and/or a regular source of health care, and low-income populations.[482]
Acute Care Use: Hospitalizations and Procedures
Total Hospitalizations
Marion County’s 2005 hospitalization rate for women (1,335 discharges per 10,000 women) was similar to the 2004 national rate (1,411)[483] while the Marion County rate for men (882 discharges per 10,000 men) was slightly lower than the national rate (965) (Table 12‑14).[484],[485] At both the national and Marion County levels, females were 55 percent more likely to be hospitalized than males. A substantial portion of this difference can be attributed to hospitalizations for childbirth.
Table 12‑14: Marion County[486] and U.S. Hospital Crude Admission Rates per 10,000 Population by Gender and Race, 2005
|
Race |
Males |
Females |
Total |
|
White |
601.3 |
1,006.9 |
807.5 |
|
Black |
834.1 |
1,178.3 |
1,017.3 |
|
Other |
4,984.3 |
7,021.9 |
6,020.9 |
|
Marion County Total |
882.1 |
1,334.6 |
1,114.9 |
|
U.S. Total (2004) |
964.9 |
1,411.3 |
1,192.3 |
Source: Marion County Hospital Discharge Data (DR0490-T9); U.S.: National Hospital Discharge Survey, CDC, NCHS.[487]
The difference between hospitalization rates of Blacks and Whites has decreased. In 2005, Blacks had a 27 percent higher admission rate than did Whites, whereas in 1998 Blacks’ admission rate was 40 percent higher than Whites. In 2005, persons categorized as “Other races” (including Hispanic, Asian, Pacific Islander, Alaskan/Native American, and multiple-race categories) had admission rates 7.5 times greater than Whites and 6 times greater than Blacks.[488]
Among patients over the age of 15 years, persons over 65 years old made up about one-third of Marion County’s discharges. Ages 25 to 44 year and 45 to 65 years each made up one-quarter of these discharges, while 15 to 24 year olds made up only 10 percent (Table 12‑16).
Leading Diagnoses for All Discharges
In 2005, the leading causes of hospitalization in Marion County were heart and circulatory disorders, childbirth and pregnancy, and respiratory conditions. The relative contribution among the major causes[489] was similar for Marion County residents and the U.S. population as a whole. However, Marion County had slightly higher rates for birth complications, and lower rates for digestive disorders and coronary conditions (Table 12‑15). Nationally, in 2002, circulatory system diseases account for 17 percent of all hospital stays, 12 percent were related to pregnancy and childbirth (the mother's stay), and 11 percent are related to the newborn infant stays.[490]
Admission rates and reasons for using acute-care varied by age group. Children under age 15 years were most frequently admitted for respiratory ailments (22.8% of hospitalizations) and mental health related causes (17%). Among 15 to 24 and 25 to 44 year-olds, 64 percent and 40 percent of admissions, respectively, were for birth complications, as these are the primary childbearing ages for women.
The second most common discharge diagnosis for Marion County patients aged 15 to 44 years was for a mental health condition (11%). Admission rates for psychoses have increased 35 percent between 1994 and 1999, and a further 22 percent since 2000. Nationally, among patients 18 to 44 years old, pregnancy and delivery, mental illness, or substance abuse are among the top 10 reasons for admission. Depression one of the 10 most common reasons for admission condition for 3 different age groups: 1 to 17, 18 to 44, and 45 to 64 years old.[491]
In persons over 45 years of age, chronic circulatory conditions made up between 20 and 27 percent of discharges, with respiratory illness contributing 10 to 15 percent.
