Complications of diabetes included in the study were kidney disease, loss extent early treatment and preventive measures are successful, diabetes …
Agency for Health Care Administration State Center for Health Statistics
Document Abstract
1999 Report
Title: Summary:
Health Outcomes Series: Complications of Diabetes Study
The Florida Agency for Health Care Administration AHCA has prepared a study of health outcomes among diabetes patients In 1998, 56,139 hospitalizations of patients with a diabetes complication were reported by Florida hospitals The average age was 65 years up from 63 years and 30,116 hospitalizations in 1992 Complications of diabetes included in the study were kidney disease, loss of vision, nerve damage, and peripheral circulatory disorders involving diminished blood flow to the legs and feet The average age of amputation with a diabetes diagnosis was 67 years up from 66 years in 1992 The average age of in-hospital deaths with a diabetes diagnosis, 74 years, did not change from 1992 to 1998 Hospital charges for hospitalizations with a diabetes complication as the first listed diagnosis were 2226 million in 1998
Future Policy Implications:
The aging of the population means that more people are susceptible to the development of diabetes and more people are living with diabetes To the extent early treatment
and preventive measures are successful, diabetes morbidity and health care costs will be reduced by delaying the average age of onset of diabetes complications Section 408023, Florida Statutes directs the AHCA to summarize health care outcomes
Relevant Florida Statutes: For Information Contact:
Carolyn H Turner, State Center for Health Statistics, 850 922-5861 To view or print any report in the Health Outcome Series, please visit the following web site: wwwfloridahealthstatcom
Health Outcome Series: Complications of Diabetes Study
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AHCA State Center for Health Statistics
Table of Contents
Abstract of Report i Table of Contents iii Executive Summary v Introduction1 Complications of Diabetes3 Amputations with a Diabetes Diagnosis7 Deaths with a Diabetes Diagnosis10 Hospital Charges for Diabetes Complications12 Insurance Status of Patients with Diabetes Complications13 Discharges to Skilled Nursing Facilities and Other Facilities 14 Complications of Diabetes Treated at Florida Hospitals 15 Conclusions and Future Studies20 References 21 Appendices 1: Diabetes Complications, ICD-9-CM Codes and Descriptions22 2: Diabetes Diagnoses, ICD-9-CM Codes and Descriptions 24 3:
Amputation Procedures, ICD-9-CM Codes and Descriptions 25 4: Complications of Diabetes Hospitalizations, 1992 1998 27 5: National Diabetes Statistics with Florida Estimates28 6: Frequent Principal Diagnoses for Complications of Diabetes, 199829
Health Outcome Series: Complications of Diabetes Study
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AHCA State Center for Health Statistics
Executive Summary
The aging of the population means that more people are susceptible to the development of diabetes and more people are living with diabetes To the extent early treatment and preventive measures are successful, diabetes morbidity and health care costs will be reduced by delaying the average age of onset of diabetes complications In 1998, 56,139 hospitalizations of patients with a diabetes complication were reported by Florida hospitals The average age was 65 years up from 63 years in 1992 Average age of amputation was 67 years in 1998 and 66 years in 1992 The average age of inhospital deaths with a diabetes diagnosis, 74 years, did not change from 1992 to 1998 Hospitalizations with reported complications increased each year from 30,116 in 1992 This study included long-term diabetes complications such as kidney disease,
loss of vision, nerve damage, peripheral circulatory disorders, and other reported complications of diabetes Short-term diabetes complications such as diabetic coma were not included unless combined with a long-term complication Among complication types, renal kidney complications had the largest increase in average age, to 63 years, up from 60 years in 1992 Complications involving diminished blood circulation to the extremities had no change in the average age of 67 years from 1992 to 1998 Among racial groups, black and black Hispanic patients were hospitalized at younger ages for diabetes complications than white patients or white Hispanic patients The average age of black and black Hispanic patients was 60 years The average age of white Hispanic patients was 65 years, and the average age of white patients was 66 years Total charges for hospitalizations with a diabetes complication as the first listed diagnosis were 2226 million in 1998 Physician fees and other medical costs for diabetes that occur before and after a hospital stay, such as nursing home care were not included In 1998, 236 percent of hospitalizations of patients with a diabetes complication resulted in a discharge
to a skilled nursing facility or other facility Because diabetes patients often have multiple health problems, costs of care cannot be clearly ascribed to any one disease Diabetic patients are more susceptible to many diseases including heart disease, stroke, and infections The costs of these diseases are not included in this report The data source for this study was the Agency for Health Care Administration AHCA hospitalization database Licensed general hospitals report information to AHCA
