Number 84 n September 28, 2015

Hospitalization, Readmission, and Death Experience of
 

Noninstitutionalized Medicare Fee-for-service
 

Beneficiaries Aged 65 and Over
 by Yelena Gorina M.S., M.P.H.; Laura A. Pratt, Ph.D.; Ellen A. Kramarow, Ph.D.; and Nazik Elgaddal, M.S.

Abstract

Objective—This report provides descriptive measures of hospitalization,

readmission, and death among the noninstitutionalized population aged 65 and

over using data from a national survey of the noninstitutionalized population

linked to Medicare data and the National Death Index. The estimates are

presented by self-reported demographic, socioeconomic, heath status, and other

characteristics gathered during the interview with the survey participants.

Methods—Data are from the 2000–2005 National Health Interview Survey

(NHIS) linked to 2000–2006 Medicare data and the National Center for Health

Statistics 2011 Linked Mortality Files. Findings are based on in-home interviews

with 25,593 linkage-eligible noninstitutionalized respondents aged 65 and over

who were enrolled in fee-for-service (FFS) Medicare during the year following

the interview. Among them, 1,100 died during the year following the interview,

5,456 were hospitalized with 3,490 hospitalized once, 1,192 hospitalized twice,

and 774 hospitalized three or more times. Among those hospitalized, 1,491 were

readmitted to the hospital within 30 days since the discharge. Both populationbased and discharge-based measures are used to present the estimates.

Results—This is the first report presenting national estimates on

hospitalization, readmission, and death using NHIS data linked to the Medicare

claims and death data. Among noninstitutionalized Medicare FFS beneficiaries

aged 65 and over, 4.5% died in the year following the interview and 21.6% were

hospitalized, with a discharge rate of 348.4 per 1,000 population. Among those

who were hospitalized and discharged alive, 17.3% were readmitted within 30

days after discharge. About one-quarter of the deceased died in the hospital

(including 7.1% who died during a readmission stay).

Keywords: Medicare claims • linked data • National Death Index • National

Health Interview Survey

Introduction

Older persons discharged from

acute care hospitals are at risk of 30-day

hospital readmission and death. In 2012,

nearly every fifth hospitalization among

Medicare fee-for-service (FFS)

beneficiaries who were discharged from

the hospital alive resulted in a

subsequent readmission within 30

days (1). Despite the fact that more than

80% of Medicare beneficiaries aged 65

and over would want to die at home (2),

in 2013, one-third of 1,904,640 deaths

among persons aged 65 and over in the

United States occurred in the

hospital (3), about the same proportion

as in the previous 12 years (4). Among

patients admitted to the hospital for

pneumonia, 12.1% died within 30 days

of admission. Of these, almost one-half

died after discharge from the

hospital (5).

Studies of hospitalization and

readmission are usually undertaken

using data from administrative databases

or from hospital records (1,6–11). These

sources of data are also used to calculate

readmission and postadmission death rates

that are included in the set of the

measures of inpatient hospital quality of

care (12,13). The most common

hospitalization and readmission measures

use the number of hospital discharges

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2 National Health Statistics Reports n Number 84 n September 28, 2015

during a time period as a denominator. In

addition, measures that are based on the

number of persons discharged (which

account for the fact that some patients are

hospitalized more than once during this

time) or on the population that the

hospital serves (which account for the fact

that some persons are not hospitalized at

all) also can be useful. However, patients’

characteristics available from

administrative databases or from hospital

records are limited, and information about

patients before the hospitalization is not

available.

Recent research shows that

patient-centered community worker

interventions, such as establishing a

measurable goal, encouraging patient

confidence in achieving the goal, and

developing and following a step-by-step

plan for goal achievement, may reduce

the 30-day readmission rate in a

high-risk population and improve

postdischarge outcomes (14). Better

community health care services that

address improving access to primary

care are associated with lower Medicare

expenditures (15). To provide such

services, it is important to identify the

population at risk for readmission and

hospitalization. For example,

readmission rates for beneficiaries with

end-stage renal disease are considerably

higher than average, which suggests that

certain subgroups of beneficiaries are at

greater risk of readmission (16). While

using hospital discharge-based measures

is particularly important for quality

assessment of inpatient care, populationbased measures of hospitalization,

readmission, and death among the

noninstitutionalized population may help

to better identify the population at risk

and may be of interest to policy makers,

managed care organizations, insurers,

and community health care

organizations such as health

centers (15).

Previous studies examining

population-based readmission rates have

usually been based on study-specific

conditions (17) or have not used

nationally representative data (18–21).

Only a few studies consider a person’s

characteristics such as socioeconomic

status, marital status,

education, self-reported health status, or

disability status as risk factors

(18,19,22,23).

The objective of this report is to

describe variation in hospitalization,

readmission, and death rates across

participant characteristics. Using data

from a national survey of the

noninstitutionalized population linked to

Medicare data and the National Death

Index (NDI) allows the presentation of

both discharge-based and populationbased measures by self-reported

characteristics gathered during the

National Health Interview Survey

(NHIS) interview with the survey

participants regardless of whether they

were hospitalized during the year

following the NHIS interview or not.

This population-based information

obtained before the hospitalization may

be helpful in finding predictors and

determinants of preventable

hospitalization and readmission and

disparities among Medicare beneficiaries

and in facilitating broad patient-centered

approaches to prevention strategies in

the community and at the time of

hospital admission (24).

Data

The 2000–2005 National Health

Interview Survey

NHIS is a cross-sectional household

interview survey that uses a multistage

area probability design to collect data on

demographic and health-related

information about the civilian

noninstitutionalized population residing

in the United States at the time of the

interview (http://www.cdc.gov/nchs/

nhis.htm). While NHIS provides

nationally representative estimates

yearly, the statistical reliability of the

estimates presented in this report is

improved by combining data from

6 years of the survey, 2000–2005.

Descriptive categories examined in

this report include self-reported

demographic characteristics,

socioeconomic status, self-reported

health and functional status, number of

chronic conditions, health risk factors,

health insurance information, and

hospitalization in the year prior to the

NHIS interview.

Age at the time of interview is

categorized into three groups: 65–74,

75–84, and 85 and over. Race and

Hispanic origin are collected separately

in NHIS, first by asking if the

participant is Hispanic or Latino, then

by asking the participant’s race or races.

For this report, race and ethnicity are

combined into three categories:

non-Hispanic white, non-Hispanic black,

and Hispanic or Latino. Estimates for

beneficiaries in other race/ethnicity

groups, as well as those who reported

two or more races are not presented due

to the small number of participants in

these groups; however, these persons are

included in statistics based on other

variables. Living arrangements are

presented as living with a spouse or

partner, living with someone other than

spouse or a partner, and living alone.

In this report, socioeconomic status

is characterized by education and family

income level. Two education categories

are used: less than a high school

education [no high school diploma or

General Educational Development

(GED) high school equivalency

certificate] and at least a high school

education (including high school

diploma, GED, some college, or more).

Because income data are often missing,

multiple imputed income files (25) were

used to categorize annual family income

into groups of below 200% of the

poverty threshold or at or above 200%

of the poverty threshold.

Self-reported health status is

presented by three categories, fair or

poor, good, and very good or excellent.

Chronic conditions are self-reported,

health professional-diagnosed

conditions. The number of reported

chronic conditions is dichotomized into

two groups: no condition or one

condition and two or more conditions.

These conditions include hypertension,

heart disease (including coronary heart

disease, angina, myocardial infarction,

and other heart disease), stroke,

emphysema, asthma, chronic bronchitis,

diabetes, kidney disease, liver disease,

ulcer, and cancers.

Health risk factors analyzed are

smoking and leisure-time physical

activity participation. Smoking status is

categorized as ever smoker (reported
National Health Statistics Reports n Number 84 n September 28, 2015 Page 3

smoking at least 100 cigarettes in a

lifetime) and never smoker. Persons who

reported they were unable to perform

leisure-time physical activity were

classified as unable, those who did not

report any sessions of light or moderate

or vigorous leisure-time physical activity

of at least 10 minutes were classified as

inactive, and others who answered the

question were categorized as performing

some or regular leisure-time physical

activity.

Disability measures used in this

report are basic actions difficulty,

complex activity limitation (26), and

needing help with activities of daily

living (ADL). Basic actions difficulty

captures limitations or difficulties in

movement (walking, standing, bending

or kneeling, reaching overhead, and

using the hands and fingers) and in

sensory (the ability of a person to see

and hear what is going on around him

or her), emotional [a score of 13 or

more on the Kessler-6 serious

psychological distress scale (27)], or

cognitive functioning (difficulties with

remembering or experiencing confusion)

that are associated with some health

problem. The complex activity limitation

variable is constructed based on reported

difficulties with any component of either

ADL such as bathing; the instrumental

activities of daily living (IADL) such as

shopping; work limitations because of a

physical, mental, or emotional problem;

or social limitation such as participation

in social activities or doing things to

relax at home. The variable ‘‘needing

help with ADL’’ is defined as needing

the help of other persons with eating,

bathing, dressing, or getting around

inside the home because of a physical,

mental, or emotional problem.

Two dichotomous (yes, no)

variables are used to classify reported

enrollment in private insurance and in

Medicaid. Another dichotomous variable

describes hospitalization in the past year.

This variable is based on self-report of

staying in a hospital overnight during

the 12 months before the interview and

is not included in the calculation of the

hospitalization and discharge measures

in this report.

Medicare data linked to

2000–2005 NHIS

The variables describing Medicare

enrollment and inpatient hospital use for

NHIS 2000–2005 participants during the

year following the interview were

constructed from the NHIS 2000–2005

Linked Medicare Files: http://

www.cdc.gov/nchs/data_access/

data_linkage/cms_medicare.htm (28).

The Centers for Disease Control and

Prevention’s National Center for Health

Statistics (NCHS) record linkage

program has linked various NCHS

surveys to administrative records from

the Centers for Medicare & Medicaid

Services (CMS) and the Social Security

Administration (SSA) under an

interagency agreement among NCHS,

CMS, SSA, and the Office of the

Assistant Secretary for Planning and

Evaluation (28).

The 2000–2005 NHIS have been

linked to 1999–2007 Medicare claims.