Table 12‑15: Percentage of Marion County Residents’ (2005) and U.S. (2004) Hospitalizations by Age and Diagnostic Group
|
Disease Group[492] |
Age in years |
MC Total |
U.S. Total |
||||
|
<15 |
15-24 |
25-44 |
45-64 |
65+ |
|||
|
Infectious & parasitic diseases |
3.6 |
1.0 |
2.2 |
2.7 |
3.7 |
2.8 |
2.7 |
|
Neoplasms |
1.4 |
0.5 |
3.7 |
7.6 |
5.7 |
5.0 |
4.7 |
|
Endocrine, nutritional & metabolic diseases, & immunity disorders |
5.6 |
1.9 |
3.5 |
5.2 |
3.7 |
3.9 |
5.0 |
|
Diseases of the blood & blood-forming organs |
2.5 |
1.5 |
1.0 |
1.1 |
1.0 |
1.2 |
1.3 |
|
Mental disorders |
17.8 |
11.3 |
11.4 |
7.6 |
2.3 |
7.6 |
6.6 |
|
Diseases of the nervous system & sense organs |
2.7 |
0.6 |
1.4 |
1.6 |
2.2 |
1.7 |
1.6 |
|
Diseases of the circulatory system[493] |
1.0 |
1.0 |
5.5 |
21.1 |
26.7 |
16.2 |
18.3 |
|
Diseases of the respiratory system |
22.8 |
1.8 |
3.7 |
10.5 |
15.0 |
10.2 |
10.2 |
|
Diseases of the digestive system |
5.5 |
3.1 |
7.3 |
10.9 |
8.7 |
8.2 |
10.3 |
|
Diseases of the genitourinary system |
2.9 |
1.8 |
4.8 |
5.1 |
6.5 |
5.1 |
5.6 |
|
Complications of pregnancy, childbirth, & the puerperium[494] |
0.7 |
64.2 |
40.3 |
0.1 |
0.0 |
16.4 |
13.4 |
|
Diseases of the skin & subcutaneous tissue |
3.0 |
0.9 |
1.7 |
2.4 |
1.5 |
1.8 |
2.2 |
|
Diseases of the musculoskeletal system & connective tissue |
1.0 |
0.6 |
2.0 |
6.2 |
5.4 |
4.1 |
5.5 |
|
Congenital Anomalies |
4.6 |
0.2 |
0.2 |
0.3 |
0.1 |
0.4 |
0.6 |
|
Certain conditions originating in the perinatal period[495] |
7.6 |
0 |
0 |
0 |
0 |
0.4 |
0.6 |
|
Symptoms, signs, & ill-defined conditions |
6.5 |
1.1 |
3.1 |
6.2 |
4.9 |
4.5 |
0.7 |
|
Injury & poisoning |
8.6 |
5.8 |
7.0 |
8.1 |
7.9 |
7.5 |
8.2 |
|
Supplementary classifications |
2.2 |
3.0 |
1.2 |
3.5 |
4.6 |
3.2 |
2.7 |
Source: Marion County Hospital Discharge Data (DR0490-T11); U.S.: National Hospital Discharge Survey, CDC, NCHS.[496]
* The total Marion County percentages are not age-adjusted. Some of the difference between theses and the U.S. percentages may be due to differences in the population age distributions.
Payment Sources for Acute Care
Hospital care was paid for by a variety of payers, depending on the age, socio-economic status and eligibility of the patient. In 2005, over half (56.2%) of hospitalizations for patients aged 15 to 24 years were covered by Medicaid, as were one of every four admissions (26.6%) among those 25 to 44 years old (Table 12‑16). In the Marion County population, nearly 90 percent of admissions for persons over 65 were charged to Medicare as the primary payer.[497]
Commercial insurance and managed care organizations were the principal payer sources for working-age individuals (covering between 18 to 28 percent of these age groups). Between 9 and 11 percent of inpatient care was paid by some combination of the patient’s resources, un-reimbursed (charity) care, or other public programs such as HHC Advantage for Marion County residents.[498]
Nationally, for patients of all ages, Medicare covers 44 percent of all stays, Medicaid pays for 18 percent, private insurance pays for 31 percent, and 5 percent of stays are uninsured. Other payer sourcesi are billed for approximately 3 percent of all hospital stays in U.S. community hospitals.[499]
Table 12‑16: Percent of Hospital Discharges by Payer-Source, Marion County Residents, 2005, by Age
|
Payer Type |
Age Group |
|
|||
|
15-24 |
25-44 |
45-64 |
65+ |
Total > 15 years |
|
|
Medicare |
1.1 |
8.3 |
22.4 |
89.2 |
38.9 |
|
Medicaid |
56.2 |
26.6 |
13.2 |
0.8 |
19.0 |
|
Other Governmental |
1.2 |
0.6 |
0.8 |
0 |
1.0 |
|
Commercial |
14.8 |
29.8 |
28.9 |
2.9 |
17.8 |
|
Managed Care |
16.1 |
21.2 |
18.2 |
1.5 |
13.1 |
|
Self-Pay |
9.7 |
11.1 |
9.1 |
0.4 |
6.4 |
|
Other/Unknown |
0.7 |
2.4 |
7.4 |
5.1 |
4.4 |
|
Total (% of all admissions) |
10.8 |
23.4 |
26.0 |
34.7 |
|
Source: 2005 Marion County Hospital Discharge Data (DR0490-T10)
Potentially Preventable Hospitalizations
Potentially preventable hospitalizations are a leading cause of admission for all ages (Table 12‑17). Hospital admission rates for “ambulatory care sensitive conditions” serve as an indicator of both limited access to primary care and low-quality primary care.[500]
Comparing Marion County’s number of potentially preventable admissions in 2000 and 2005, three major conditions increased: diabetes related admissions by 13 percent, cellulitis cases increased 38 percent, and malignant hypertension admissions increased 6 percent.