Health Outcome Series: Complications of Diabetes Study
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quarterly Information reported includes up to ten diagnoses, surgical procedures performed, billed hospital charges, type of payer or insurer, and patient demographics
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AHCA State Center for Health Statistics
Introduction
Diabetes is a disease of insulin metabolism and elevated blood sugar As the disease progresses, it can affect many systems of the body The goal of medical treatment is to establish control of blood sugar levels and prevent or delay the development of diabetes complications There is no type of diabetes that is not a serious health problem Many adult-onset diabetic patients must take insulin to control their disease
Both juvenile-onset and adultonset diabetes are associated with life-threatening complications and diminished quality of life due to health effects of the disease This study examined long-term diabetes complications such as kidney disease, loss of vision due to retinopathy and other conditions, nerve damage, peripheral circulatory disorders involving diminished blood flow to the extremities, and other reported complications of diabetes Short-term diabetes complications such as ketoacidosis or diabetic coma were not included unless combined with a long-term complication Type I and Type II diabetes were included in the study Type I diabetes is caused by a lack of insulin production in the pancreas Type II diabetes is caused by improperly functioning insulin metabolism and other factors Gestational diabetes diabetes of pregnancy was not included in this study The average age of hospitalization for complications of diabetes provides a measure of the impact of diabetes in the population It is a broad measure of outcome reflecting health care and preventive services in the community Average age of hospitalization may also be affected by social conditions eg income, education and the
general health status of the population All of these factors are likely to influence the successful treatment of diabetes Trends in average age of hospitalization from 1992 to 1998 are reported for: Diabetes complications, Amputations, and Deaths Appendix 1 describes diabetes complications included in this study Hospitalizations with a diabetes complication reported as either the principal or a secondary diagnosis were included
Health Outcome Series: Complications of Diabetes Study
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Appendix 2 describes all diabetes diagnoses, with and without complications Amputations and in-hospital deaths with any diabetes diagnosis were included in the study Appendix 3 describes amputation procedures included in the study Hospital charges for hospitalizations with a diabetes complications as the first listed ie, principal diagnosis were reported in this study These costs are a fraction of the economic impact of diabetes Diabetic patients are susceptible to many diseases including heart disease, stroke or infections The costs of these diseases were not included in this report The costs of medical treatment of diabetes complications in circumstances other than hospital care were not
included in this report The data source for this study was the Agency for Health Care Administration AHCA hospitalization database, years 1992 through 1998 Licensed general hospitals report information to AHCA quarterly Information reported includes up to ten diagnoses, surgical procedures performed, billed hospital charges, type of payer or insurer, and patient demographics Hospitals also report whether the patient was discharged home, to another facility, or whether the patient died during the hospital stay For years 1997 and 1998, data reported as of September 1999 were included in this study
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AHCA State Center for Health Statistics
Complications of Diabetes
In 1998, 56,139 hospitalizations of patients with a diabetes complication were reported by Florida hospitals The average age among these hospitalizations was 65 years Tables 1 and 2 provide information about the age and gender of patients with a diabetes complication in 1998 The majority of hospitalizations were for patients ages 65 years or older
Table 1 Complications of Diabetes Hospitalizations Among Age Groups, 1998 Ages 0 to 24 years Ages 25 to 44 years Ages 45 to 64 years Ages 65 and older TOTAL Source: AHCA
Hospitalizations 415 5,264 18,421 32,039 56,139 Percent 07 94 328 571 1000
Table 2 displays the percent of hospitalizations for males and females The results showed little distinction between genders
Table 2 Complications of Diabetes Hospitalizations Between Genders, 1998 Male Female TOTAL Hospitalizations 28,241 27,895 56,139 Percent 503 497 1000 Average Age 65 65 65
Note: Numbers may not add due to unclassified gender records
Source: AHCA
Table 3 displays the number of hospitalizations and average age among racial groups in 1998 White patients were 675 percent of hospitalizations, black and black Hispanic patients were 210 percent, and white Hispanic patients were 93 percent with other racial groups constituting the remainder
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The average age of black and black Hispanic patients was 60 years, five years younger than the average age for all hospitalizations
Table 3 Complications of Diabetes Hospitalizations Among Racial Groups, 1998 Black and Black Hispanic White White Hispanic Other TOTAL Source: AHCA Hospitalizations 11,811 37,916 5,214 1,198 56,139 Percent 210 675 93 21 1000 Average Age 60 66 65 65 65