Those NHIS participants who had

sufficient personal identifier information

(PII), agreed to provide their Social

Security number (SSN) and Health

Insurance Claim number, and had an

SSN verified by the SSA Enumeration

Verification System were eligible for

linkage to CMS and SSA records

(linkage-eligible). Among the linkageeligible, those with participant-supplied

PII matching the CMS denominator file

on SSN, date of birth (month, day,

year), and sex, were considered to be a

match (linked) to CMS records (28).

Among 65,069 NHIS 2000–2005

participants aged 65 and over, 32,136

were linkage-eligible. Of these, 98% of

the sample adults (n = 31,589) were

linked to the Medicare data.

CMS denominator files were used

to obtain information on Medicare plan

coverage. Provider Analysis and Review

(MEDPAR) files contain Medicare

claims for inpatient hospitalizations and

skilled nursing facilities stays and were

used to determine the dates of admission

and discharge for overnight inpatient

stays in the hospital.

Mortality records linked to

2000–2005 NHIS

The mortality experience of all

Medicare-linked NHIS 2000–2005

participants was identified from the

NCHS 2011 Linked Mortality Files (29).

Mortality status of NCHS survey

participants was ascertained primarily

through probabilistic record matching

with NDI (30). NDI is an NCHS

centralized database of all U.S. deaths

beginning in 1979 (31). Additional

sources of information to determine the

mortality status of a survey participant

include SSA, CMS, and death

certificates. If a source of mortality

other than an NDI record was available,

the participant was considered deceased

for the linked files (32). Among 31,589

NHIS 2000–2005 participants aged 65

and over who were linked to Medicare,

41% (12,862) were deceased by the end

of 2011.

Methods

Study population

Among 31,589 NHIS 2000–2005

Medicare-linked participants aged 65

and over, 99% of participants

(n = 31,355) were enrolled in Medicare

during the year following the NHIS

interview or until death if the date of

death was 12 months or less after the

date of the NHIS interview. For

example, if a person was interviewed in

October 2004 and hospitalized and

discharged in January 2005, readmitted

on February 1 and discharged on

February 15, 2005, hospitalized again in

July 2005, and died in August 2005, this

person would account for three

discharges, one readmission, and a death

within the year following the NHIS

interview.

CMS denominator files allow

obtaining information on Medicare plan

coverage by month of the year. During

the year following the NHIS interview,

25,593 linked NHIS participants were

enrolled only in Medicare FFS, and

5,762 were enrolled in a Medicare

Advantage (including Medicare HMO)

plan for at least 1 month. The analysis

was weighted to obtain national
Page 4 National Health Statistics Reports n Number 84 n September 28, 2015

estimates for noninstitutionalized

Medicare participants. To assess how

Medicare FFS enrollees (n = 25,593)

differ from those enrolled in Medicare

Advantage (n = 4,542) and those who

switched between Medicare FFS and

Medicare Advantage plans at least once

during the year (n = 1,220), the

percentages of enrollees in these three

groups of enrollment by beneficiary’s

characteristic were estimated. Because

Medicare claims generally are not

submitted to CMS for health services

provided to Medicare Advantage

(including Medicare HMO) enrollees,

those who were enrolled in Medicare

Advantage plan for at least 1 month

during the study follow-up period were

excluded from further study analysis.

Study follow-up period

This report reviews inpatient

hospitalization, hospital 30-day

readmission, and 1-year mortality

experience of NHIS 2000–2005

participants who were Medicare FFS

beneficiaries during the year following

the NHIS interview. Medicare

Denominator files were used to identify

months of enrollment or disenrollment

to and from Medicare FFS and

Medicare Advantage plans during the

year. Using the data from the Linked

Medicare Files and NCHS 2011 Linked

Mortality Files, a timeline was created

for each participant for the year

following the NHIS interview. Medicare

inpatient claims data were used to

identify the dates of admission and

discharge from the hospital. The NCHS

2011 Linked Mortality Files were used

to identify the vital status and the date

of death, if applicable. Linked

participants with a date of death later

than 12 months after the date of the

interview or without a death record in

the NCHS 2011 Linked Mortality Files

were assumed alive at the end of the

year following the NHIS interview (n =

30,058).

Statistical analysis

To account for the complex survey

design, the statistical packages SAS

version 9.3 (SAS Institute, Cary, N.C.)

and SUDAAN release 11.0.0 (RTI

International, Research Triangle Park,

N.C.) were used for data analysis. All

analyses include sample adult weights

for NHIS 2000–2005. To account for

possible differences between adults who

were eligible for linkage and those who

were not, sample weights were further

adjusted for linkage ineligibility by

using the SUDAAN procedure PROC

WTADJUST. With PROC WTADJUST,

the model-based calibration approach

was used to adjust the NHIS sample

adult weights for race and sex (33).

The standard errors (SE), 95%

confidence intervals (CI), and relative

standard errors (RSE) were calculated

using SUDAAN software. Estimates

with RSE of 30% or more and those

based on fewer than 30 unweighted

records are considered unreliable and

are not presented in this report.

Estimates based on 30 or more but less

than 59 unweighted records and with an

RSE less than 30% are considered of

low reliability and are shown with a

preceding dagger in the tables.

Differences between survey estimates

were tested for statistical significance

using two-tailed t tests with a level of

significance of 0.05. Terms such as

‘‘higher than’’ and ‘‘lower than’’ indicate

a statistically significant difference at

the 0.05 level.

Unless stated otherwise, the rates

and percentages among persons or

discharges aged 65 and over are

age-adjusted to the 2000 U.S. standard

population using the age groups 65–74,

75–84, and 85 and over.

Hospitalization measures

For the purpose of this analysis,

hospitalization is defined as a hospital

stay in any short- or long-term hospital

with more than 1 day between the

admission and discharge dates on the

hospital claims. Because more than one

claim may be submitted for one

inpatient stay, subsequent claims were

reviewed to identify hospitalization

admission and discharge dates. Two

inpatient hospital stays with the

discharge date on one claim that was the

same as the admission date on another

inpatient claim were defined as a

transfer and were counted as one

hospitalization with admission date from

the first claim and discharge date from

the second claim.

In this report, the number of

discharges is computed as a weighted

sum of all discharges with an admission

date within the year of the NHIS

interview. Among 25,593 Medicare FFS

study participants, 5,456 were

hospitalized in the year following the

NHIS interview (Figure 1) with 3,490

hospitalized once, 1,192 hospitalized

twice, and 774 hospitalized 3–13 times.

Among those hospitalized, less than 1%

of beneficiaries (n = 71) were

hospitalized 6–13 times (Figure 1). A

live discharge is defined as a discharge

with a recorded status ‘‘discharged

alive’’ on an inpatient claim for a

patient. During the year following the

interview, 5,355 participants were

discharged alive at least once (Figure 1).

Among live discharges, 85% of

participants were hospitalized and

discharged alive once (n = 3,477) or

twice (n = 1,157), and less than 1% (n =

66) were hospitalized and discharged

6–13 times (Figure 1).

The discharge rate per 1,000

population was calculated by dividing

the weighted number of all discharges in

the year following the NHIS interview

by the weighted number of

noninstitutionalized Medicare FFS

beneficiaries (NHIS 2000–2005

participants) and multiplying the ratio

by 1,000. The live discharge rate per

1,000 population was calculated by

dividing the weighted number of all live

discharges in the year following the

interview by the weighted number of

noninstitutionalized Medicare FFS

beneficiaries and multiplying the ratio

by 1,000. Because a person may be

hospitalized and discharged multiple

times during a year, the discharge rate is

a measure of the number of discharges

per population and does not represent

the number of persons discharged during

a year.

The percentage of

noninstitutionalized Medicare FFS

beneficiaries discharged at least once

during the year following the NHIS

interview was calculated by dividing the

weighted number of beneficiaries with
National Health Statistics Reports n Number 84 n September 28, 2015 Page 5

 

 

 

 

 

 

 

 

Figure 1. The 2000–2005 National Health Interview Survey linkage-eligible participants

aged 65 and over enrolled in Medicare FFS during the year following the interview, by

hospitalization and readmission status

at least one discharge record during the

year following the NHIS interview by

the weighted number of all beneficiaries

and multiplying the ratio by 100. This

represents the percentage of persons

hospitalized during a year, including

those with multiple discharges.

Mortality measures

Among study participants, 1,100

died during the year following the NHIS

interview. The death rate per 100

population (percentage of persons died)

was calculated by dividing the weighted

number of deaths in the year by the

weighted number of noninstitutionalized

Medicare FFS beneficiaries and

multiplying the ratio by 100. The death

was determined to occur within 30 days

of discharge if there were 30 days or

fewer between the date of death and the

date of discharge (n = 356). The

percentage of persons who had died

within 30 days after hospital discharge

was calculated by dividing the weighted

number of deaths during 30 days after

hospital discharge (but not at the date of

discharge) by the weighted number of

participants and multiplying the ratio by

100.

The death was determined to occur

in the hospital if inpatient claim

contains a status ‘‘discharged dead.’’ For

the purpose of this report, those who

died during the year following the NHIS

interview were stratified by

hospitalization status: deceased within

30 days of discharge (n = 356, including

275 who died outside of the hospital

and 81 who died during readmission

hospital stay); deceased who died in the

hospital but not during a readmission

stay (n = 195); those who were

hospitalized and died after 30 days since

the discharge date (n = 166); and

deceased who were not hospitalized

after the NHIS interview (n = 383)

(Figure 2). The crude percentage of

deaths by hospitalization status was

calculated by dividing the weighted

number of deaths in the hospitalization

status category by the weighted total

number of deaths.

Readmission measures

In this report, a readmission

inpatient stay is defined as a

hospitalization with a date of admission

within 30 days of the day following

discharge from another hospitalization,

as defined in this report (n = 1,491)

(Figure 1). The readmission rate per 100

live discharges is calculated by dividing

the weighted number of readmissions by

the weighted number of live discharges

and multiplying the ratio by 100.

Because a person may be discharged

and readmitted multiple times during a

year, readmission rate is a measure of

the number of readmissions per live

discharges and does not represent the

number of persons readmitted during a

year.

The percentage of

noninstitutionalized Medicare FFS

beneficiaries with at least one

readmission is calculated by dividing the

weighted number of beneficiaries who

were readmitted at least once by the

weighted number of beneficiaries and

multiplying the ratio by 100. This

represents a percentage of persons who

were hospitalized and readmitted during

the year, including those with multiple

discharges and readmissions.