Numbers of admissions for asthma, heart failure, bleeding ulcer, congestive heart failure, and ruptured appendix have decrease by 6 to 14 percent, respectively, during this period.
Table 12‑17: Frequency of Potentially Preventable Hospitalizations Marion County Residents, 2000 and 2005
|
Cause of Hospitalization |
2000 |
2005 |
Percent Change |
|
Asthma |
1425 |
1338 |
(6.1%) |
|
Pneumonia |
3398 |
3433 |
1.0% |
|
Congestive Heart Failure |
3450 |
3092 |
(10.4%) |
|
Cellulitis |
990 |
1369 |
38.3% |
|
Diabetes |
1286 |
1452 |
12.9% |
|
Pyelonephritis |
418 |
359 |
(14.1%) |
|
Perforated/Bleeding Ulcer |
416 |
370 |
(11.1%) |
|
Ruptured Appendix |
220 |
197 |
(10.5%) |
|
Hypokalemia |
64 |
61 |
(4.7%) |
|
Malignant Hypertension |
95 |
101 |
6.3% |
|
Total |
11,762 |
11,772 |
--- |
Source: 2000, 2005 Marion County Hospital Discharge Data (DR0490-T12-13)
Ambulatory Care Sensitive (ACS) Conditions
Ambulatory care sensitive (ACS) conditions are conditions for which hospitalizations may be prevented by appropriate access to primary care.[501] These conditions are often considered to be indicators of limited access to primary care, or of low-quality primary care. ACS conditions may occur more frequently if patients do not have a usual source of primary care, do not receive or adhere to treatments, rely on episodic emergent care, or cannot afford prescribed treatments. Proper disease management may help individuals avoid hospitalizations due to these conditions.
Nationally, 12 percent of all admissions have been attributed to ACS conditions.[502] Healthy People 2010 set objective 1-9 for three specific ACS conditions: 17.3 pediatric asthma cases per 10,000 admissions in persons under 18; 5 uncontrolled diabetes cases per 10,000 admissions in persons 18 to 64 years old; and 8 vaccine preventable influenza and pneumonia cases per 10,000 admission in patients over 65.[503]
Marion County’s overall rate of congestive heart failure (CHF) admissions declined by over 10 percent between 2000 and 2005. The total 2005 CHF discharges of 374.2 per 100,000 was similar to the overall rate in the U.S. (373 per 100,000)[504].
In contrast, the rate of diabetes-related admissions [505] increased 12.9 percent between 2000 and 2005 (See Table 12‑17.).
The four leading ACS conditions in Marion County are pneumonia, congestive heart failure, asthma, and diabetes. Their total contribution to admissions or 10 percent of admissions has not changed since 2000, and do not differ from overall U.S. estimates (Table 12‑18).