Note:
Percents may not add to totals due to rounding
Table 4 shows the average age of hospitalization among racial groups in 1992 and 1998 Among all racial groups, the average age increased from 1992 to 1998
Table 4 Complications of Diabetes Hospitalizations Average Age Among Racial Groups, 1992 and 1998 Black and Black Hispanic White White Hispanic Other TOTAL Source: AHCA 1992 59 64 64 63 63 1998 60 66 65 65 65
Tables 5 and 6 provide information about the types of complications reported These are: Renal dysfunction kidney disease, Loss of vision partial or complete, Nerve damage, Peripheral circulatory disorders, and Other specified complications
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AHCA State Center for Health Statistics
More than one type of complication may be reported during a hospital stay Total complications reported in 1998 were 76,038 Table 5 Nerve damage complications Table 5 accounted for the largest proportion
Table 5 Complications of Diabetes Hospitalizations Among Complication Types, 1998 Hospitalizations Percent Renal Kidney Disease 19,246 253 Loss of Vision 10,533 139 Nerve Damage 25,937 341 Blood Circulation Disorders 8,443 111 Other 11,879 156 TOTAL 76,038 1000
Note: More than one
complication may be reported per hospitalization
Average Age 63 60 64 67 65 65
Source: AHCA
Table 6 shows the average age of hospitalization among complication types in 1992 and 1998 Among complication types, renal kidney complication had the largest increase in average age, to 63 years, from 60 years in 1992 Complications involving diminished blood circulation to the extremities had no change in the average age of 67 years from 1992 to 1998
Table 6 Complications of Diabetes Hospitalizations Average Age Among Complication Types, 1992 and 1998 Renal Kidney Disease Loss of Vision Nerve Damage Blood Circulation Disorders Other TOTAL Source: AHCA 1992 60 58 63 67 62 63 1998 63 60 64 67 65 65
Hospitalizations with a reported diabetes complication increased each year from 1992 to 1998, up from 30,116 in 1992 and 51,733 in 1997 to 56,139 in 1998 Number of
Health Outcome Series: Complications of Diabetes Study
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hospitalizations and average age among racial groups, 1992 to 1998, are shown in Appendix 4
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AHCA State Center for Health Statistics
Amputations with a Diabetes Diagnosis
Amputation of the extremities may be necessary to treat gangrene or other wounds as a result of
nerve damage or problems with adequate blood circulation to the extremities This analysis included hospitalizations in which an amputation was reported with any diabetes diagnosis with or without complications Appendix 2 and Appendix 3 describe the diabetes diagnosis and amputation procedures included Table 7 displays the percent of hospitalizations with an amputation and a diabetes diagnosis for males and females Of the 5,615 hospitalizations with an amputation and diabetes diagnosis reported, males accounted for the larger proportion, and were younger, on average, than females
Table 7 Hospitalizations with an Amputation and a Diabetes Diagnosis Between Genders, 1998 Male Female TOTAL Source: AHCA Hospitalizations 3,441 2,173 5,615 Percent 613 387 1000 Average Age 66 68 67
Note: Numbers may not add due to unclassified gender records
Table 8 displays the number of hospitalizations and average age among racial groups in 1998 White patients were 613 percent of hospitalizations, black and black Hispanic patients were 261 percent of hospitalizations, and white Hispanic patients were 101 percent of hospitalizations
Table 8 Hospitalizations with an Amputation and Diabetes Diagnosis
Among Racial Groups, 1998 Black and Black Hispanic White White Hispanic Other TOTAL Source: AHCA Hospitalizations 1,468 3,443 568 136 5,615 Percent 261 613 101 24 1000 Average Age 65 67 67 65 67
Note: Percents may not add to totals due to rounding
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The average age of black and black Hispanic patients was 65 years, two years younger than the average age for all hospitalizations Table 9 shows the average age in 1992 and 1998 for hospitalizations with an amputation and a diabetes diagnosis The average age of hospitalization among white patients did not change from 1992 to 1998 The average age of black and black Hispanic patients and white Hispanic patients each increased by one year from 1992 to 1998
Table 9 Hospitalizations with an Amputation and Diabetes Diagnosis Average Age Among Racial Groups, 1992 and 1998 1992 1998 Black and Black Hispanic 64 65 White 67 67 White Hispanic 66 67 Other 66 65 TOTAL 66 67 Source: AHCA
Table 10 provides information about types of amputations performed in Florida hospitals The sum total in Table 10 is greater than 5,615 Tables 7 and 8 because more than one 8 Tables type of amputation may be
performed during a hospital stay
Table 10 Hospitalizations with an Amputation and a Diabetes Diagnosis Among Amputation Types, 1998 Toe Below Knee Above Knee Other TOTAL Source: AHCA Hospitalizations 2,195 1,726 1,003 1,004 5,928 Percent 370 291 169 169 1000 Average Age 64 67 73 64 67
Note: More than one amputation may be reported per hospitalization
Of the 5,928 amputations in 1998, toe amputations were 370 percent of the total and occurred at a younger age, on average, than below knee or above knee amputations