Results

Medicare beneficiary by type

of enrollment

Of noninstitutionalized Medicare

beneficiaries aged 65 and over, 82.5%

remained enrolled in Medicare FFS for

an entire year (or until death), 13.9%

were enrolled in a Medicare Advantage

Plan (including Medicare HMO), and

3.7% switched between Medicare

Advantage and Medicare FFS plans at

least once (Table 1). The percentage of

Medicare FFS enrollees among

non-Hispanic white and non-Hispanic

black beneficiaries was 1.2 times the

percentage among Hispanic or Latino

beneficiaries (84.1% and 81.1% among

non-Hispanic white and non-Hispanic

black beneficiaries, respectively
Page 6 National Health Statistics Reports n Number 84 n September 28, 2015

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 2. Age-adjusted percent distribution of noninstitutionalized Medicare FFS beneficiaries aged 65 and over who died during the

year following the National Health Interview Survey interview, by hospitalization and readmission status: United States, 2000–2006

compared with 67.7% among Hispanic

or Latino beneficiaries). The percentage

of Medicare Advantage Plan enrollees

was twice as high among Hispanic or

Latino beneficiaries (25.1%) as among

non-Hispanic black (12.8%) and

non-Hispanic white (12.8%)

beneficiaries (Table 1, Figure 3).

The percentage of Medicare FFS

enrollment was higher among those who

reported receiving Medicaid benefits

(89.8%) or being enrolled in private

insurance (87.1%) compared with those

who did not report Medicaid (81.7%) or

private insurance (74.4%) (Table 1).

Those enrolled in a Medicare

Advantage plan and those who switched

between Medicare Advantage and

Medicare FFS during the follow-up

period were excluded from further

analysis.

Mortality among

noninstitutionalized

Medicare FFS beneficiaries

aged 65 and over

Death rates

Among noninstitutionalized

Medicare FFS beneficiaries aged 65 and

over, 4.5% died in the year following

the NHIS interview (Table 2). The death

rate increased with age from 2.3%

among those aged 65–74 to 12.7%

among those aged 85 and over, and was

1.5 times (95% CI 1.3, 1.7) as high

among men (5.6%) as among women

(3.7%).

The death rate was higher among

those with less than a high school

education compared with those with at

least a high school education, among

those with family incomes below 200%

compared with those at or above 200%

of the poverty threshold, and among

those not living alone compared with

those living alone. Persons with two or

more chronic conditions died at a rate

2.5 times (95% CI 2.0, 3.1) the rate of

those who reported none or one

condition (6.1% compared with 2.4%).

Among those who reported their health

as fair or poor, 9.3% died within a year

of the NHIS interview, a rate 4.9 times

(95% CI 3.8, 6.0) as high as the rate of

1.9% among those who reported their

health as excellent or very good

(Table 2).

Among those who reported any

difficulties with basic actions or

complex activity limitations, 5.4% died

in the year following the NHIS

interview, compared with 1.8% of those

who did not report such difficulties.

Among those who needed help with

ADL, 17.9% died within the year of the

NHIS interview, a rate 5.3 times
National Health Statistics Reports n Number 84 n September 28, 2015 Page 7

 

Figure 3. Medicare enrollment among noninstitutionalized Medicare beneficiaries aged 65 and over during the year following the National

Health Interview Survey interview, by race and Hispanic origin: United States, 2000–2006

(95% CI 4.6, 6.0) as high as the rate of

3.4% among those who did not need

such help. Current and former smokers

died at a rate 1.7 times (95% CI 1.3,

2.0) as high as the rate for those who

never smoked (5.3% compared with

3.2%). Among those who reported an

overnight hospital stay during the year

prior to the NHIS interview, 9.6% died

during the year following the interview,

compared with 3.1% of those who did

not report an overnight hospital stay.

Among Medicaid recipients, the death

rate (6.1%) was 1.4 times (95% CI 1.2,

1.7) the rate for those who did not

report receiving Medicaid (4.3%).

Observed differences in death rates by

race and Hispanic origin were not

statistically significant (Table 2).

Distribution of deaths by

hospitalization and readmission

status

Among noninstitutionalized

Medicare FFS beneficiaries deceased

during the year following the NHIS

interview, about one-third (31.8%) died

within 30 days after an inpatient

hospital discharge, including 7.1% who

died during their readmission hospital

stay. Another 17.5% died in the hospital

but not during a readmission stay,

15.8% were discharged alive but died

more than 30 days after discharge, and

34.9% died but were not hospitalized

(Table 2, Figure 2).

Those who reported hospitalization

in the year prior to the NHIS interview

and those who reported two or more

chronic conditions were more likely to

be hospitalized before death. Those who

reported hospitalization in the year prior

to the NHIS interview also were more

likely to die in the hospital (Table 2).

Other observed differences in percent

distribution (where available) by

hospitalization and readmission status

were not statistically significant.

Percentage of persons who died

within 30 days after discharge

Among noninstitutionalized FFS

Medicare beneficiaries aged 65 and

over, 1.5% were hospitalized, discharged

alive, and died within 30 days after

discharge (including those who died

during a readmission hospital stay)

(Table 3). This percentage increased

with age, from 0.8% among those aged

65–74 to 1.8% among those aged 75–84

and 3.9% among those aged 85 and

over. Men were more likely (95% CI

1.3, 2.0) to die within 30 days after

discharge (2.0%) than women (1.2%).

Persons with any type of basic actions

difficulties were 2.9 times (95% CI 1.9,

3.9) as likely to die within 30 days of

discharge as persons without such

difficulties (2.0% and 0.7%,

respectively). The percentage of those

hospitalized, discharged alive, and

deceased within 30 days among persons

with any type of complex activity

limitations (2.9%) was 3.6 times (95%

CI 2.5, 4.8) as high as among those

without such limitations (0.8%). Those

in fair or poor health (3.2%) were 2.9

times as likely (95% CI 2.3, 3.6) to die

within 30 days after the discharge as

those in good health (1.1%). The

percentage of persons who were

hospitalized and died within 30 days of

discharge among those who needed help

with ADL (6.0%) was 5.0 times (95%

CI 3.6, 6.4) the percentage among those

who did not need such help (1.2%).

Among those who reported an overnight
Page 8 National Health Statistics Reports n Number 84 n September 28, 2015

hospital stay during the year prior to the

NHIS interview, 3.4% died within 30

days of discharge, 3.4 times (95% CI

2.5, 4.3) the percentage of those who

did not report an overnight stay (1.0%).

Hospitalizations among

noninstitutionalized FFS

Medicare beneficiaries aged

65 and over

Discharge rates

The discharge rate for

hospitalizations among

noninstitutionalized FFS Medicare

beneficiaries during the year following

the NHIS interview was 348.4 per 1,000

population (Table 4, Figure 4). The rates

increased with age from 264.0 per 1,000

population among beneficiaries aged

65–74 to 580.1 per 1,000 among those

aged 85 and over. The rates were about

the same among male and female

discharges (358.5 and 341.1 per 1,000

population, respectively). The discharge

rate for non-Hispanic black beneficiaries

(433.0 per 1,000) was about 1.3 times

(95% CI 1.1, 1.4) the rate for nonHispanic white beneficiaries (343.6 per

1,000).

The discharge rate was 1.4 times

(95% CI 1.3, 1.5) as high among

beneficiaries with less than a high

school education (440.8 per 1,000) as

among those with at least a high school

education (307.3 per 1,000). Similarly,

the discharge rate was 1.4 times (95%

CI 1.3, 1.5) as high among those below

200% (425.5 per 1,000) as among those

at or above 200% of the poverty

threshold (307.0 per 1,000). Those who

lived with persons other than a spouse

or partner were more likely to be

hospitalized (428.8 per 1,000

population) compared with those living

alone or with spouse or partner (365.1

and 330.5 per 1,000 population,

respectively).

The discharge rate among persons

with any basic actions difficulties (439.2

per 1,000) was 2.1 times (95% CI 1.9,

2.4) the rate of those without such

difficulties (206.1 per 1,000). Those

 

Figure 4. Hospital discharge rate among noninstitutionalized Medicare FFS beneficiaries aged 65 and over during the year following the

National Health Interview Survey interview, by selected characteristics: United States, 2000–2006
National Health Statistics Reports n Number 84 n September 28, 2015 Page 9

with complex activity limitation had a

discharge rate (562.9 per 1,000) that

was 2.4 times the rate of those without

complex activity limitation (237.2 per

1,000). Those in fair or poor health

were three times as likely (95% CI 2.7,

3.3) to be hospitalized as those in

excellent or very good health (599.4

compared with 199.7 per 1,000

population). Among those who reported

an overnight hospital stay during the

year prior to the NHIS interview, the

discharge rate was 677.8 per 1,000

population, 2.6 times (95% CI 2.4, 2.7)

as high as the rate among those who did

not report an overnight stay (264.4 per

1,000 population).

The discharge rate for those who

needed help with ADL was 875.0 per

1,000, 2.8 times (95% CI 2.5, 3.1) the

rate among those who did not need such

help (314.1 per 1,000 population).

 

 

 

 

 

 

 

 

 

Percentage of persons

hospitalized

Among noninstitutionalized FFS

Medicare beneficiaries, 21.6% were

hospitalized at least once during the

year following the NHIS interview

(Table 3, Figures 5 and 6). A higher

percentage of persons aged 85 and over

were hospitalized (34.3%) compared

with those aged 65–74 (16.7%), while

the percentage of hospitalization among

men and women was about the same,

22.1% and 21.2%, respectively. About

one-quarter of those with less than a

high school education (25.2%) or those

with family incomes below 200% of the

poverty threshold (24.7%) were

hospitalized, compared with about

one-fifth of those with at least a high

school education (19.9%) or those at or

above 200% of the poverty threshold

 

 

 

 

 

 

 

 

 

 

 

 

(19.9%). One-third of those who

reported fair or poor health (33.3%)

were hospitalized during the year

following the NHIS interview, compared

with 14.1% of those who reported

excellent or very good health. Among

those with two or more chronic

conditions, 27.3% were hospitalized

during the year following the NHIS

interview, compared with 15.1% of

those with none or one chronic

condition. The percentage hospitalized

during the year following the NHIS

interview was 26.2% among those with

basic actions difficulties, 31.3% among

those with complex activity limitations,

and 43.2% among those who needed

help with ADL. Among those who

reported an overnight hospital stay in

the year prior to the NHIS interview,

36.6% were hospitalized, compared with

17.8% of those who did not report an

overnight stay.

