Abstract
This study calculated yearly estimated national hospital discharge (1985 to 1994) and age-adjusted death rates (1980 to 1992) due to bacterial, viral, protozoal, and ill-defined enteric pathogens. Infant and young child hospitalization (but not death) rates in each category increased more than 50% during 1990 to 1994. Age-adjusted death and hospitalization rates due to enteric bacterial infections and hospitalizations due to enteric viral infections have increased since 1988. The increases in hospitalization and death rates from enteric bacterial infections were due to a more than eightfold increase in rates for specified enteric bacterial infections that were uncoded during this period (ICD9 00849). To identify bacterial agents responsible for most of these infections, hospital discharges and outpatient claims (coded with more detail after 1992) were examined for New Mexico's Lovelace Health Systems for 1993 to 1996. Of diseases due to uncoded enteric pathogens, 73% were due to Clostridium difficile infection. Also, 88% of Washington State death certificates (1985 to 1996) coded to unspecified enteric pathogen infections (ICD0084) listed C. difficile infection.
Highlights
This study calculated yearly estimated national hospital discharge (1985 to 1994) and age-adjusted death rates (1980 to 1992) due to bacterial, viral, protozoal, and illdefined enteric pathogens
To ascertain the specific bacterial agents responsible for the increase, deaths were initially categorized by each three- and four-digit International Classification of Disease 9th revision (ICD9) code included in the bacterial category
Approximately 96% of U.S deaths coded to ICD9 0080-0084 were coded to ICD9 0084, which includes other specified but uncoded enteric bacterial pathogens
Summary
Age-adjusted hospitalization and death rates for each year, standardized to the 1990 U.S population, were calculated for each of the four ICD9 enteric pathogen categories (bacterial, parasitic, viral, and ill-defined). Hospitalizations and Deaths–Bacterial Causes Hospitalizations and deaths due to bacterial causes (including cholera, typhoid and paratyphoid fever, other salmonella infections, shigellosis, other food poisoning bacteria, and infections due to other specified bacteria) were analyzed (Table 1). Additional cause codes were added in 1992 (ICD9 00843-00847 for hospital ICD coding, including 00845 for Clostridium difficile (Table 1). These codes were not yet incorporated for this analysis of national hospital discharge data. Cholera Typhoid and paratyphoid fevers Other salmonella infections Shigellosis Other food poisoning bacterial Intestinal infections due to other organisms Escherichia coli Arizona group of paracolon bacilli Aerobacter aerogenes (Enterobacter) Proteus Other specified bacteria Bacterial enteritis (unspecified) Bacterial infection in conditions classified elsewhere and of unspecified site
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