Patterns and costs of hospital care for coronary heart disease related and not related to diabetes

Abstract

Objective: To describe the epidemiology and costs of coronary heart disease (CHD) requiring hospital admission, with particular reference to diabetes.

Setting: The former South Glamorgan Health Authority, South Wales.

Methods: Routine hospital activity data were record linked and all diabetic and non-diabetic individuals over a four year period (1991-95) were identified. A cost weight was included for each admission based on diagnosis related groups.

Results: There were 10,214 patients admitted with a primary diagnostic code for CHD, representing an incidence of 6.3 per 1000 per annum. Including all CHD and non-CHD admissions, these individuals were responsible for 17% of acute inpatient activity. Men had a consistently higher age specific prevalence of CHD than women. The age adjusted relative risk of CHD for patients with diabetes compared with those without was 4.1 for men and 5.5 for women. Patients with diabetes accounted for 16.9% of CHD related admissions and had a fourfold increased probability of undergoing a cardiac procedure. The total cost of CHD was estimated to be 6% of NHS revenue at 1994-95 pay and prices. Patients with diabetes were responsible for 16% of this expenditure. This translated to an estimated NHS acute hospital expenditure for CHD of 1.1 billion pounds per year at 1994-95 pay and prices.

Conclusions: CHD was responsible for a larger proportion of NHS expenditure than had previously been reported. Nearly one in five acute hospital admissions were for patients whose condition included cardiac problems. The relation between diabetes and CHD was particularly evident, and may offer opportunities for disease prevention.

Figure 1

Frequency distribution of patients presenting with a primary diagnosis related to coronary heart disease over a four year period by age and sex.

Figure 2

Incidence of coronary heart disease events requiring hospital admission in the diabetic and non-diabetic populations.

Figure 3

Relative risk of admission for coronary heart disease by age and sex: patients with and without diabetes.

Figure 4

Age related to the proportions of all admissions for coronary heart disease: patients with and without diabetes.

Figure 5

Age at death related to the proportion of all coronary heart disease deaths: patients with and without diabetes.