 

 

 

 

 

 

 

 

 

 

Figure 5. Percentage ever hospitalized among noninstitutionalized Medicare FFS beneficiaries aged 65 and over during the year

following the National Health Interview Survey interview, by age, sex, education, and readmission status: United States, 2000–2006
 

Page 10 National Health Statistics Reports n Number 84 n September 28, 2015 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 6. Percentage ever hospitalized among noninstitutionalized Medicare FFS beneficiaries aged 65 and over during the year

following the National Health Interview Survey interview, by selected characteristics and readmission status: United States, 2000–2006

Readmission among

noninstitutionalized FFS

Medicare beneficiaries aged

65 and over

Readmission rates

During 2000–2006, among

noninstitutionalized FFS Medicare

beneficiaries aged 65 and over, the

readmission rate was 17.3 per 100 live

discharges (Table 4, Figure 7).

The readmission rate was 20.6 per

100 live discharges among those with

less than a high school education, 1.3

times (95% CI 1.2, 1.5) the rate among

those with at least a high school

education (15.4 per 100 live discharges).

The readmission rate was 19.5 per 100

live discharges among those with family

income of below 200% of the poverty

threshold, 1.3 times (95% CI 1.1, 1.4)

the readmission rate of those at or above

200% of the poverty threshold (15.5 per

100 live discharges). Those living with

another person who was not a spouse or

partner were readmitted at the rate of

20.9 per 100 live discharges, 1.3 times

(95% CI 1.1, 1.5) the rate among those

living with a spouse or partner (15.9 per

100 live discharges). Among those with

two or more chronic conditions, the

readmission rate was 20.5 per 100 live

discharges compared with the rate of

12.7 among those with no or one

chronic condition. Those in fair or poor

health had a readmission rate of 20.7

per 100 live discharges compared with

the rate of 12.0 among those in

excellent or very good health. The

readmission rate for those with complex

activity limitations was 20.8 per 100

live discharges compared with the rate

of 15.0 per 100 live discharges among

those without limitations. Among ever

smokers, the readmission rate was 20.0

per 100 live discharges compared with

the rate of 15.3 among those who never

smoked. Persons who reported an

overnight hospital stay in the year prior

to the NHIS interview had a

readmission rate of 21.5 per 100 live

discharges compared with 14.5

readmissions per 100 live discharges

among those who did not. Those who

needed help with ADL had a

readmission rate of 25.4 per 100 live

discharges, 1.6 times (95% CI 1.4, 1.8)

the readmission rate of those who did

not need help (15.9 per 100 live

discharges).

Observed differences in the

readmission rates by age, sex, race and

Hispanic origin, basic action difficulty,

Medicaid enrollment, or participation in

private insurance were not statistically

significant.

Percentage of persons

hospitalized and readmitted at

least once

Among noninstitutionalized

Medicare FFS beneficiaries aged 65 and

over, 4.1% were hospitalized and

readmitted within 30 days at least once
National Health Statistics Reports n Number 84 n September 28, 2015 Page 11

 

Figure 7. Readmission rate per 100 live discharges among noninstitutionalized Medicare FFS beneficiaries aged 65 and over during the

year following the National Health Interview Survey interview, by selected characteristics: United States, 2000–2006

during the year (Table 3, Figures 5 and

6). The percentage increased with age

from 3.0% among those aged 65–74 to

7.6% among those aged 85 and over.

Men were 1.2 times as likely (95% CI

1.1, 1.4) to be hospitalized and

readmitted as women (4.5% and 3.7%,

respectively). Non-Hispanic black

persons were 1.4 times as likely (95%

CI 1.1, 1.6) to be hospitalized and

readmitted (5.4%) as non-Hispanic white

persons (4.0%).

Among those with two or more

chronic conditions, 6.1% were

hospitalized and readmitted, 2.8 times

(95% CI 2.2, 3.4) the percentage of

those with no or one chronic condition

(2.2%). The percentage of readmission

was 7.7% among those in fair or poor

health, 4.1 times (95% CI 3.1, 5.0) the

percentage of those in excellent and

very good health (1.9%). Among those

who reported an overnight hospital stay

in the year prior to the NHIS interview,

8.9% were hospitalized and readmitted,

3.1 times (95% CI 2.7, 3.4) the

percentage among those who did not

report an overnight stay (2.9%).

Percentage of persons who were

hospitalized and readmitted at

least once or died within 30 days

after discharge

During the year following the NHIS

interview, 4.8% of beneficiaries were

hospitalized and readmitted at least once

or died within 30 days after discharge.

This percentage was 9.4% among

persons aged 85 and over, 2.8 times

(95% CI 2.4, 3.2) the percentage among

those aged 65–74 (3.4%). Men were

hospitalized and readmitted at least once

or died within 30 days after discharge,

1.3 times (95% CI 1.1, 1.4) as high as

women (5.5% compared with 4.3%),

and non-Hispanic black beneficiaries

were 1.3 times (95% CI 1.1, 1.6) as

high as non-Hispanic white beneficiaries

(6.2% compared with 4.7%) to be

hospitalized and readmitted or die

within 30 days after discharge. This

percentage was 6.6% among

beneficiaries with less than a high

school education, 6.2% among those

below 200% of the poverty threshold,

and 6.5% among those living with

others than spouse or partner.
Page 12	 National Health Statistics Reports n Number 84 n September 28, 2015

The percentage of hospitalized and

readmitted or deceased within 30 days

after discharge was 2.2% among those

who reported very good or excellent

health, 4.1% among those in good

health, and 9.1% among those in fair or

poor health. Persons with two or more

chronic conditions were 2.3 times as

likely (95% CI 2.2, 3.3) to be

hospitalized and readmitted or die

within 30 days after discharge as those

with no or one condition (7.2%

compared with 2.6%). This percentage

was 6.3% among persons with basic

actions difficulties, 8.6% among those

with complex activity limitations, and

15.6% among those who needed help

with ADL. The latter percentage was 3.8

times (95% CI 3.3, 4.3) the percentage

among those who did not need help

with ADL (4.1%).

Those who reported an overnight

hospital stay in the previous year were

3.1 times as likely (95% CI 2.7, 3.4) to

be hospitalized and readmitted or die

within 30 days after discharge as those

who did not report an overnight stay

(10.4% compared with 3.4%).

Discussion

Among noninstitutionalized

Medicare FFS beneficiaries aged 65 and

over, 21.6% were hospitalized in the

year following the NHIS interview, with

a discharge rate of 348.4 per 1,000

population. Among live discharges,

17.3% were readmitted within 30 days

after discharge. Although it was not

possible to obtain directly corresponding

discharge and readmission rates

published previously, the discharge rate

of 348.4 per 1,000 noninstitutionalized

population is comparable to the 2006

discharge rate of 3,507.9 discharges per

10,000 civilian population aged 65 and

over reported by the National Hospital

Discharge Survey (34). The readmission

rate of 17.3% is comparable to the 2005

estimate of ‘‘almost 18 percent of

admissions resulted in readmissions

within 30 days of discharge’’ as reported

to Congress by the Medicare Payment

Advisory Commission (16) and to the

2007–2012 national average 30-day

all-cause readmission rate of 19% (8).

During the year following the NHIS

interview, 4.5% of the beneficiaries

died. About one-third of the deceased

died within 30 days after discharge from

the hospital, including 7.1% who died

during a readmission stay. The

percentage of deceased who died within

30 days of discharge did not differ

across demographic and socioeconomic

status characteristics, health and

functional status, health risk factors, or

health insurance.

About one-quarter of the deceased

died in the hospital (including those

7.1% who died during a readmission

stay), which is consistent with other

estimates (3). The observed differences

in the percentage of deceased who died

in the hospital were not significant by

age, sex, race and Hispanic origin, and

other categories with the exception of

those who had an overnight hospital

stay during the year before the NHIS

interview. Those deceased who had

reported an overnight stay in the year

before the NHIS interview were twice

as likely to die in the hospital as those

who did not report an overnight stay.

This report presents rates of

discharge per 1,000 population and

readmission per 100 live discharges by

patients’ characteristics that were

self-reported before hospitalization.

While there was a difference in

discharge rates by most of patients’

characteristics except sex, readmission

rates did not differ by age, sex, race and

Hispanic origin, disability status (e.g.,

basic actions difficulties at the time of

the NHIS interview), or type of the

supplemental insurance (Medicaid or

private).

This report presents national

estimates of the percentage of

noninstitutionalized beneficiaries aged

65 and over who were hospitalized at

least once and readmitted in the year

following the NHIS interview. The

differences between percentages of those

hospitalized by selected variables reflect

the risk factors of being hospitalized and

generally are consistent with the

differences between discharge rates by

these variables. The risk associated with

readmission among beneficiaries reflects

a combination of risk factors for

hospitalization among persons not yet

hospitalized and for readmission among

persons at the time of hospital

discharge, which may differ from the

factors associated with the risk of

readmission among live discharges only.

An understanding of these risk factors

may help community and health

management organizations in prevention

efforts required for reducing

unnecessary hospitalizations and

readmissions.

Limitations

Only Medicare FFS participants

were included in the analysis, as

Medicare claims for HMO participants

are not available. Data from NHIS and

Medicare are from 2000 to 2006, and

readmission patterns may have changed

since that time. Although nonresponse

adjustments have been made, exclusion

of NHIS respondents who are linkageineligible may create some residual bias

in final estimates.

The calculations of the

hospitalization and readmissions

measures in the report do not include

inpatient hospital stays before the NHIS

interview; therefore, a hospitalization in

the first few weeks after the NHIS

interview may itself be a readmission

stay. Finally, the NHIS self-reported

data on chronic conditions and disability

measures may be subject to reporting

bias.

