Objective
The purpose of this study was to examine trends in hospitalizations for gynecologic disorders in the United States.
Study Design
Data on hospitalizations from 1998–2005 among women 15–54 years old were from the Nationwide Inpatient Sample, a nationally representative survey of inpatient hospitalizations. Hospitalizations with a principal diagnosis of a gynecologic disorder were used to estimate rates per 10,000 women.
Results
Gynecologic disorders accounted for 7% and 14% of all hospitalizations among women 15–44 and 45–54 years old, respectively. The most common diagnoses were uterine leiomyomas (rate = 27.5), menstrual disorders (rate = 12.3), endometriosis (rate = 9.5), genital prolapse (rate = 7.0), benign ovarian cysts (rate = 6.5), and pelvic inflammatory disease (rate = 6.1). The hospitalization rate for menstrual disorders increased from 9.8 in 1998 to 13.3 in 2005 ( P trend < .001). In contrast, rates declined for pelvic inflammatory disease, genital prolapse, benign ovarian cysts, and endometriosis ( P trend < .05) and were unchanged for uterine leiomyoma.
Conclusion
Gynecologic disorders are an important contributor to inpatient hospitalization among women in the United States.
Gynecologic conditions are common among women in the United States; an estimated 4.5 million women 18–50 years old (10%) report ≥1 chronic gynecologic conditions annually. Besides affecting quality of life, these conditions impact the healthcare system through ambulatory visits, emergency department visits, and inpatient hospitalizations. Although inpatient hospitalizations have a substantial impact on individual women and the healthcare system, research on hospitalizations for gynecologic conditions is limited; Velebil et al described inpatient hospitalizations for gynecologic conditions among US reproductive-aged women for 1988–1990. However, since that period, the management and/or prevalence of gynecologic conditions may have changed. Additionally, information is limited about hospitalizations for gynecologic conditions among women of later reproductive age or who are undergoing menopause. Because 46 years is the mean age at inpatient hysterectomy in the United States, gynecologic conditions are likely to be an important cause of hospitalizations among women at mid life as well as reproductive-aged women.
The examination of hospitalizations for gynecologic conditions and associated surgical procedures is useful to assess the relative public health burden that is associated with these conditions, to identify changes in clinical practice, and to stimulate future research. Using a large nationally representative database of inpatient hospitalizations, we assessed the impact of gynecologic disorders in the United States by describing rates of hospitalizations for the most frequent gynecologic disorders among women 15–54 years of age, the proportions of these hospitalizations that were associated with surgical procedures, and the trends in hospitalization rates for these disorders over time.
Materials and Methods
We used data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) for 1998–2005. HCUP is a family of healthcare databases and related software tools that were developed through a federal-state-industry partnership, sponsored by the US Agency for Healthcare Research and Quality, in which state partners contribute hospital discharge data to HCUP. As of 2005, 37 state partners contributed hospital discharge data to HCUP. The NIS, the largest all-payer inpatient care database in the United States, contains data on approximately 7 million hospital stays from 800–1000 hospitals per year to approximate a 20% stratified sample of US community hospitals.
The NIS is a stratified probability sample of hospitals in the United States that is based on a sampling frame with 5 strata: location (rural or urban), hospital size (based on number of beds), region of the country, teaching status, and type of ownership. The universe of US community hospitals includes all those hospitals that are open during any part of the calendar year and are designated as community hospitals in the American Hospital Association Annual Survey of Hospitals. Data are retained for 100% of discharges for each sampled hospital. Inpatient-stay records in the NIS include information on patient characteristics, medical diagnoses, and surgical procedures.
Analyses were limited to discharge records for women 15–54 years old. International Classification of Diseases, 9th revision, Clinical Modification codes were used to categorize discharges into diagnoses groups, following the groupings used in an earlier report. The 6 most frequent principal diagnoses were examined in greater detail. The principal diagnosis in NIS is defined as the condition that is the chief reason for the hospital stay, as determined after evaluation during this stay. Rates of hospitalization for principal diagnoses of gynecologic disorders were calculated with the use of denominators from US Census Bureau population estimates of female civilian residents. Rates were calculated by year and age group. Race was not examined because a large proportion of records did not have race information.
Among hospitalizations with a principal diagnosis of a gynecologic disorder, we also calculated the proportions that were associated with a gynecologic surgical procedure. Procedures were identified with International Classification of Diseases, 9th revision, Clinical Modification , procedure codes and were grouped according to the following hierarchy: hysterectomy (further classified as abdominal, vaginal, or laparoscopically assisted vaginal), other uterine and cervical surgery, ovarian surgery, and other gynecologic surgery.
SAS-callable SUDAAN software (version 9.1; RTI International, Research Triangle Park, NC) was used to account for the complex sampling design in NIS. Tests for trends in rates and proportions were performed by weighted least-squares regression. Because NIS does not contain personal identifiers, this analysis was determined by the Centers for Disease Control and Prevention to be exempt from institutional review board review.