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AHCA State Center for Health Statistics
Table 11 shows the average age of hospitalization among amputation types in 1992 and 1998 The average age of below knee complications decreased one year The average age of toe amputation and above knee amputation remained unchanged
Table 11 Hospitalizations with an Amputation and a Diabetes Diagnosis Average Age Among Amputation Types, 1992 and 1998 Toe Below Knee Above Knee Other TOTAL Source: AHCA 1992 64 68 73 63 66 1998 64 67 73 64 67
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Deaths with a Diabetes Diagnosis
Tables 12, 13, and 14 provide information about deaths with a diabetes diagnosis occurring in
Florida hospitals The analysis included hospitalizations in which a death was reported with any diabetes diagnosis with or without complications Appendix 2 describes the diabetes diagnoses included Table 12 displays the percent of in-hospital deaths with a diabetes diagnosis for males and females In 1998, 10,449 deaths with a diabetes diagnosis were reported by Florida hospitals The results indicated little difference between the genders with males slightly younger than females at age of death
Table 12 In-Hospital Deaths and a Diabetes Diagnosis Between Genders, 1998 Hospitalizations Percent Average Age 5,288 506 73 5,160 494 74 10,449 1000 74
Male Female TOTAL
Note: Numbers may not add due to unclassified gender records
Source: AHCA
As shown in Table 13, white patients were 708 percent of deaths with an average age of 13 75 years The average age of black and black Hispanic patients was 67 years, significantly below any other racial groups
Table 13 In-Hospital Deaths and a Diabetes Diagnosis Among Racial Groups, 1998 Hospitalizations Percent Average Age Black and Black Hispanic 1,466 140 67 White 7,402 708 75 White Hispanic 1,238 118 75 Other 343 33 72 TOTAL 10,449 1000
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Note: Percents may not add to totals due to rounding
Source: AHCA
Table 14 shows the average age of hospitalization among racial groups in 1992 and 1998 The average age of black and black Hispanic patients decreased by one year
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AHCA State Center for Health Statistics
from 1992 to 1998 The average age of white patients and white Hispanic patients each increased by one year
Table 14 In-Hospital Deaths and a Diabetes Diagnosis Average Age Among Racial Groups, 1992 and 1998 1992 1998 Black and Black Hispanic 68 67 White 74 75 White Hispanic 74 75 Other 72 72 TOTAL 74 74 Source: AHCA
The National Institutes of Health reports that diabetes contributed to 193,140 deaths in the US in 1996 Floridas proportion of the US population is 55 percent Assuming Florida represents 55 percent of US diabetes deaths, Florida had an estimated 10,623 deaths in which diabetes was a contributory cause This estimate includes deaths that did not occur during a hospital stay National statistics for diabetes with Florida estimates are reported in Appendix 5
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Hospital Charges for Diabetes Complications
Hospital charges for diabetes
complications reported as the principal diagnosis are shown in Table 15 The principal diagnosis is the condition chiefly responsible for necessitating 15 the admission of the patient to the hospital for medical care The principal diagnosis is the first listed diagnosis as reported to AHCA Secondary diagnoses include conditions that affect the treatment received or length of stay in the hospital Hospital charges for diseases in which diabetes may play a causal role or complicate care during the hospital stay were not included These include both diabetes complications listed as a secondary diagnosis and other diseases, such as heart disease, stroke, and infections, that are either a principal or secondary diagnosis Appendix 6 lists the ten most frequent principal diagnoses reported for hospitalizations with a diabetes complication in 1998
Table 15 Diabetes Complications as the Principal Cause of Hospitalization Among Racial Groups, 1998
Hospitalizations 3,041 7,781 1,408 295 12,525 Hospital Charges, in Millions 546 1355 259 66 2226 Percent of Total Charges 245 608 116 30 1000 Average Age 58 64 64 62 62
Black and Black Hispanic White White Hispanic Other TOTAL Source: AHCA
Note:
Percents may not add to totals due to rounding
Of the 56,139 hospitalizations with a diabetes complication in 1998, there were 12,525 hospitalizations with a diabetes complication reported as the principal diagnosis Total hospital charges were 2226 million These amounts do not include hospitalizations for direct, short-term complications of diabetes involving control of blood sugar and related problems such as ketoacidosis or diabetic coma Furthermore, these amounts do not include physician fees and other medical costs for diabetes that occur before or after a hospital stay, such as nursing home care
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AHCA State Center for Health Statistics
Insurance Status of Patients with Diabetes Complications
Most patients over 65 years have Medicare hospitalization coverage Information about the insurance status of those patients age 64 years or younger with a diabetes complication is shown in Table 16 Government programs such as Medicare and 16 Medicaid were the principal payer for the largest proportion of hospitalizations with Medicare accounting for 377 percent Charity and self-pay constituted 86 percent