References

1.	 Gerhardt G, Yemane A, Apostle K,

Oelschlaeger A, Rollins E, Brennan

N. Evaluating whether changes in

utilization of hospital outpatient

services contributed to lower

Medicare readmission rate. Medicare

Medicaid Res Rev 4(1). 2014.

2.	 Barnato AE, Anthony DL, Skinner J,

Gallagher PM, Fisher ES. Racial and

ethnic differences in preferences for

end-of-life treatment. J Gen Intern

Med 24(6):695–701. 2009.

3.	 CDC. About multiple cause of death,

1999–2013. CDC WONDER. 2015.

Available from: http://

wonder.cdc.gov/mcd-icd10.html.

4.	 Hall MJ, Levant S, DeFrances CJ.

Trends in inpatient hospital deaths:

National Hospital Discharge Survey,

2000–2010. NCHS data brief, no
National Health Statistics Reports n Number 84 n September 28, 2015	 Page 13

118. Hyattsville, MD: National

Center for Health Statistics. 2013.

5.	 Metersky ML, Waterer G, Nsa W,

Bratzler DW. Predictors of

in-hospital versus postdischarge

mortality in pneumonia. Chest

142(2):476–81. 2012.

6.	 Morley M, Bogasky S, Gage B,

Flood S, Ingber MJ. Medicare

post-acute care episodes and payment

bundling. Medicare Medicaid Res

Rev 4(1). 2014.

7.	 Gerhardt G, Yemane A, Hickman P,

Oelschlaeger A, Rollins E, Brennan

N. Medicare readmission rates

showed meaningful decline in 2012.

Medicare Medicaid Res Rev 3(2).

2013.

8.	 Silverstein MD, Qin H, Mercer SQ,

Fong J, Haydar Z. Risk factors for

30-day hospital readmission in

patients ≥ 65 years of age. Proc

(Bayl Univ Med Cent) 21(4):363–72.

2008.

9.	 Dharmarajan K, Hsieh AF, Lin Z,

Bueno H, Ross JS, Horwitz LI, et al.

Diagnoses and timing of 30-day

readmissions after hospitalization for

heart failure, acute myocardial

infarction, or pneumonia. JAMA

309(4):355–63. 2013.

10. Jencks SF, Williams MV, Coleman

EA. Rehospitalizations among

patients in the Medicare fee-forservice program. N Engl J Med

360(14):1418–28. 2009.

11. Joynt KE, Orav EJ, Jha AK.

Thirty-day readmission rates for

Medicare beneficiaries by race and

site of care. JAMA 305(7):675–81.

2011.

12. AHRQ. Inpatient quality indicators

technical specifications—Version

4.5, May 2013. Available from:

http://www.qualityindicators.

ahrq.gov/Modules/IQI_TechSpec.aspx.

13. CMS. 30-day unplanned readmission

and death measures. Available from:

http://www.medicare.gov/

hospitalcompare/Data/30-daymeasures.html.

14. Kangovi S, Mitra N, Grande D,

White ML, McCollum S, Sellman J,

et al. Patient-centered community

health worker intervention to

improve posthospital outcomes: A

randomized clinical trial. JAMA

Intern Med 174(4):535–43. 2014.

15. Sharma R, Lebrun-Harris LA,

Ngo-Metzger Q. Costs and clinical

quality among Medicare

beneficiaries: Associations with

health center penetration of lowincome residents. Medicare Medicaid

Res Rev 4(3). 2014.

16. MedPAC. Report to the Congress:

Promoting greater efficiency in

Medicare. Washington, DC:

MedPAC. 2007.

17. DePalma G, Xu H, Covinsky KE,

Craig BA, Stallard E, Thomas J 3rd,

Sands LP. Hospital readmission

among older adults who return home

with unmet need for ADL disability.

Gerontologist 53(3):454–61. 2013.

18. Kansagara D, Englander H, Salanitro

A, Kagen D, Theobald C, Freeman

M, Kripalani S. Risk prediction

models for hospital readmission: A

systematic review. JAMA

306(15):1688–98. 2011.

19. Amarasingham R, Moore BJ, Tabak

YP, Drazner MH, Clark CA, Zhang

S, et al. An automated model to

identify heart failure patients at risk

for 30-day readmission or death

using electronic medical record data.

Med Care 48(11):981–8. 2010.

20. Sellers MM, Merkow RP, Halverson

A, Hinami K, Kelz RR, Bentrem DJ,

Bilimoria KY. Validation of new

readmission data in the American

College of Surgeons National

Surgical Quality Improvement

Program. J Am Coll Surg

216(3):420–7. 2013.

21. Brock J, Mitchell J, Irby K, Stevens

B, Archibald T, Goroski A, Lynn J.

Association between quality

improvement for care transitions in

communities and rehospitalizations

among Medicare beneficiaries.

JAMA 309(4):381–91. 2013.

22. Garrison GM, Mansukhani MP, Bohn

B. Predictors of thirty-day

readmission among hospitalized

family medicine patients. J Am

Board Fam Med 26(1):71–7. 2013.

23. Vaduganathan M, Bonow RO,

Gheorghiade M. Thirty-day

readmissions: The clock is ticking.

JAMA 309(4):345–6. 2013.

24. Williams MV. A requirement to

reduce readmissions: Take care of the

patient, not just the disease. JAMA

309(4):394–6. 2013.

25. Schenker N, Raghunathan TE, Chiu

P, Makuc DM, Zhang G, Cohen AJ.

Multiple imputation of missing

income data in the National Health

Interview Survey. J Am Stat Assoc

101(475):924–33. 2006.

26. Altman B, Bernstein A. Disability

and health in the United States,

2001–2005. Hyattsville, MD:

National Center for Health Statistics.

2008.

27. Kessler RC, Andrews G, Colpe LJ,

Hiripi E, Mroczek DK, Normand

SLT, et al. Short screening scales to

monitor population prevalences and

trends in non-specific psychological

distress. Psychol Med 32(6):959–76.

2002.

28. NCHS. Linkages between survey

data from the National Center for

Health Statistics and Medicare

program data from the Centers for

Medicare and Medicaid Services.

2012. Available from: http://

www.cdc.gov/nchs/data/datalinkage/

cms_medicare_methods_report_final.pdf.

29. NCHS. NCHS data linked to

mortality files. Available from:

http://www.cdc.gov/nchs/data_access/

data_linkage/mortality.htm.

30. NCHS. NCHS 2011 linked mortality

files matching methodology. 2013.

Available from: http://www.cdc.gov/

nchs/data/datalinkage/2011_linked_

mortality_file_matching_methodology.pdf.

31. NCHS. National Death Index user’s

guide. Hyattsville, MD. 2013.

Available from: http://www.cdc.gov/

nchs/data/ndi/NDI_Users_Guide.pdf.

32. NCHS. Analytic guidelines for

NCHS 2011 linked mortality files.

2013. Available from: http://www.

cdc.gov/nchs/data/datalinkage/2011_

linked_mortality_analytic_guidelines.pdf.

33. NCHS. Use of survey weights for

linked data files—Preliminary

guidance. 2013. Available from:

http://www.cdc.gov/nchs/data/

datalinkage/use_of_survey_weights_

for_linked_data_files.pdf.

34. DeFrances CJ, Lucas CA, Buie VC,

Golosinskiy A. 2006 National

Hospital Discharge Survey. National

health statistics reports; no 5.

Hyattsville, MD: National Center for

Health Statistics. 2008.
Page 14 National Health Statistics Reports n Number 84 n September 28, 2015

Table 1. Medicare enrollment among noninstitutionalized Medicare beneficiaries aged 65 during the year following the NHIS interview, by

selected characteristics: United States, 2000–2006

Number of persons

Percentage in

Medicare FFS1

Percentage in Medicare

Advantage plan1

Percentage switched

between FFS and

Medicare HMO1

Characteristic

Sample

size

Number (in

thousands)

Standard

error (in

thousands) Percent

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound

65 and over2 ................ 31,355 197,943 2,703 82.5 81.7 83.2 13.9 13.2 14.6 3.7 3.4 3.9

Age in years

65–74 ....................

75–84 ....................

85 and over.................

17,076

11,219

3,060

105,542

72,649

19,752

1,523

1,256

525

82.2

82.1

85.1

81.3

81.2

83.6

83.1

83.1

86.5

13.8

14.5

12.0

13.0

13.6

10.7

14.7

15.4

13.4

4.0

3.4

2.9

3.7

3.0

2.3

4.3

3.8

3.5

Sex

Men .....................

Women ...................

14,219

17,136

88,524

109,419

1,362

1,550

82.8

82.2

81.9

81.3

83.7

83.1

13.6

14.1

12.8

13.4

14.3

14.9

3.6

3.7

3.3

3.4

4.0

4.0

Race and ethnicity

White, non-Hispanic3 ...........

Black, non-Hispanic3 ...........

Hispanic or Latino .............

24,247

3,147

3,177

161,943

16,527

13,498

2,432

625

547

84.1

81.1

67.7

83.3

79.0

64.8

85.0

83.1

70.6

12.8

12.8

25.1

12.1

11.1

22.4

13.5

14.5

27.7

3.1

6.2

7.2

2.8

5.2

6.0

3.3

7.1

8.4

Education

High school diploma, GED,4

or more ..................

No high school diploma or GED4

....

20,993

9,974

137,396

58,201

2,221

1,015

82.6

82.0

81.7

81.0

83.6

83.0

14.1

13.5

13.2

12.6

14.9

14.3

3.3

4.5

3.0

4.0

3.6

5.0

Income level5

200% or higher ..............

Below 200% poverty level ........

19,079

12,276

124,515

73,429

2,090

1,304

83.2

81.2

82.3

80.1

84.1

82.2

13.6

14.3

12.8

13.4

14.4

15.2

3.2

4.5

2.8

4.1

3.5

4.9

Living arrangement

Living with a spouse or partner.....

Living alone.................

Living with others .............

18,005

9,279

4,070

114,868

58,970

24,100

1,903

1,110

464

82.2

83.8

80.5

81.2

82.8

79.0

83.1

84.9

81.9

14.3

12.7

14.8

13.4

11.8

13.6

15.2

13.6

16.1

3.5

3.5

4.7

3.2

3.1

4.0

3.9

3.9

5.4

Chronic conditions

None or one ................

Two or more ................