Table 12‑18: Percentage of ACS Conditions Admitted: Marion County 2000 & 2005, and U.S. 2004
|
Cause |
Marion County 2000 |
Marion County 2005 |
U.S. 2004 |
|
Pneumonia |
3.5% |
3.6% |
3.8% |
|
Congestive Heart Failure |
3.6% |
3.2% |
3.1% |
|
Asthma |
1.5% |
1.4% |
1.4% |
|
Diabetes |
1.3% |
1.5% |
1.7% |
|
Total Admissions |
96,110 |
96,231 |
|
Source: Marion County Hospital Discharge Data 2000,2005 (DR0490-T12-13); U.S.: National Hospital Discharge Survey, CDC, NCHS.[506]
Changes in Hospital Utilization
Between 2000 and 2005, admission rates increased for several of the most common diagnoses, including Cesarean births, psychoses, pneumonia, and Chronic Obstructive Pulmonary Disease (COPD). The greatest percentage increase was 32 percent for Cesarean section rates (Table 12‑19). In 2005, Cesarean sections made up 30.2 percent of all births in the U.S.[507] Healthy People 2010 objective 16-9 for maternal and child health include a 15 percent Cesarean section rate among all low-risk (full-term, singleton, vertex presentation) primapara mothers.[508]
Hospital admission rates for psychoses increased 35 percent between 1994 and 1999, and increased 22 percent more in the past five years. Like many chronic conditions, mental health conditions often can be effectively treated and controlled through appropriate mental health care. The growth in hospitalizations may indicate need for greater outpatient mental health services.
Table 12‑19: Leading Causes for Admission Among Marion County Residents: Frequency and Rate per 100,000 Persons, 2000 and 2005
|
Cause |
2000 |
2005 |
Percent Change |
||
|
Frequency |
Rate |
Frequency |
Rate |
||
|
Vaginal Delivery* |
11,153 |
2510.0 |
10,185 |
2293.5 |
-8.6% |
|
Cesarean Delivery* |
2,985 |
671.8 |
3,938 |
886.8 |
32.0% |
|
Heart Failure and Shock |
3,220 |
374.2 |
3,062 |
354.8 |
-5.2% |
|
Psychoses |
3,612 |
419.8 |
4,428 |
513.0 |
22.2% |
|
Non-malignant Uterine Tumors* |
2,092 |
470.8 |
1,768 |
398.1 |
-15.4% |
|
Pneumonia (> age 17) |
2,735 |
317.9 |
2,840 |
329.0 |
3.5% |
|
Chronic Obstructive Pulmonary Disease |
2,096 |
243.6 |
2,213 |
256.4 |
5.3% |
* per 10,000 women
Source: Marion County Hospital Discharge Data 2000, 2005 (DR0490-T14)
Inpatient Hospital Procedures
Over 60,000 hospital procedures were performed on Marion County residents during 2005, with the greatest portion being performed on individuals 15 to 44 years old (40%) and in those over age 65 (30%) (Table 12‑20). The high proportion of procedures among 15 to 44 year olds is heavily influenced by women’s obstetrical procedures during their child-bearing years.
Table 12‑20: Number and Percent of Inpatient Procedures by Age, Marion CountyResidents 2005, and U.S. 2004
|
Age (years) |
Total Number of Procedures, Marion County 2005 |
Percent of All Procedures, Marion County 2005 |
Percent of All Procedures, U.S. 2004 |
|
Less Than 15 |
2,023 |
3.4% |
5.1% |
|
15 – 44 |
24,012 |
40.0% |
33.6% |
|
45 – 64 |
15,585 |
25.9% |
26.0% |
|
65 Plus |
18,477 |
30.8% |
35.3% |
|
Total |
60,097 |
100% |
100% |
Source: Marion County Hospital Discharge Data 2005 (DR0490-T15); U.S. National Hospital Discharge Survey, CDC, NCHS.[509] Totals may not equal the sum of categories due to rounding.
The distribution of hospital procedures in Marion County in 2005 was generally similar to that of the nation in 2004. The largest differences were that nearly one-fourth of all procedures performed in Marion County were for obstetrical conditions, compared to 15.5 percent nationally, and only 18 percent of Marion County procedures fell in the miscellaneous or new technology category, compared to 29 percent nationally.