Table 16 Complications of Diabetes Hospitalizations Among Payer Groups, 1998,
Patient Ages 0 to 64 Years Medicare Medicaid Private Insurance Self-Pay and Charity Government and Other Payment Sources TOTAL Source: AHCA Hospitalizations 9,081 3,719 8,490 2,077 733 24,100 Percent 377 154 352 86 30 1000 Average Age 52 49 52 49 52 51
Note: Percents may not add to totals due to rounding
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Discharges to Skilled Nursing Facilities and Other Facilities
Table 17 displays the discharge status among patients with a diabetes complication In 1998, 236 percent of hospitalizations resulted in a discharge to a skilled nursing facility or other facility
Table 17 Complications of Diabetes Hospitalizations Among Discharge Status Groups, 1998 Home Other Hospital Skilled Nursing Facility Intermediate Care Facility Other Facility Home Health Care Left Against Medical Advice Home IV Medications Expired TOTAL Source: AHCA Hospitalizations 31,344 1,389 8,606 667 2,575 8,809 453 187 2,109 56,139 Percent 558 25 153 12 46 157 08 03 38 1000 Average Age 62 66 72 71 69 67 52 58 71 65
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AHCA State Center for Health Statistics
Complications of Diabetes Treated at Florida Hospitals
Table 18 shows the number of hospitalizations
with a diabetes complication reported by Florida hospitals in 1998 Hospitals are listed by average age of hospitalization within each county Hospitals with less than five hospitalizations reported were not included Within counties with 10 or more hospitals Broward, Dade, Hillsborough, Palm Beach, and Pinellas, the average age of hospitalization for patients with a diabetes complication varied by twelve years to twenty years among the hospitals The greatest variation in age occurred in Dade County, and the smallest variation occurred in Pinellas County, excluding childrens hospitals
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Table 18
Complications of Diabetes Hospitalizations Among Hospitals, 1998
County ALACHUA ALACHUA ALACHUA ALACHUA BAKER BAY BAY BRADFORD BREVARD BREVARD BREVARD BREVARD BREVARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD BROWARD CALHOUN CHARLOTTE CHARLOTTE CHARLOTTE CITRUS CITRUS CLAY CLAY COLLIER COLLIER COLUMBIA COLUMBIA DADE DADE DADE DADE DADE DADE DADE DADE DADE DADE DADE DADE DADE DADE DADE DADE DADE DADE DADE Hospital SHANDS HOSPITAL AT THE UNIV
OF FLORIDA SHANDS AT VISTA NORTH FLORIDA REGIONAL MEDICAL CENTER SHANDS AT AGH ED FRASER MEMORIAL HOSPITAL BAY MEDICAL CENTER GULF COAST MEDICAL CENTER SHANDS AT STARKE CAPE CANAVERAL HOSPITAL PALM BAY COMMUNITY HOSPITAL HOLMES REGIONAL MEDICAL CENTER PARRISH MEDICAL CENTER WUESTHOFF MEMORIAL HOSPITAL BROWARD GENERAL MEDICAL CENTER IMPERIAL POINT MEDICAL CENTER MEMORIAL REGIONAL HOSPITAL PLANTATION GENERAL HOSPITAL CORAL SPRINGS MEDICAL CENTER MEMORIAL HOSPITAL WEST HOLLYWOOD MEDICAL CENTER HOLY CROSS HOSPITAL, INC NORTH BROWARD MEDICAL CENTER WESTSIDE REGIONAL MEDICAL CENTER MEMORIAL HOSPITAL PEMBROKE NORTHWEST MEDICAL CENTER FLORIDA MEDICAL CENTER NORTH RIDGE MEDICAL CENTER FLORIDA MEDICAL CENTER, SOUTH CLEVELAND CLINIC HOSPITAL UNIVERSITY HOSPITAL AND MEDICAL CENTER VENCOR HOSPITAL-FORT LAUDERDALE CALHOUN LIBERTY HOSPITAL FAWCETT MEMORIAL HOSPITAL CHARLOTTE REGIONAL MEDICAL CENTER SAINT JOSEPH HOSPITAL OF PORT CHARLOTTE CITRUS MEMORIAL HOSPITAL SEVEN RIVERS COMMUNITY HOSPITAL ORANGE PARK MEDICAL CENTER VENCOR HOSPITAL-NORTH FLORIDA NORTH COLLIER HOSPITAL NAPLES COMMUNITY HOSPITAL SHANDS AT LAKE SHORE LAKE CITY MEDICAL CENTER MIAMI CHILDRENS HOSPITAL ANNE BATES LEACH EYE HOSPITAL
JACKSON MEMORIAL HOSPITAL NORTH SHORE MEDICAL CENTER HOMESTEAD HOSPITAL PARKWAY REGIONAL MEDICAL CENTER BAPTIST HOSPITAL OF MIAMI SOUTH MIAMI HOSPITAL CEDARS MEDICAL CENTER DORAL PALMS HOSPITAL HEALTHSOUTH DOCTORS HOSPITAL COLUMBIA DEERING HOSPITAL PALMETTO GENERAL HOSPITAL WESTCHESTER GENERAL HOSPITAL HIALEAH HOSPITAL MOUNT SINAI MEDICAL CENTER MERCY HOSPITAL INC AVENTURA HOSPITAL AND MEDICAL CENTER KENDALL MEDICAL CENTER City GAINESVILLE GAINESVILLE GAINESVILLE GAINESVILLE MACCLENNY PANAMA CITY PANAMA CITY STARKE COCOA BEACH MELBOURNE MELBOURNE TITUSVILLE ROCKLEDGE FORT LAUDERDALE FORT LAUDERDALE HOLLYWOOD PLANTATION CORAL SPRINGS PEMBROKE PINES HOLLYWOOD FORT LAUDERDALE POMPANO BEACH PLANTATION PEMBROKE PINES MARGATE LAUDERDALE LAKES FORT LAUDERDALE PLANTATION FORT LAUDERDALE TAMARAC FORT LAUDERDALE BLOUNTSTOWN PORT CHARLOTTE PUNTA GORDA PORT CHARLOTTE INVERNESS CRYSTAL RIVER ORANGE PARK GREEN COVE SPRINGS NAPLES NAPLES LAKE CITY LAKE CITY MIAMI MIAMI MIAMI MIAMI HOMESTEAD NORTH MIAMI BEACH MIAMI SOUTH MIAMI MIAMI MIAMI CORAL GABLES MIAMI HIALEAH MIAMI HIALEAH MIAMI BEACH MIAMI AVENTURA MIAMI Hospitalizations 525 6 378 335 20 573 142 21 173 62 672 299 417 478 149 672 230 243 179
79 493 360 341 163 315 431 515 29 218 270 20 55 309 186 231 340 206 214 22 63 630 99 93 17 71 887 369 172 595 663 408 686 6 97 121 294 61 355 715 403 373 188 Average Age 54 59 64 65 61 61 65 65 62 63 64 65 66 59 61 62 63 63 66 67 67 68 68 69 70 71 71 71 71 73 74 70 68 70 70 67 71 66 66 63 66 64 65 12 53 54 62 62 63 64 64 64 65 66 66 67 69 69 69 69 69 70
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AHCA State Center for Health Statistics
Table 18
Complications of Diabetes Hospitalizations Among Hospitals, 1998
