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The Hospitalization Life Cycle

Summary:
The Canadian Institute for Health Information has just released a report on Hospital Stays in Canada which provides a plethora of interesting tables on hospital stays in Canada at a national and provincial level.  Both the age-standardized hospitalization rate (per 100,000 population) and the age standardized average length of stay (in days) in Canada have fallen since 2013-14 going from 8,205 to 7,944 and 7.0 to 6.8 respectively.  The summary graphic for their report lists the top 5 reasons for inpatient hospitalizations as:1) Giving birth (362,700), 2) COPD and bronchitis (93,353), 2) Acute myocardial infarction (71,192), 4) Pneumonia (70,149) and 5) Heart failure (68,972) with the total number of inpatient hospitalizations in brackets beside each reason.  These five causes make up

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The Canadian Institute for Health Information has just released a report on Hospital Stays in Canada which provides a plethora of interesting tables on hospital stays in Canada at a national and provincial level.  Both the age-standardized hospitalization rate (per 100,000 population) and the age standardized average length of stay (in days) in Canada have fallen since 2013-14 going from 8,205 to 7,944 and 7.0 to 6.8 respectively.  The summary graphic for their report lists the top 5 reasons for inpatient hospitalizations as:1) Giving birth (362,700), 2) COPD and bronchitis (93,353), 2) Acute myocardial infarction (71,192), 4) Pneumonia (70,149) and 5) Heart failure (68,972) with the total number of inpatient hospitalizations in brackets beside each reason.  These five causes make up 21.6 percent of total hospitalizations in 2017-18.

What I found most interesting the data set accompanying the release was the top ten reasons for hospital stays by age category because they paint a picture of hospitalization across the life cycle.  Figure 1 plots that data and at a glance allow you to see the most likely reasons for entering a hospital based on your age.  For those aged 4 years or less, it is most likely to be acute lower respiratory infections (e.g., Acute bronchitis), neonatal jaundice from other and unspecified causes and pneumonia.  In olden days, these were the kind of events likely to carry off young children during their early years and students of historical census data will be aware of the fact that in the 19thcentury half of deaths were children under age five.

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Children between the ages of 5 and 17 are most likely to be hospitalized for mental health disorders, diseases of the appendix and mood (affective) disorders.  Once you grow up and enter the age 18-64 world of productive adults, giving birth is by far the main reason for hospitalizations accounting for 23.7 percent of hospitalizations.  This is undoubtedly can be one of the most joyous reasons for being hospitalized and still remains to date in the 21stcentury a largely female experience.  Substance abuse and mood (affective) disorders are the next two most likely reasons with Schizophrenia, schizotypal and delusional disorders in third place.  Mental health issues are important reasons for hospitalization in both the 5-17 and 18-64 age categories. 

By the time the golden years arrive and the journey to the final economic equilibrium begins, mental health issues recede somewhat as factors requiring hospitalization though one suspects they can be highly correlated with the main reasons for hospitalization in the age 65 plus category: COPD and bronchitis, heart failure, acute myocardial infarction and then pneumonia.  Further down the list for those over age 65 are osteoarthritis of the knee, other medical care (palliative and chemotherapy) and organic mental disorders (Alzheimer’s).  Needless to say, it is not a pretty picture.

I guess I would have liked to see average cost data for these categories right alongside as they would have made for some interesting reading as well as ready calculations of what the total share of hospital spending these conditions are once you get the data on total hospital spending out of the NHEX. However, in lieu of that, you can go to another report on the hospital costs of key conditions which provides numbers on total hospital costs per condition as well as average cost by condition. For example, the top condition for total hospital costs was COPD (Chronic obstructive pulmonary disease) came in at $753.3 million in 2016-17 while in terms of average cost per condition, the top one was Ventricular assist device implantation at $238,274.  The numbers are pretty eye-opening.

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