8,653

9,518

93,912

103,215

1,636

1,753

82.3

82.7

81.3

81.6

83.3

83.8

14.0

13.7

13.0

12.7

14.9

14.7

3.7

3.6

3.2

3.2

4.2

4.0

Self-reported health status

Excellent or very good ..........

Good.....................

Fair or poor.................

11,626

10,787

8,942

75,600

68,218

54,126

1,331

1,100

1,012

81.9

82.1

83.6

80.9

81.1

82.5

83.0

83.1

84.7

14.8

14.5

11.9

13.8

13.6

10.9

15.7

15.4

12.9

3.3

3.4

4.5

2.9

3.0

4.0

3.7

3.8

5.0

Any limitation

Yes ......................

No ......................

11,875

6,365

127,400

70,498

2,106

1,371

83.4

81.0

82.4

79.7

84.3

82.3

12.9

15.5

12.1

14.3

13.8

16.7

3.7

3.5

3.3

3.0

4.1

4.1

Basic actions difficulty

Yes ......................

No ......................

11,373

6,867

122,420

75,479

2,060

1,428

83.2

81.4

82.3

80.1

84.2

82.6

13.1

15.1

12.2

14.0

13.9

16.3

3.7

3.5

3.3

3.0

4.1

4.1

Movement difficulty

Yes ......................

No ......................

Cognitive difficulty

9,731

8,440

104,218

92,919

1,869

1,634

83.4

81.5

82.4

80.3

84.4

82.6

12.8

15.0

11.9

14.0

13.7

16.1

3.8

3.5

3.4

3.0

4.2

4.0

Yes ......................

No ......................

1,508

16,719

16,282

181,522

607

2,731

83.8

82.4

81.4

81.5

86.2

83.3

11.3

14.1

9.2

13.3

13.4

14.9

4.9

3.5

3.7

3.2

6.1

3.9

See footnotes at end of table.
National Health Statistics Reports n Number 84 n September 28, 2015 Page 15

Table 1. Medicare enrollment among noninstitutionalized Medicare beneficiaries aged 65 during the year following the NHIS interview, by

selected characteristics: United States, 2000–2006—Con.

Number of persons

Percentage in

Medicare FFS1

Percentage in Medicare

Advantage plan1

Percentage switched

between FFS and

Medicare HMO1

Characteristic

Sample

size

Number (in

thousands)

Standard

error (in

thousands) Percent

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound

Emotional difficulty (K–6)

Yes ......................

No ......................

546

17,469

5,519

189,761

285

2,867

82.5

82.5

78.8

81.6

86.2

83.4

9.6

14.0

6.7

13.2

12.6

14.8

†

7.9

3.5

†

5.3

3.1

†

10.4

3.8

Seeing or hearing (sensory) difficulty

Yes ......................

No ......................

4,943

13,295

54,070

143,809

1,147

2,281

83.4

82.2

82.1

81.2

84.7

83.1

13.1

14.1

11.9

13.3

14.3

15.0

3.5

3.7

3.0

3.3

4.1

4.1

Complex activity limitations

Yes ......................

No ......................

6,584

11,656

68,069

129,829

1,394

2,070

84.9

81.3

83.7

80.2

86.1

82.3

11.0

15.3

10.0

14.4

12.1

16.3

4.1

3.4

3.6

3.0

4.6

3.8

Needs help with ADL6

Yes ......................

No ......................

2,162

29,193

13,189

184,754

370

2,529

85.7

82.2

84.1

81.4

87.3

83.0

9.1

14.2

7.9

13.5

10.4

15.0

5.2

3.6

4.3

3.3

6.1

3.8

Leisure-time physical activity

Unable....................

Inactive ...................

Some or regular ..............

1,086

8,281

8,818

11,470

85,939

99,824

501

1,721

1,834

83.9

82.2

82.7

81.0

81.0

81.6

86.9

83.3

83.8

11.5

13.8

14.1

8.8

12.7

13.2

14.1

14.8

15.1

†1

4.6

4.1

3.2

†

3.2

3.6

2.7

†

6.0

4.6

3.6

Smoking

Ever smoker ................

Never smoked ...............

9,210

8,966

101,669

95,491

1,842

1,627

82.4

82.7

81.3

81.6

83.5

83.7

14.0

13.7

13.1

12.7

15.0

14.6

3.6

3.7

3.2

3.2

4.1

4.1

Hospitalized during the year

prior to interview

Yes ......................

No ......................

6,135

25,178

38,691

158,990

727

2,203

85.1

81.8

84.0

81.0

86.1

82.7

10.9

14.6

10.0

13.9

11.8

15.4

4.1

3.6

3.5

3.3

4.6

3.8

Medicaid (dual eligible)

Yes ......................

No ......................

3,250

28,105

17,570

180,374

520

2,549

89.8

81.7

88.4

80.9

91.2

82.6

6.6

14.6

5.5

13.9

7.7

15.3

3.6

3.7

2.9

3.4

4.3

3.9

Private (supplemental) insurance

Yes ......................

No ......................

19,004

12,351

125,128

72,815

2,004

1,322

87.1

74.4

86.3

73.1

88.0

75.7

10.3

20.0

9.6

18.8

11.1

21.1

2.5

5.6

2.2

5.1

2.8

6.1

† Estimate of low reliability (sample size between 30 and 59).
 1During the year following the interview.
 2Includes other racial and ethnic groups not shown separately and missing or unknown responses for poverty level, education, and marital status.
 3Excludes those who reported two or more races.
 4GED is General Educational Development high school equivalency diploma.
 5Based on family income and family size.
 6Activities of daily living include eating, bathing, dressing, or getting around inside the home.
 

SOURCE: CDC/NCHS, National Health Interview Survey, 2000–2005 linked to 2000–2006 Medicare data and NCHS 2011 Linked Mortality Files.
wing the NHIS interview—Number, rates, and hospitalization and readmission status at the time of death among deceased noninstitutionalized

and over, by selected characteristics: United States, 2000–2006

Percentage among deceased who died

umber of deaths in the year

ollowing the NHIS interview

Death rates per

100 persons

Within 30 days

since discharge1

In the hospital, but not

during a readmission stay

In more than 30 days

after last discharge

Never being hospitalized

after the NHIS interview

ple

Number (in

thousands)

Standard

error

(in thousands) Rate

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound

0 7,058 264 4.5 4.3 4.7 31.8 29.0 34.7 17.5 15.2 19.7 15.8 13.4 18.1 34.9 31.9 38.0

08

2

2,0132,912

2,132

119

157

135

2.3

4.9

12.7

2.1

4.5

11.3

2.5

5.3

14.1

32.0

33.9

28.9

27.1

28.9

23.9

36.9

38.8

33.9

†15.4

16.3

21.0

†11.2

12.9

16.7

†19.7

19.7

25.4

†15.2

15.1

†17.1

†10.5

11.4

†12.7

†19.9

18.8

†21.6

37.334.733.0

31.529.928.0

43.139.637.9

73

3,747

3,311

183

169

5.6

3.7

5.2

3.3

6.0

4.1

33.8

29.6

29.5

25.4

38.1

33.9

17.7

17.2

14.6

14.0

20.7

20.4

15.6

15.9

12.6

12.2

18.7

19.6

32.9

37.2

29.0

32.3

36.8

42.1

15

0

5,857

721383

247

7154

4.4

5.84.6

4.04.83.4

4.86.85.8

32.1

†29.5†35.0

29.0

†21.4†24.2

35.2

†37.6†45.8

17.9

**

15.4

**

20.3

**

15.8

**

13.3

**

18.4

**

34.2

†35.5†36.7

30.9

†26.5†25.5

37.5

†44.6†48.0

28

4,051

2,774

189

158

4.0

5.5

3.6

4.9

4.4

6.1

30.0

35.1

26.3

30.3

33.7

39.8

17.4

17.5

14.4

14.0

20.4

21.0

14.4

17.1

11.5

12.9

17.2

21.3

38.2

30.3

34.3

25.6

42.2

35.0

0

0

3,832

3,226

198

165

4.2

5.2

3.8

4.8

4.6

5.6

29.6

34.5

25.7

30.0

33.6

38.9

18.2

16.7

14.8

13.6

21.5

19.7

16.5

14.9

13.2

11.4

19.7

18.4

35.8

33.9

31.7

29.3

39.9

38.6

6

40

3,434

2,102

1,522

168

127

102

4.7

3.8

6.9

4.3

3.4

5.9

5.1

4.2

7.9

32.9

30.9

30.7

28.9

26.0

24.0

36.9

35.8

37.5

17.2

†17.4†18.2

14.1

†13.1†13.0

20.4

†21.6†23.4

16.0

†14.0†17.7

12.6

†9.6

†11.9

19.3

†18.4†23.5

33.9

37.833.4

29.8

32.326.7

38.1

43.340.0

99

1,652

5,147

145

324

2.4

6.1

2.0

5.3

2.8

6.9

29.1

34.9

21.0

30.0

37.2

39.9

*

20.3

*

15.7

*

24.9

*

15.1

*

10.6

*

19.6

44.4

29.7

35.0

24.7

53.7

34.6

77

6

959

1,7494,350

82

125192

1.93.29.3

1.52.88.5

2.33.6

10.1

†31.3

29.432.9

†23.6

23.429.1

†39.1

35.436.7

*

†16.9

18.1

*

†12.1

15.1

*

†21.7

21.1

*

†14.1

17.3

*

†9.7

14.2

*

†18.5

20.4

41.539.631.6

32.933.728.1

50.045.635.2

Page 16 National Health Statistics Reportsn Number 84n September 28, 2015
wing the NHIS interview—Number, rates, and hospitalization and readmission status at the time of death among deceased noninstitutionalized

and over, by selected characteristics: United States, 2000–2006—Con.

