Obstetric emergencies

Respectful Maternal Care, Antenatal care, Early pregnancy bleeding?, Hypertensive emergencies?, Pregnancy-related infection?, Obstetric haemorrhage?, Intrapartum emergencies?

National Trends and Disparities in Hospitalization for Hypertensive Emergencies Among Medicare Beneficiaries, 1999-2019

Background: In the last two decades, hypertension control in the U.S. population has not improved, and there are widening disparities. Less is known, however, about progress in reducing hospitalizations related to hypertensive emergencies. Methods: We conducted serial cross-sectional analysis of Medicare fee-for-service beneficiaries aged 65 years or older between 1999 and 2019 using Medicare denominator and inpatient files. We evaluated trends in national hospitalization rates for hypertensive emergencies and longer-term outcomes, including 30-day readmission and 30-day mortality. Because substantial demographic and regional variation may exist in hypertension prevalence and outcomes, we also evaluated rates of hospitalization and associated outcomes by demographic subgroups and county. We identified all beneficiaries admitted with a primary discharge diagnosis of hypertensive emergency, hypertension urgency, or hypertension crisis (ICD-9 code of 401.0, 402.0x, 403.0x, 404.0x, and 405.0x from January 1, 1999, to September 31, 2015, ICD-10 code of I100, I119, I110, I120, I132, I150, and I158 from October 1, 2015, to September 31, 2016, ICD-10 code of I16.0, I16.1, I16.9 from October 1, 2016, to December 31, 2019). Results: The sample consisted of 397,238 individual Medicare fee-for-service beneficiaries. From 1999 through 2019, the annual hospitalization rates for hypertensive emergencies increased significantly from 51.5 to 125.9 per 100,000 beneficiary-years; this increase was most pronounced among the following subgroups: adults ≥85 years (66.8 to 274.1), females (64.9 to 160.1), Blacks (144.4 to 369.5), and Medicare-Medicaid insured (dual eligible, 93.1 to 270.0). Across all subgroups, Black adults had the highest hospitalization rate in 2019, and there was a significant increase in the differences in hospitalizations between Blacks and Whites from 1999 to 2019. Marked geographic variation was also present, with the highest hospitalization rates in the South (so-called "Stroke Belt"). Among 3,143 counties and county-equivalents included in the study, less than 1% of counties either had no change (n=7) or decreased (n=20) hospitalization rates since 1999. Among patients hospitalized for a hypertensive emergency, the observed 30-day all-cause mortality rate decreased from 2.6% to 1.7% and 30-day all-cause readmission rate decreased from 15.7% to 11.8%. Conclusion: Among Medicare fee-for-service beneficiaries aged 65 years or older, hospitalization rates for hypertensive emergencies increased substantially and significantly from 1999 to 2019. Black adults had the largest increase in hospitalization rates across age, sex, race, and dual-eligible strata. There was significant national variation, with the highest rates generally in the South.