County DADE DADE DADE DADE DADE DADE DADE DESOTO DUVAL DUVAL DUVAL DUVAL DUVAL DUVAL DUVAL DUVAL ESCAMBIA ESCAMBIA ESCAMBIA FLAGLER FRANKLIN GADSDEN GULF HAMILTON HARDEE HENDRY HERNANDO HERNANDO HERNANDO HIGHLANDS HIGHLANDS HIGHLANDS HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH HOLMES INDIAN RIVER INDIAN RIVER JACKSON JACKSON LAKE LAKE LAKE LEE LEE LEE LEE LEE LEE LEON LEON LEVY MADISON MANATEE MANATEE Hospital City Hospitalizations 74 6 223 182 192 63 340 42 459 473 859 508 576 92 42 265 373 749 533 40 11 11 19 16 15 12 162 129 470 58 210 233 867 1004 433 681 120 15 174 81 130 23 178 146 18 330 156 85 12
64 373 363 31 446 410 62 192 243 733 494 45 21 489 342 Average Age 71 71 71 72 72 72 74 69 52 59 61 63 64 65 65 66 62 62 63 70 64 65 67 68 67 63 65 67 67 67 68 68 57 63 63 64 64 64 66 67 67 67 69 71 65 68 69 59 68 61 64 67 58 62 65 68 68 70 61 66 70 70 67 68
CORAL GABLES HOSPITAL CORAL GABLES VENCOR HOSPITAL-CORAL GABLES CORAL GABLES PALM SPRINGS GENERAL HOSPITAL HIALEAH LARKIN COMMUNITY HOSPITAL SOUTH MIAMI MIAMI HEART INSTITUTE AND MEDICAL CENTER MIAMI BEACH SOUTH SHORE HOSPITAL AND MEDICAL CENTER MIAMI BEACH PAN AMERICAN HOSPITAL MIAMI DESOTO MEMORIAL HOSPITAL ARCADIA SHANDS JACKSONVILLE MEDICAL CENTER JACKSONVILLE BAPTIST MEDICAL CENTER JACKSONVILLE SAINT VINCENTS MEDICAL CENTER JACKSONVILLE SHANDS JACKSONVILLE MEDICAL CENTER JACKSONVILLE MEMORIAL HOSPITAL JACKSONVILLE JACKSONVILLE BEACHES MEDICAL CENTER JACKSONVILLE BEACH SPECIALTY HOSPITAL JACKSONVILLE JACKSONVILLE SAINT LUKES HOSPITAL JACKSONVILLE SACRED HEART HOSPITAL PENSACOLA BAPTIST HOSPITAL PENSACOLA WEST FLORIDA REGIONAL MEDICAL CENTER PENSACOLA MEMORIAL HOSPITAL - FLAGLER BUNNELL GEORGE E WEEMS MEMORIAL HOSPITAL APALACHICOLA GADSDEN COMMUNITY HOSPITAL QUINCY GULF PINES HOSPITAL PORT ST JOE TRINITY COMMUNITY HOSPITAL
JASPER FLORIDA HOSPITAL WAUCHULA WAUCHULA HENDRY REGIONAL MEDICAL CENTER CLEWISTON BROOKSVILLE REGIONAL HOSPITAL BROOKSVILLE SPRING HILL REGIONAL HOSPITAL SPRING HILL OAK HILL HOSPITAL SPRING HILL FLORIDA HOSPITAL-LAKE PLACID LAKE PLACID HIGHLANDS REGIONAL MEDICAL CENTER SEBRING FLORIDA HOSPITAL HEARTLAND MEDICAL CENTER AVON PARK THE TAMPA GENERAL HOSPITAL TAMPA SAINT JOSEPHS HOSPITAL TAMPA BRANDON REGIONAL HOSPITAL BRANDON UNIVERSITY COMMUNITY HOSPITAL TAMPA TOWN COUNTRY HOSPITAL TAMPA VENCOR HOSPITAL-TAMPA TAMPA SOUTH FLORIDA BAPTIST HOSPITAL PLANT CITY VENCOR HOSPITAL CENTRAL TAMPA TAMPA UNIVERSITY COMMUNITY HOSPITAL AT CARROLLWOOD TAMPA H LEE MOFFITT CANCER CTR RESEARCH INSTITUTE HOSPITAL TAMPA MEMORIAL HOSPITAL OF TAMPA TAMPA SOUTH BAY HOSPITAL SUN CITY CENTER DOCTORS MEMORIAL HOSPITAL - BONIFAY BONIFAY INDIAN RIVER MEMORIAL HOSPITAL VERO BEACH SEBASTIAN RIVER MEDICAL CENTER SEBASTIAN JACKSON HOSPITAL MARIANNA CAMPBELLTON-GRACEVILLE HOSPITAL GRACEVILLE SOUTH LAKE MEMORIAL HOSPITAL CLERMONT LEESBURG REGIONAL MEDICAL CENTER LEESBURG FLORIDA HOSPITAL WATERMAN EUSTIS GULF COAST HOSPITAL FORT MYERS SOUTHWEST FLORIDA REGIONAL MEDICAL CENTER FORT MYERS LEE MEMORIAL HOSPITAL FT
MYERS EAST POINTE HOSPITAL LEHIGH ACRES LEE MEMORIAL HOSPITAL-HEALTHPARK FORT MYERS CAPE CORAL HOSPITAL CAPE CORAL TALLAHASSEE MEMORIAL HOSPITAL TALLAHASSEE TALLAHASSEE COMMUNITY HOSPITAL TALLAHASSEE NATURE COAST MEDICAL CENTER WILLISTON MADISON COUNTY MEMORIAL HOSPITAL MADISON MANATEE MEMORIAL HOSPITAL BRADENTON BLAKE MEDICAL CENTER BRADENTON
Health Outcome Series: Complications of Diabetes Study
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Table 18
Complications of Diabetes Hospitalizations Among Hospitals, 1998
County MARION MARION MARION MARTIN MARTIN MONROE MONROE MONROE NASSAU OKALOOSA OKALOOSA OKALOOSA OKEECHOBEE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE OSCEOLA OSCEOLA OSCEOLA OSCEOLA PALM BEACH PALM BEACH PALM BEACH PALM BEACH PALM BEACH PALM BEACH PALM BEACH PALM BEACH PALM BEACH PALM BEACH PALM BEACH PALM BEACH PALM BEACH PASCO PASCO PASCO PASCO PASCO PINELLAS PINELLAS PINELLAS PINELLAS PINELLAS PINELLAS PINELLAS PINELLAS PINELLAS PINELLAS PINELLAS PINELLAS PINELLAS PINELLAS PINELLAS POLK POLK POLK POLK POLK Hospital CHARTER SPRINGS HOSPITAL MUNROE REGIONAL MEDICAL CENTER OCALA REGIONAL MEDICAL CENTER MARTIN MEMORIAL HOSPITAL SOUTH MARTIN MEMORIAL MEDICAL CENTER FISHERMENS
HOSPITAL LOWER KEYS MEDICAL CENTER MARINERS HOSPITAL NASSAU MEDICAL CENTER NORTH OKALOOSA MEDICAL CENTER FORT WALTON BEACH MEDICAL CENTER TWIN CITIES HOSPITAL COLUMBIA RAULERSON HOSPITAL ARNOLD PALMER HOSPITAL PRINCETON HOSPITAL ORLANDO REGIONAL MEDICAL CENTER FLORIDA HOSPITAL LUCERNE MEDICAL CENTER SAND LAKE HOSPITAL HEALTH CENTRAL FLORIDA HOSPITAL-EAST ORLANDO FLORIDA HOSPITAL-APOPKA WINTER PARK MEMORIAL HOSPITAL FLORIDA HOSPITAL-CELEBRATION HEALTH OSCEOLA REGIONAL MEDICAL CENTER FLORIDA HOSPITAL-KISSIMMEE ST CLOUD HOSPITAL SAINT MARYS HOSPITAL GLADES GENERAL HOSPITAL GOOD SAMARITAN HOSPITAL WELLINGTON REGIONAL MEDICAL CENTER PALM BEACH GARDENS MEDICAL CENTER COLUMBIA HOSPITAL BETHESDA MEMORIAL HOSPITAL PALMS WEST HOSPITAL JUPITER MEDICAL CENTER JFK MEDICAL CENTER WEST BOCA MEDICAL CENTER BOCA RATON COMMUNITY HOSPITAL DELRAY MEDICAL CENTER PASCO COMMUNITY HOSPITAL NORTH BAY HOSPITAL EAST PASCO MEDICAL CENTER REGIONAL MEDICAL CENTER BAYONET POINT COMMUNITY HOSPITAL OF NEW PORT RICHEY ALL CHILDRENS HOSPITAL BAYFRONT MEDICAL CENTER EDWARD WHITE HOSPITAL SAINT ANTHONYS HOSPITAL VENCOR HOSPITAL-ST PETERSBURG NORTHSIDE HOSPITAL HELEN ELLIS MEMORIAL HOSPITAL SAINT PETERSBURG GENERAL
