Hospitalization for Uncomplicated Hypertension: An Ambulatory Care Sensitive Condition

• Published in: Canadian journal of cardiology 2013-11, Vol.29 (11), p.1462-1469
• Main Authors: Walker, Robin L., MSc, Chen, Guanmin, MD, PhD, McAlister, Finlay A., MD, MSc, Campbell, Norm R.C., MD, Hemmelgarn, Brenda R., MD, PhD, Dixon, Elijah, MD, MSc, Ghali, William, MD, MPH, Rabi, Doreen, MD, MSc, Tu, Karen, MD, MSc, Jette, Nathalie, MD, MSc, Quan, Hude, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Canada - epidemiology; Cardiovascular; Cohort Studies; Comorbidity; Diabetes Mellitus - epidemiology; Emergency Service, Hospital - utilization; Female; HIV Infections - epidemiology; Hospitalization - statistics & numerical data; Hospitalization - trends; Humans; Hypertension - epidemiology; Income; Kidney Diseases - epidemiology; Logistic Models; Male; Middle Aged; Risk Adjustment; Rural Population; Sex Factors; State Government; Urban Population; Young Adult
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2013.05.002

Abstract Background Hospitalizations for ambulatory care sensitive conditions (ACSC) represent an indirect measure of access and quality of community care. This study explored hospitalization rates for 1 ACSC, uncomplicated hypertension, and the factors associated with hospitalization. Methods A cohort of patients with incident hypertension, and their covariates, was defined using validated case definitions applied to International Classification of Disease administrative health data in 4 Canadian provinces between fiscal years 1997 and 2004. We applied the Canadian Institute for Health Information's case definition to detect all patients who had an ACSC hospitalization for uncomplicated hypertension. We employed logistic regression to assess factors associated with an ACSC hospitalization for uncomplicated hypertension. Results The overall rate of hospitalizations for uncomplicated hypertension in the 4 provinces was 3.7 per 1000 hypertensive patients. The risk-adjusted rate was lowest among those in an urban setting (2.6 per 1000; 95% confidence interval [CI], 2.3-2.7), the highest income quintile (3.4 per 1000; 95% CI, 2.8-4.2), and those with no comorbidities (3.6 per 1000; 95% CI, 3.2-3.9). Overall, Newfoundland had the highest adjusted rate (5.7 per 1000; 95% CI, 4.9-6.7), and British Columbia had the lowest (3.7 per 1000; 95% CI, 3.4-4.2). The adjusted rate declined from 5.9 per 1000 in 1997 to 3.7 per 1000 in 2004. Conclusions We found that the rate of hospitalizations for uncomplicated hypertension has decreased over time, which might reflect improvements in community care. Geographic variations in the rate of hospitalizations indicate disparity among the provinces and those residing in rural regions.