PATTERNS AND COSTS OF HOSPITAL-CARE FOR CORONARY HEART-DISEASE RELATED AND NOT RELATED TO DIABETES

Objective-To describe the epidemiology and costs of coronary heart dis ease (CHD) requiring hospital admission, with particular reference to diabetes. Setting-The former South Glamorgan Health Authority, South W ales. Methods-Routine hospital activity data were record linked and al l diabetic and non-diabetic individuals over a four year period (1991- 95) were identified. A cost weight was included for each admission bas ed on diagnosis related groups. Results-There were 10 214 patients adm itted with a primary diagnostic code for CHD, representing an incidenc e of 6.3 per 1000 per annum. Including all CHD and non-CHD admissions, these individuals were responsible for 17% of acute inpatient activit y. Men had a consistently higher age specific prevalence of CHD than w omen. The age adjusted relative risk of CHD for patients sith diabetes compared with those without was 4.1 for men and 5.5 for women. Patien ts with diabetes accounted for 16.9% of CHD related admissions and had a fourfold increased probability of undergoing a cardiac procedure. T he 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 thi s expenditure. This translated to an estimated NHS acute hospital expe nditure for CHD of pound 1.1 billion per year at 1994-95 pay and price s. Conclusions-CHD was responsible for a larger proportion of NHS expe nditure than had previously been reported, Nearly one in five acute ho spital admissions were for patients whose condition included cardiac p roblems. The relation between diabetes and CHD was particularly eviden t, and may offer opportunities for disease prevention.