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The Burden of Diabetes-Associated Cardiovascular Hospitalizations in Veterans Administration (VA) and Non-VA Medical Facilities

¹ Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington; the
² Department of Epidemiology, University of Washington, Seattle, Washington; and the
³ Department of Health Services, University of Washington, Seattle, Washington

Address correspondence and reprint requests to Nicholas L. Smith, PhD, MPH, Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle Division, 1660 South Columbian Way, Mailstop 152E, Seattle, WA 98108. E-mail: nlsmith{at}u.washington.edu

OBJECTIVE—This study examines the relative burden of cardiovascular disease in diabetic and nondiabetic admissions to Veterans Administration (VA) and non-VA hospitals.

RESEARCH DESIGN AND METHODS—Calendar year 1997 hospitalization data were collected from the VA Patient Treatment File and the National Hospital Discharge Survey, National Center for Health Statistics. Discharge diagnoses based on ICD-9 codes were used to classify cardiovascular events and procedures and diabetes. Proportionate hospitalization ratios (PHRs) were calculated based on the number of cardiovascular hospitalizations from among all hospitalizations.

RESULTS—We identified 119,653 VA hospitalizations (19.1%) and 3,765,696 non-VA hospitalizations (16.8%) that coded diabetes among the discharge diagnoses. Cardiovascular hospitalizations, primarily coronary in origin, accounted for nearly 50% of all hospitalizations of persons with diabetes within VA and non-VA medical care systems. Coronary events and procedures (PHR = 1.85 and 1.68) and, to a lesser extent, cerebrovascular events and procedures (PHR = 1.55 and 1.33) were more common in VA hospitalizations where diabetes was listed as a comorbidity than in VA hospitalizations where diabetes was not listed. The burden of coronary hospitalizations was larger in VA than non-VA facilities for men (PHR = 1.82 vs. 1.66) and smaller in VA than non-VA facilities for women (PHR = 3.11 vs. 3.44) in age and race-standardized analyses. The burden of coronary hospitalization was higher for whites and blacks in VA facilities (PHR = 1.83 and 2.01) when compared with non-VA facilities (PHR = 1.68 and 1.84).

CONCLUSIONS—The burden of cardiovascular hospitalizations is not equally borne across hospitalizations with and without diabetes and across VA and non-VA facilities.

Abbreviations: CVD, cardiovascular disease • NHDS, National Hospital Discharge Survey • PHR, proportionate hospitalization ratio • PTF, Patient Treatment File • VA, Veterans Administration • VISN, Veteran Integrated Service Network

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