HOSPITAL MORTON PLANT HOSPITAL SUN COAST HOSPITAL MEASE HOSPITAL- COUNTRYSIDE PALMS OF PASADENA HOSPITAL LARGO MEDICAL CENTER MEASE HOSPITAL - DUNEDIN CLEARWATER COMMUNITY HOSPITAL BARTOW MEMORIAL HOSPITAL WINTER HAVEN HOSPITAL LAKELAND REGIONAL MEDICAL CENTER LAKE WALES MEDICAL CENTER HEART OF FLORIDA REGIONAL MEDICAL CENTER City OCALA OCALA OCALA STUART STUART MARATHON KEY WEST TAVERNIER FERNANDINA BEACH CRESTVIEW FORT WALTON BEACH NICEVILLE OKEECHOBEE ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO OCOEE ORLANDO APOPKA WINTER PARK CELEBRATION KISSIMMEE KISSIMMEE SAINT CLOUD WEST PALM BEACH BELLE GLADE WEST PALM BEACH WEST PALM BEACH PALM BEACH GARDENS WEST PALM BEACH BOYNTON BEACH LOXAHATCHEE JUPITER ATLANTIS BOCA RATON BOCA RATON DELRAY BEACH DADE CITY NEW PORT RICHEY ZEPHYRHILLS HUDSON NEW PORT RICHEY SAINT PETERSBURG SAINT PETERSBURG ST PETERSBURG ST PETERSBURG SAINT PETERSBURG SAINT PETERSBURG TARPON SPRINGS ST PETERSBURG CLEARWATER LARGO DUNEDIN ST PETERSBURG LARGO DUNEDIN CLEARWATER BARTOW WINTER HAVEN LAKELAND LAKE WALES DAVENPORT Hospitalizations 7 561 470 90 408 46 94 12 46 96 277 69 103 19 93 1064 1480 482 124 138 164 32 172 12 350 181 116 215 136 258 51 316 155 191
172 308 695 170 496 385 118 124 174 581 406 32 306 73 336 24 348 240 170 742 179 232 150 426 243 113 69 479 893 107 115 Average Age 53 66 67 63 65 66 67 70 70 61 63 65 65 24 61 61 62 64 64 64 65 67 68 61 63 64 67 58 60 64 65 65 66 67 67 67 69 71 73 73 63 67 67 69 70 43 61 64 64 65 65 65 66 66 66 68 68 68 71 73 63 63 64 64 67
18
AHCA State Center for Health Statistics
Table 18
Complications of Diabetes Hospitalizations Among Hospitals, 1998
County PUTNAM SANTA ROSA SANTA ROSA SANTA ROSA SARASOTA SARASOTA SARASOTA SARASOTA SEMINOLE SEMINOLE SEMINOLE ST JOHNS ST LUCIE ST LUCIE SUWANNEE TAYLOR UNION VOLUSIA VOLUSIA VOLUSIA VOLUSIA VOLUSIA VOLUSIA VOLUSIA WALTON WASHINGTON Hospital PUTNAM COMMUNITY MEDICAL CENTER JAY HOSPITAL SANTA ROSA MEDICAL CENTER GULF BREEZE HOSPITAL SARASOTA MEMORIAL HOSPITAL COLUMBIA DOCTORS HOSPITAL OF SARASOTA BON SECOURS-VENICE HOSPITAL ENGLEWOOD COMMUNITY HOSPITAL SOUTH SEMINOLE HOSPITAL CENTRAL FLORIDA REGIONAL HOSPITAL FLORIDA HOSPITAL-ALTAMONTE FLAGLER HOSPITAL LAWNWOOD REGIONAL MEDICAL CENTER SAINT LUCIE MEDICAL CENTER SHANDS AT LIVE OAK DOCTORS MEMORIAL HOSPITAL RAMADAN HAND INSTITUTE/LAKE BUTLER HOSPITAL ATLANTIC MEDICAL CENTER - ORMOND HALIFAX
MEDICAL CENTER MEMORIAL HOSPITAL-WEST VOLUSIA ATLANTIC MEDICAL CENTER-DAYTONA FLORIDA HOSPITAL FISH MEMORIAL MEMORIAL HOSPITAL - ORMOND BEACH BERT FISH MEDICAL CENTER WALTON REGIONAL HOSPITAL NORTHWEST FLORIDA COMMUNITY HOSPITAL City PALATKA JAY MILTON GULF BREEZE SARASOTA SARASOTA VENICE ENGLEWOOD LONGWOOD SANFORD ALTAMONTE SPRINGS SAINT AUGUSTINE FORT PIERCE PORT SAINT LUCIE LIVE OAK PERRY LAKE BUTLER ORMOND BEACH DAYTONA BEACH DELAND DAYTONA BEACH ORANGE CITY ORMOND BEACH NEW SMYRNA BEACH DEFUNIAK SPRINGS CHIPLEY Hospitalizations 201 65 83 78 672 324 255 145 97 271 299 350 386 344 11 9 18 77 531 179 133 255 246 166 17 41 Average Age 67 58 61 68 66 69 71 72 64 64 65 62 64 68 65 68 62 54 61 65 66 66 69 69 68 70
Incomplete 1998 Data as of 9/7/99 Source: AHCA
Health Outcome Series: Complications of Diabetes Study
19
Conclusions and Future Studies
This study found that the average age of hospitalization of patients with a diabetes complication has increased by two years since 1992 One of the most significant findings of the analysis is the relative stability of age of hospitalization while the number of hospitalizations has increased each year from 1992 to 1998 It is possible
that other factors are affecting hospitalizations of diabetes patients and that the typical age of onset of complications is not, in fact, increasing among diabetes patients The average age of hospitalization may be increasing because patients are surviving with complications over a longer period of time The purpose of the Health Outcomes Series is to gain a better understanding of the health outcomes being achieved through the intervention of medical care, and to provide this information to physicians, other health professionals and to consumers and patients
20
AHCA State Center for Health Statistics
References
State of Florida Agency for Health Care Administration Diabetes Medical Practice Guidelines Tallahassee, FL: State of Florida Agency for Health Care Administration National Institute of Child Health and Human Development Understanding Gestational Diabetes NICHD Publication No 0003 Bethesda, MD: National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases Diabetes in African Americans August 1998 NIH Publication No 98-3266 Bethesda, MD: National Institutes of Health National Institute of Diabetes and Digestive and Kidney Disease Diabetes
in America, 2nd Edition 1995 NIH Publication No 95-1468 Bethesda, MD: National Institutes of Health National Institute of Diabetes and Digestive and Kidney Disease Diabetes in Hispanic Americans April 1997 NIH Publication No 97-3266 Bethesda, MD: National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Overview November 1998 NIH Publication No 96-3873 Bethesda, MD: National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases Diabetes Statistics March 1999 NIH Publication No 99-3926 Bethesda, MD: National Institutes of Health
Health Outcome Series: Complications of Diabetes Study
21
Appendix 1 Diabetes Complications Included in Complications of Diabetes Study
ICD-9-CM Code 25040 25041 25042 25043 Description Diabetes with renal manifestations, Type II or unspecified type, not stated as uncontrolled Diabetes with renal manifestations, Type I, not stated as uncontrolled Diabetes with renal manifestations, Type II or unspecified type, uncontrolled Diabetes with renal manifestations, Type I, uncontrolled
25050 25051 25052 25053