Percentage among deceased who died

umber of deaths in the year

ollowing the NHIS interview

Death rates per

100 persons

Within 30 days

since discharge1

In the hospital, but not

during a readmission stay

In more than 30 days

after last discharge

Never being hospitalized

after the NHIS interview

ple

Number (in

thousands)

Standard

error

(in thousands) Rate

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound Percent

95% confidence

interval

Lower

bound

Upper

bound

6,009

789

344

115

5.41.8

4.81.5

6.02.3

33.9

*

29.3

*

38.4

*

19.0

*

14.8

*

23.1

*

15.1

*

11.1

*

19.1

*

32.1

†41.8

27.3

†28.3

36.9

†55.3

5,7771,022

337130

5.42.1

4.81.5

6.02.7

34.6

*

29.9

*

39.2

*

19.3

*

15.1

*

23.6

*

15.0

*

10.9

*

19.1

*

31.145.2

26.332.8

35.957.5

5,3121,329

317150

5.82.1

5.21.7

6.42.5

34.1

†31.3

29.0

†22.7

39.2

†39.9

19.5

*

15.1

*

23.8

*

15.6

*

11.2

*

19.9

*

30.9

†42.0

26.0

†32.0

35.8

†52.1

1,7645,026

175308

10.4

3.6

8.43.2

12.4

4.0

†32.9

33.8

†23.6

28.7

†42.1

38.9

*

18.3

*

13.9

*

22.7

*

16.7

*

11.9

*

21.5

38.7

31.2

29.6

25.9

47.7

36.5

†527

5,899

†90.1

337

†11.4

3.9

†8.1

3.5

†14.7

4.3

*

32.9

*

28.6

*

37.3

*

17.9

*

14.0

*

21.9

*

16.1

*

12.0

*

20.3

*

33.0

*

28.3

*

37.8

2,7883,998

249268

5.73.8

4.7

3.4

6.74.2

33.533.7

26.128.4

40.838.9

†22.0†15.2

†15.1†10.9

†28.8†19.5

†15.6†14.8

†8.3

†10.6

†23.0†19.1

29.036.3

22.230.4

35.842.2

4,9201,879

310173

7.92.1

6.91.7

8.92.5

33.633.4

28.426.0

38.740.8

19.2

*

14.6

*

23.8

*

15.9

*

11.4

*

20.4

*

31.438.2

26.230.2

36.546.1

2,2464,812

129210

17.9

3.4

15.7

3.2

20.1

3.6

29.233.1

23.729.5

34.636.7

19.416.6

15.413.7

23.319.5

16.215.5

12.412.5

20.118.5

35.234.8

30.130.9

40.438.7

1,045

4,161

1,586

119

289

173

10.3

5.7

2.2

8.1

4.9

1.8

12.5

6.5

2.6

†39.2

33.0

†30.9

†29.0

27.5

†21.7

†49.4

38.5

†40.2

*

20.4

*

*

15.4

*

*

25.4

*

*

†14.0

*

*

†8.7

*

*

†19.2

*

†27.9

32.7

†38.3

†17.8

26.7

†28.1

†38.1

38.7

†48.6

National Health Statistics Reportsn Number 84n September 28, 2015 Page 17
wing the NHIS interview—Number, rates, and hospitalization and readmission status at the time of death among deceased noninstitutionalized

and over, by selected characteristics: United States, 2000–2006—Con.

Percentage among deceased who died

umber of deaths in the year Death rates per Within 30 days In the hospital, but not In more than 30 days Never being hospitalized

ollowing the NHIS interview 100 persons since discharge1 during a readmission stay after last discharge after the NHIS interview

95% confidence 95% confidence 95% confidence 95% confidence 95% confidence

interval interval interval interval interval

Standard

ple Number (in error Lower Upper Lower Upper Lower Upper Lower Upper Lower Upper

thousands) (in thousands) Rate bound bound Percent bound bound Percent bound bound Percent bound bound Percent bound bound

4,045 257 5.3 4.7 5.9 33.3 27.6 38.9 19.6 14.3 25.0 †15.0 †9.3 †20.6 32.2 27.0 37.4

2,650 221 3.2 2.6 3.8 34.6 27.7 41.5 †16.1 †10.9 †21.3 †15.4 †10.1 †20.6 34.0 26.9 41.1

3,278 154 9.6 8.8 10.4 33.9 29.5 38.2 22.3 18.5 26.1 17.8 14.3 21.4 26.0 21.9 30.03,765 182 3.1 2.9 3.3 29.8 25.9 33.7 13.3 10.6 16.0 14.0 11.0 16.9 42.9 38.6 47.2

940 76 6.1 5.1 7.1 37.0 28.5 45.5 †18.0 †11.5 †24.4 * * * †35.8 †27.5 †43.0

6,119 255 4.3 3.9 4.7 31.0 28.1 34.0 17.4 14.9 19.9 16.7 14.1 19.3 34.9 31.6 38.2

4,251 207 4.1 3.7 4.5 32.1 28.3 35.8 18.3 15.3 21.2 16.5 13.5 19.6 33.2 29.4 37.02,807 148 5.3 4.7 5.9 31.5 26.9 36.1 16.3 12.6 19.9 14.6 11.0 18.2 37.6 32.7 42.5

and 59).

cision.

stay.

0 standard population using age groups 65–74, 75–84, and 85 and over.

eparately and missing or unknown responses for poverty level, education, and marital status.

ool equivalency diploma.

sing, or getting around inside the home.

vey, 2000–2005 linked to 2000–2006 Medicare data and NCHS 2011 Linked Mortality Files.

Page 18 National Health Statistics Reportsn Number 84n September 28, 2015
National Health Statistics Reports n Number 84 n September 28, 2015 Page 19

Table 3. Percentage of noninstitutionalized Medicare FFS beneficiaries aged 65 and over who were hospitalized, readmitted, or died

within 30 days after discharge during the year following the NHIS interview, by selected characteristics: United States, 2000–2006

Percentage hospitalized at

least once during the year

following the NHIS interview

Percentage died within

30 days after discharge1

Percentage readmitted

within 30 days

after discharge

at least once

Percentage readmitted at

least once or died

within 30 days

after discharge1

95% confidence

interval

95% confidence

interval

95% confidence

interval

95% confidence

interval

Characteristic Percent

Lower

bound

Upper

bound Percent

Lower

bound

Upper

bound Percent

Lower

bound

Upper

bound Percent

Lower

bound

Upper

bound

65 and over, age-adjusted2,3 ...... 21.6 21.0 22.2 1.5 1.3 1.7 4.1 3.9 4.3 4.8 4.6 5.0

Age in years

65–74 ....................

75–84 ....................

85 and over.................

16.7

24.4

34.3

16.0

23.5

32.2

17.4

25.3

36.3

0.8

1.8

3.9

0.6

1.5

3.2

1.0

2.1

4.6

3.0

4.5

7.6

2.8

4.0

6.4

3.2

4.9

8.7

3.4

5.4

9.4

3.0

4.9

8.1

3.7

5.9

10.6

Sex2

Men .....................

Women ...................

22.1

21.2

21.1

20.4

23.1

22.0

2.0

1.2

1.8

1.0

2.2

1.4

4.5

3.7

4.1

3.3

4.9

4.1

5.5

4.3

5.1

3.9

5.9

4.7

Race and ethnicity2

White, non-Hispanic4 ...........

Black, non-Hispanic4 ...........

Hispanic or Latino .............

21.5

24.7

22.3

20.9

22.5

20.1

22.1

26.9

24.5

1.5

†

1.9

†

1.8

1.3

†

1.3

†

1.0

1.7

†

2.5

†

2.6

4.0

5.4

4.3

3.8

4.4

3.3

4.2

6.4

5.3

4.7

6.2

5.2

4.3

5.2

4.2

5.1

7.2

6.2

Education2

High school diploma, GED5,

or more ..................

No high school diploma or GED5

....

19.9

25.2

19.3

24.0

20.5

26.4

1.3

2.0

1.1

1.6

1.5

2.4

3.4

5.7

3.2

5.1

3.6

6.3

4.0

6.6

3.6

6.0

4.4

7.2

Income level2,6

200% or higher ..............

Below 200% poverty level ........

19.9

24.7

19.1

23.7

20.7

25.7

1.3

1.9

1.1

1.5

1.5

2.3

3.4

5.4

3.0

4.8

3.8

6.0

4.1

6.2

3.7

5.6

4.5

6.8

Living arrangement2

Living with a spouse or partner.....

Living alone.................

Living with others .............

21.1

21.9

24.5

20.3

20.9

22.9

21.9

22.9

26.1

1.6

1.4

2.2

1.4

1.2

1.6

1.8

1.6

2.8

3.7

4.5

5.4

3.3

3.9

4.6

4.1

5.1

6.2

4.4

5.1

6.5

4.0

4.5

5.5

4.8

5.7

7.5

Chronic conditions2

None or one ................

Two or more ................

15.1

27.3

14.1

26.1

16.1

28.5

†

0.7

2.3

†

0.5

1.9

†

0.9

2.7

2.2

6.1

1.8

5.5

2.6

6.7

2.6

7.2

2.2

6.4

3.0

8.0

Self-reported health status2

Excellent or very good ..........

Good.....................

Fair or poor.................

14.1

20.5

33.3

13.3

19.5

32.1

14.9

21.5

34.5

†

0.7

1.1

3.2

†

0.5

0.9

2.8

†

0.9

1.3

3.6

1.9

3.5

7.7

1.5

3.1

6.9

2.3

3.9

8.5

2.2

4.1

9.1

1.8

3.7

8.3

2.6

4.5

9.9

Any limitation2

Yes ......................

No ......................

25.9

13.4

24.9

12.2

26.9

14.6

2.0

0.7

1.6

0.3

2.4

1.1

5.2

2.5

4.6

1.9

5.8

3.1

6.3

2.8

5.7

2.2

6.9

3.4

Basic actions difficulty2

Yes ......................

No ......................

26.2

13.6

25.2

12.4

27.2

14.8

2.0

0.7

1.6

0.5

2.4

0.9

5.3

2.7

4.7

2.1

5.9

3.3

6.3

2.9

5.7

2.3

6.9

3.5

Movement difficulty2

Yes ......................

No ......................

27.9

13.8

26.7

12.8

29.1

14.8

2.2

0.8

1.8

0.6

2.6

1.0

5.6

2.5

5.0

2.1

6.2

2.9

6.7

2.9

6.1

2.5

7.3

3.3

See footnotes at end of table.
Page 20 National Health Statistics Reports n Number 84 n September 28, 2015

Table 3. Percentage of noninstitutionalized Medicare FFS beneficiaries aged 65 and over who were hospitalized, readmitted, or died

within 30 days after discharge during the year following the NHIS interview, by selected characteristics: United States, 2000–2006—Con.