Results
During 1998–2005, gynecologic disorders accounted for 7% of all inpatient hospitalizations among women of reproductive age (15–44 years) and 14% of all inpatient hospitalizations among midlife women (45–54 years). The most common diagnosis among inpatient hospitalizations with a principal diagnosis of a gynecologic condition in women 15–54 years old was uterine leiomyoma, accounting for 29% of gynecologic hospitalizations overall, 26% of gynecologic hospitalizations among women 15–44 years old, and 35% of gynecologic hospitalizations among women 44–54 years old ( Table 1 ). The next most frequently occurring diagnoses were menstrual disorders, endometriosis, genital prolapse, benign cysts of the ovary, and pelvic inflammatory disease (PID).
| Diagnosis group | International Classification of Diseases, 9th revision, Clinical Modification codes | Total, % | Age: 15–44 y, % | Age: 45–54 y, % | |||
|---|---|---|---|---|---|---|---|
| Principal diagnosis (n = 6,187,273) | Any diagnosis (n = 9,091,203) | Principal diagnosis (n = 3,984,682) | Any diagnosis (n = 6,217,916) | Principal diagnosis (n = 2,202,591) | Any diagnosis (n = 2,873,287) | ||
| Uterine leiomyomas | 218.0–218.9 | 29.0 | 33.0 | 25.7 | 28.6 | 35.0 | 42.5 |
| Menstrual disorders | 625.2–625.4, 626.0–626.9 | 13.0 | 27.5 | 14.6 | 27.6 | 10.2 | 27.3 |
| Endometriosis | 617.0–617.9 | 10.0 | 19.6 | 12.1 | 19.3 | 6.2 | 20.3 |
| Genital prolapse | 618.0–618.9 | 7.4 | 8.6 | 5.4 | 6.4 | 11.0 | 13.5 |
| Benign cysts of the ovary | 620.0–620.2 | 6.9 | 19.9 | 8.8 | 20.8 | 3.5 | 18.0 |
| Pelvic inflammatory disease | 614.0–614.9, 615.0, 615.1, 615.9, 098.10, 098.16, 098.17, 098.30, 098.36, 098.37, 098.39, 098.86 | 6.4 | 21.8 | 8.6 | 25.2 | 2.5 | 14.2 |
Most hospitalizations for genital prolapse (97.3%), endometriosis (94.8%), uterine leiomyomas (94.4%), menstrual disorders (87.8%), and benign cysts of the ovary (72.9%) included some type of surgical procedure ( Table 2 ). In contrast, women who were hospitalized for PID had surgery less frequently (38.3%). Approximately 80% of women who were hospitalized for uterine leiomyomas, menstrual disorders, or endometriosis underwent hysterectomy. Ovarian procedures were the most common surgical procedure for women who were hospitalized for benign cysts of the ovary.
| Surgical procedure | % (SE) | |||||
|---|---|---|---|---|---|---|
| Uterine leiomyoma (n = 1,795,473) | Menstrual disorder (n = 807,331) | Endometriosis (n = 618,111) | Genital prolapse (n = 458,119) | Benign cysts of the ovary (n = 428,042) | Pelvic inflammatory disease (n = 397,468) | |
| Hysterectomy (any approach) | 79.2 (0.3) | 83.7 (0.3) | 77.2 (0.3) | 67.8 (0.3) | 16.1 (0.2) | 16.9 (0.3) |
| Abdominal | 63.3 (0.2) | 48.6 (0.4) | 55.6 (0.3) | 11.4 (0.2) | 13.5 (0.2) | 15.0 (0.2) |
| Vaginal | 9.3 (0.1) | 22.8 (0.3) | 9.7 (0.2) | 48.2 (0.4) | 0.7 (0.03) | 0.5 (0.03) |
| Laparoscopically assisted vaginal | 6.5 (0.2) | 12.1 (0.3) | 11.8 (0.3) | 8.2 (0.3) | 1.9 (0.1) | 1.4 (0.1) |
| Other procedures on the uterus and cervix | 12.6 (0.2) | 1.7 (0.1) | 3.4 (0.1) | 0.4 (0.02) | 2.0 (0.1) | 1.3 (0.04) |
| Ovarian procedures | 2.7 (0.1) | 2.0 (0.1) | 13.7 (0.2) | 2.1 (0.06) | 54.5 (0.2) | 17.9 (0.2) |
| Other surgical procedures | 0.1 (0.01) | 0.6 (0.02) | 0.6 (0.02) | 27.0 (0.3) | 0.4 (0.02) | 2.3 (0.1) |
| No surgical procedures | 5.6 (0.1) | 12.2 (0.2) | 5.2 (0.1) | 2.7 (0.1) | 27.1 (0.2) | 61.7 (0.4) |
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