Besides obstetrical and diagnostics, the most frequent hospital procedures included cardiovascular (17.6%), digestive (13.8%) and musculoskeletal systems (9.9%) procedures for both Marion County and the nation (Table 12‑21).[510]
Table 12‑21: Percentage of Hospital Inpatient Procedures, by Type, Marion County Residents (2005), and National Discharge Data (2004)
|
Procedure |
Percent Of All Procedures Marion County 2005 |
Percent Of All Procedures U.S. 2004 |
|
Obstetrical procedures |
23.8% |
15.5% |
|
Miscellaneous diagnostic and therapeutic procedures and new technologies[511] |
17.7% |
29.4% |
|
Operations on the cardiovascular system |
17.6% |
15.5% |
|
Operations on the digestive system |
13.8% |
12.9% |
|
Operations on the musculoskeletal system |
9.9% |
9.0% |
|
Operations on the female genital organs |
4.4% |
4.6% |
|
Operations on the respiratory system |
3.1% |
2.3% |
|
Operations on the integumentary system[512] |
3.0% |
3.3% |
|
Operations on the nervous system |
2.6% |
2.9% |
|
Operations on the urinary system |
2.0% |
2.1% |
|
Operations on the male genital organs[513] |
0.7% |
0.5% |
|
Operations on the hemic and lymphatic system |
0.6% |
0.8% |
|
Operations on the nose, mouth, and pharynx |
0.4% |
0.7% |
|
Operations on the endocrine system |
0.3% |
0.2% |
|
Operations on the eye |
0.1% |
0.2% |
|
Operations on the ear |
0.1% |
0.1% |
Source: Marion County Hospital Discharge Data 2005 (DR0490-T16); U.S.: National Hospital Discharge Survey, CDC, NCHS.[514] Aggregated procedures in this chart follows ICD-9 formatting from CDC Advance Data From Vital and Health Statistics Number 371, May 4 2006, page 8. Totals may not equal the sum of categories due to rounding.
Obstetrical procedures account for over half of all procedures done among patients under age 44 (Table 12‑22). In progressively older age groups, the most common types of procedures are for diagnostic, cardiovascular, digestive, and musculoskeletal system interventions. These four procedure categories make up over three-quarters of procedures for the 45 to 64 year olds, reflecting the greater prevalence of chronic diseases in older age groups.[515]
Table 12‑22: Percent of Hospital Procedures In Marion County Residents by Age, 2005
|
Procedure |
Age |
||
|
15-24 |
25-44 |
45-64 |
|
|
Obstetrical procedures |
76.8 |
50.8 |
0.1 |
|
Miscellaneous diagnostic and therapeutic procedures and new technologies |
4.7 |
8.6 |
22.5 |
|
Operations on the cardiovascular system |
4.7 |
7.9 |
25.9 |
|
Operations on the digestive system |
4.3 |
10.1 |
17.7 |
|
Operations on the musculoskeletal system |
2.8 |
5.0 |
12.6 |
|
Operations on the male genital organs |
0.0 |
0.1 |
1.1 |
|
Operations on the female genital organs |
2.1 |
8.6 |
5.3 |
|
Operations on the respiratory system |
0.8 |
1.8 |
4.0 |
|
Operations on the integumentary system |
1.3 |
2.7 |
3.7 |
|
Operations on the nervous system |
1.3 |
2.1 |
2.7 |
|
Operations on the urinary system |
0.7 |
1.3 |
2.6 |
|
Operations on the hemic and lymphatic system |
0.2 |
0.4 |
0.8 |
|
Operations on the nose, mouth, and pharynx |
0.2 |
0.3 |
0.4 |
|
Operations on the endocrine system |
0.0 |
0.3 |
0.4 |
|
Operations on the eye |
0.1 |
0.0 |
0.1 |
|
Operations on the ear |
0.0 |
0.0 |
0.0 |
Source: Marion County Hospital Discharge Data, 2005 (DR0490-T16). Aggregated procedures in this chart follows ICD-9 formatting from CDC Advance Data From Vital and Health Statistics Number 371, May 4 2006, page 8. Totals may not equal the sum of categories due to rounding.
Lost work days
There were 30,100 occupational injuries and illnesses in Indiana in 2004 resulting in days away from work. This number decreased to 26,900 in 2005.[516] No equivalent data were available for Marion County at the time of this report.