TRENDS IN INFECTIOUS-DISEASE HOSPITALIZATIONS IN THE UNITED-STATES, 1980-1994

Background: A recent study concluded that between 1980 and 1992, death s from infectious diseases increased 58%. This article explores trends in infectious diseases as a cause of hospitalization. Methods: We ana lyzed data from the National Hospitalization Discharge Survey for 1980 through 1994 using a previously developed approach to evaluate infect ious diseases in data coded according to the International Classificat ion of Diseases, Ninth Revision. Results: Between 1980 and 1994, the r ate of hospitalizations in the United States declined approximately 33 %; hospitalizations occurred at a rate of 133 +/- 5 per 1000 US popula tion (35 million +/- 1 million discharges) in 1994. The rate of hospit alization for infectious diseases declined less steeply - 12% during t his interval - resulting in an increased proportion of hospitalization s because of infectious diseases. In 1994, the rate of hospitalization s for infectious diseases was 15.4 +/- 0.7 per 1000 US population (4.0 million +/- 0.2 million discharges). The fatality rate associated wit h hospitalizations for infectious diseases increased from 1.9% +/- 0.1 % to 4.0% +/- 0.3%, attributable to increased hospitalizations of elde rly persons and an increased fatality rate among those younger than 65 years. Among selected categories, hospitalizations for human immunode ficiency virus infections and acquired immunodeficiency syndrome, pros thetic device infections, sepsis, and mycosis increased substantially, and hospitalizations for upper respiratory tract infections, pelvic i nflammatory disease, and oral infections declined sharply. Hospitaliza tions for lower respiratory tract infections constituted 37% of all in fectious disease hospitalizations in 1994. Conclusions: Considering ho spitalizations as a dimension of the burden of infectious diseases inv olves an array of factors: secular trends in hospitalization, changing case management practices, demographic changes, and trends in the var iety of infectious diseases themselves. Increases in the proportions o f hospitalizations because of infectious diseases during years when ho spitalizations for all causes were decreasing reflect an increasing bu rden of infectious diseases in the United States between 1989 and the mid-1990s.