Diabetes with ophthalmic manifestations, Type II or unspecified type, not
stated as uncontrolled Diabetes with ophthalmic manifestations, Type I, not stated as uncontrolled Diabetes with ophthalmic manifestations, Type II or unspecified type, uncontrolled Diabetes with ophthalmic manifestations, Type I, uncontrolled
25060 25061
Diabetes with neurological manifestations, Type II or unspecified type, not stated as uncontrolled Diabetes with neurological manifestations, Type I, not stated as uncontrolled
22
AHCA State Center for Health Statistics
25062 25063
Diabetes with neurological manifestations, Type II or unspecified type, uncontrolled Diabetes with neurological manifestations, Type I, uncontrolled
25070 25071 25072 25073
Diabetes with peripheral circulatory disorders, Type II or unspecified type, not stated as uncontrolled Diabetes with peripheral circulatory disorders, Type I, not stated as uncontrolled Diabetes with peripheral circulatory disorders, Type II or unspecified type, uncontrolled Diabetes with peripheral circulatory disorders, Type I, uncontrolled
25080 25081 25082 25083
Diabetes with other specified manifestations, Type II or unspecified type, not stated as uncontrolled Diabetes with other specified manifestations, Type I, not
stated as uncontrolled Diabetes with other specified manifestations, Type II or unspecified type, uncontrolled Diabetes with other specified manifestations, Type I, uncontrolled
Note: In 1993, a change in ICD-9-CM coding added the fifth digit 2 or 3 to report uncontrolled diabetes Prior to this, uncontrolled diabetes was reported using ICD-9-CM code 2509
Health Outcome Series: Complications of Diabetes Study
23
Appendix 2 Diabetes Diagnoses Used to Select Amputation Hospitalizations and In-Hospital Deaths
ICD-9-CM Code 25000-25003 25010-25013 25020-25023 25030-25033 25040-25043 25050-25053 25060-25063 25070-25073 25080-25083 25090-25093 Description Diabetes mellitus without mention of complication Diabetes with ketoacidosis Diabetes with hyperosmolarity Diabetes with other coma Diabetes with renal manifestations Diabetes with ophthalmic manifestations Diabetes with neurological manifestations Diabetes with peripheral circulatory disorders Diabetes with other specified manifestations Diabetes with unspecified complications
Note: In 1993, a change in ICD-9-CM coding added the fifth digit 2 or 3 to report uncontrolled diabetes Prior to this, uncontrolled diabetes was reported
using ICD-9-CM code 2509
24
AHCA State Center for Health Statistics
Appendix 3 Amputation Procedures Included in Complication of Diabetes Study
ICD-9-CM Code 8400 8401 8402 8403 8404 8405 8406 8407 8408 8409 8410 8411 8412 8413 8414 8415 8416 8417 Description Upper limb amputation, not otherwise specified Amputation and disarticulation of finger Amputation and disarticulation of thumb Amputation through hand Disarticulation of wrist Amputation through forearm Disarticulation of elbow Amputation through humerus upper arm Disarticulation of shoulder Fourquarter amputation Lower limb amputation, not otherwise specified Amputation of toe Amputation through foot Disarticulation of ankle Amputation of ankle through malleoli of tibia and fibula Other amputation below knee Disarticulation of knee Amputation above knee
Health Outcome Series: Complications of Diabetes Study
25
8418 8419
Disarticulation of hip Abdominopelvic amputation
26
AHCA State Center for Health Statistics
Appendix 4
Appendix 4 Complications of Diabetes Hospitalizations Among Racial Groups, 1992-1998
1992
1993 60 7,088 65 25,164 64 1,954 62 515 64 34,721
1994 60 8,661 65 29,990 64 2,770 62 666 64
42,087
1995 60 9,462 66 31,398 65 3,305 63 898 64 45,063
1996 60 10,187 66 32,954 64 4,020 63 1,009 64 48,170
1997 60 10,777 66 35,154 65 4,694 64 1,108 65 51,733
1998 60 11,811 66 37,916 65 5,214 65 1,198 65 56,139
Black and Black Hispanic Average Age Hospitalizations White Average Age Hospitalizations White Hispanic Average Age Hospitalizations Other Average Age Hospitalizations TOTAL Average Age Hospitalizations
Source: AHCA
59 6,039 64 21,721 64 1,756 63 600 63 30,116
Health Outcome Series: Complications of Diabetes Study
27
Appendix 5
Appendix 5 National Diabetes Statistics with Florida Estimates Persons Diagnosed Persons with with Diabetes, Type I Diabetes, 1997 1997 Deaths 1996 African Americans with Diagnosed Diabetes 1998 1,500,000 97,500
United States 10,300,000 772,500 193,140 Florida Estimates 566,500 42,488 10,623 Deaths for which diabetes was the cause or contributed to deaths Source: National Institute of Health and AHCA
28
AHCA State Center for Health Statistics
Appendix 6
Appendix 6 Frequent Principal Diagnoses for Complications of Diabetes Hospitalizations, 1998
Principal Diagnosis
Congestive Heart Failure Coronary Atherosclerosis Diabetes with Other
Specified Complications, Type II Diabetes with Other Specified Complications, Type I Diabetes with Peripheral Circulatory Disorders, Type II Acute Myocardial Infarction Diabetes with Peripheral Circulatory Disorders, Type I Pnemonia, Organism Unspecified Diabetes with Neurological Manifestations, Type I Cerebral Artery Occlusion, With Cerebral Infarction Other Diagnosis TOTAL Source: AHCA
ICD-9-CM Code
4280 41401 25080 25081 25070 41071 25071 486 25061 43491
Hospitalizations
4,466 2,288 1,685 1,315 1,212 1,191 1,177 1,007 885 862 40,051 56,139
Percent
80 41 30 23 22 21 21 18 16 15 713 1000
Average Age
69 65 69 61 71 69 65 69 56 69 64 65
Health Outcome Series: Complications of Diabetes Study
29
Source:hap.org