Percentage hospitalized at

least once during the year

following the NHIS interview

Percentage died within

30 days after discharge1

Percentage readmitted

within 30 days

after discharge

at least once

Percentage readmitted at

least once or died

within 30 days

after discharge1

95% confidence

interval

95% confidence

interval

95% confidence

interval

95% confidence

interval

Characteristic Percent

Lower

bound

Upper

bound Percent

Lower

bound

Upper

bound Percent

Lower

bound

Upper

bound Percent

Lower

bound

Upper

bound

Cognitive difficulty2

Yes ......................

No ......................

29.6

20.7

26.5

19.9

32.7

21.5

3.7

1.3

2.3

1.1

5.1

1.5

6.6

4.0

4.6

3.6

8.6

4.4

8.4

4.7

6.4

4.3

10.4

5.1

Emotional difficulty (K–6)2

Yes ......................

No ......................

32.8

20.8

27.3

20.0

38.3

21.6

*

1.4

*

1.2

*

1.6

†

9.3

4.0

†

6.4

3.6

†

12.2

4.4

†

12.2

4.7

†

8.5

4.3

†

15.9

5.1

Seeing or hearing (sensory) difficulty2

Yes ......................

No ......................

26.2

19.9

24.6

19.1

27.8

20.7

2.1

1.3

1.5

1.1

2.7

1.5

5.7

3.8

4.7

3.4

6.7

4.2

6.7

4.4

5.7

4.0

7.7

4.8

Complex activity limitations2

Yes ......................

No ......................

31.3

16.1

29.7

15.3

32.9

16.9

2.9

0.8

2.3

0.6

3.5

1.0

7.2

2.7

6.4

2.3

8.0

3.1

8.6

3.1

7.6

2.7

9.6

3.5

Needs help with ADL2,7

Yes ......................

No ......................

43.2

20.1

40.5

19.5

45.9

20.7

6.0

1.2

4.6

1.0

7.4

1.4

12.9

3.5

11.1

3.3

14.7

3.7

15.6

4.1

13.6

3.9

17.6

4.3

Leisure-time physical activity2

Unable....................

Inactive ...................

Some or regular ..............

38.6

24.5

16.6

34.3

23.3

15.6

42.9

25.7

17.6

†

4.6

2.0

†

0.7

†

3.2

1.6

†

0.5

†

6.0

2.4

†

0.9

9.8

5.1

2.8

7.4

4.5

2.4

12.2

5.7

3.2

11.6

6.0

3.2

9.2

5.2

2.6

14.0

6.8

3.8

Smoking2

Ever smoker ................

Never smoked ...............

23.5

19.2

22.3

18.2

24.7

20.2

1.9

1.2

1.5

0.8

2.3

1.6

5.1

3.4

4.5

2.8

5.7

4.0

6.0

4.0

5.4

3.4

6.6

4.6

Hospitalized during the year

prior to interview2

Yes ......................

No ......................

36.6

17.8

35.0

17.2

38.2

18.4

3.4

1.0

2.8

0.8

4.0

1.2

8.9

2.9

8.1

2.7

9.7

3.1

10.4

3.4

9.4

3.2

11.4

3.6

Medicaid (dual eligible)2

Yes ......................

No ......................

27.5

21.0

25.7

20.4

29.3

21.6

2.4

1.5

1.8

1.3

3.0

1.7

6.4

3.8

5.4

3.6

7.4

4.0

7.6

4.5

6.4

4.3

8.8

4.7

Private (supplemental) insurance2

Yes ......................

No ......................

21.2

22.4

20.6

21.4

21.8

23.4

1.4

1.8

1.2

1.4

1.6

2.2

3.8

4.6

3.4

4.2

4.2

5.0

4.5

5.4

4.1

4.8

4.9

6.0

† Estimate of low reliability (sample size between 30 and 59).

* Figure does not meet standards of reliability or precision.
 1Includes those who died during readmission hospital stay.
 2Percentages are age-adjusted to the 2000 standard population using age groups 65–74, 75–84, and 85 and over.
 3Includes other racial and ethnic groups not shown separately and missing or unknown responses for poverty level, education, and marital status.
 4Excludes those who reported two or more races.
 5GED is General Educational Development high school equivalency diploma.
 6Based on family income and family size.
 7Activities of daily living include eating, bathing, dressing, or getting around inside the home.
 

SOURCE: CDC/NCHS, National Health Interview Survey, 2000–2005 linked to 2000–2006 Medicare data and NCHS 2011 Linked Mortality Files.
mission rates among noninstitutionalized Medicare FFS beneficiaries aged 65 and over during the year after the NHIS interview, by selected

006

mber of discharges during the year

following the NHIS interview Discharge rates per 1,000 persons

Live discharge1 rates

per 1,000 persons Number of readmissions

Readmission rate per 100

live discharges1

95% confidence

interval

95% confidence

interval

95% confidence

interval

Standard Standard

mple Number (in error (in Lower Upper Lower Upper Sample Number (in error (in Lower Upper

ze thousands) thousands) Rate bound bound Rate bound bound size thousands) thousands) Rate bound bound

28 56,069 1,270 348.4 337.2 359.6 336.9 326.0 347.8 1,491 9,447 379 17.3 16.4 18.2

37 22,905 689 264.0 251.0 277.1 258.8 246.0 271.6 626 3,800 216 16.9 15.6 18.3

10 23,416 700 392.5 374.9 410.1 380.5 363.3 397.7 603 3,919 247 17.3 15.8 18.881 9,748 471 580.1 536.0 624.1 543.2 500.3 586.1 262 1,729 155 18.9 16.5 21.3

20 25,324 817 358.5 340.3 376.6 343.6 326.1 361.0 698 4,390 253 17.9 16.6 19.2

08 30,744 839 341.1 326.1 356.1 332.0 317.2 346.7 793 5,058 290 16.8 15.4 18.2

63 46,504 1,156 343.6 331.7 355.6 332.2 320.5 343.9 1,124 7,709 344 17.0 15.9 18.0

92 5,622 347 433.0 390.0 476.0 416.7 375.1 458.3 216 1,084 112 20.1 17.1 23.0

71 3,199 266 383.3 335.9 430.7 374.3 328.1 420.5 138 565 88 17.8 13.9 21.7

01 33,579 925 307.3 295.2 319.5 296.8 285.0 308.7 773 5,046 252 15.4 14.4 16.5

82 21,574 775 440.8 416.0 465.6 427.1 402.7 451.4 702 4,305 288 20.6 18.8 22.4

19 30,333 891 307.0 294.0 320.1 296.6 283.9 309.2 712 4,619 256 15.5 14.3 16.7

09 25,736 838 425.5 403.1 447.8 411.8 390.1 433.6 779 4,829 303 19.5 17.8 21.1

17 28,321 821 330.5 314.9 346.1 317.6 302.6 332.5 691 4,356 234 15.9 14.7 17.1

39 18,899 716 365.1 342.2 387.9 356.4 333.9 378.9 520 3,380 256 18.4 16.4 20.4

72 8,848 408 428.8 391.0 466.5 410.9 374.2 447.5 280 1,712 164 20.9 17.6 24.2

28 15,961 693 217.0 200.7 233.3 212.8 196.7 229.0 202 2,071 213 12.7 10.6 14.8

03 40,367 1,331 472.8 446.7 498.9 455.4 429.9 480.9 699 7,989 537 20.5 18.6 22.434 11,396 460 199.7 185.8 213.5 194.3 180.7 207.9 210 1,362 126 12.0 10.4 13.6

68 17,252 578 310.2 293.3 327.1 303.0 286.1 319.9 405 2,615 177 15.4 13.8 16.9

26 27,421 858 599.4 570.5 628.3 575.1 547.0 603.1 876 5,471 325 20.7 19.2 22.3

National Health Statistics Reportsn Number 84n September 28, 2015 Page 21
mission rates among noninstitutionalized Medicare FFS beneficiaries aged 65 and over during the year after the NHIS interview, by selected

006—Con.

mber of discharges during the year

following the NHIS interview Discharge rates per 1,000 persons

Live discharge1 rates

per 1,000 persons Number of readmissions

Readmission rate per 100

live discharges1

95% confidence

interval

95% confidence

interval

95% confidence

interval

mple

ze

Number (in

thousands)

Standard

error (in

thousands) Rate

Lower

bound

Upper

bound Rate

Lower

bound

Upper

bound

Sample

size

Number (in

thousands)

Standard

error (in

thousands) Rate

Lower

bound

Upper

bound

3494

46,555

9,870

1,471

559

432.9203.6

410.6180.5

455.2226.7

418.2200.0

396.6177.2

439.8222.7

1,201

290

8,5411,541

548194

18.915.8

17.213.0

20.618.6

0127

45,362

11,063

1,469

583

439.2206.1

415.8184.9

462.5227.3

424.3201.8

401.7180.9

446.9222.7

1,024

467

8,2971,785

545198

18.816.4

17.113.8

20.519.0

7885

41,78114,004

1,431

604

473.5202.1

446.7185.5

500.2218.7

457.3198.0

431.4181.7

483.3214.2

894577

7,7302,096

539188

19.015.3

17.213.1

20.817.4

4477

7,827

48,551

549

1,434

540.6333.4

467.2317.0

613.9349.8

512.8323.9

442.5307.9

583.1340.0

265

1,225

1,4498,621

207526

19.218.2

14.916.7

23.419.7

09

77

3,124

51,420

357

1,521

692.2

334.0

554.4

318.1

830.0

350.0

660.0

323.9

524.3

308.2

795.8

339.6

56

810

†612

8,957

†122

531

†20.5

17.8

†15.2

16.4

†25.8

19.2

2215

20,94335,457

967

1,188

454.8316.2

416.8297.8

492.9334.6

437.0307.7

400.3289.7

473.8325.7

352550

4,1255,957

402416

20.717.1

17.915.5

23.618.7

6959

32,99223,433

1,246

842

562.9237.2

526.1222.6

599.8251.7

540.2233.2

504.4218.8

575.9247.5

920571

6,5903,492

514294

20.815.0

18.613.1

23.016.8

1612

9,666

46,403

454

1,157

875.0314.1

797.5303.0

952.4325.2

828.3305.6

752.1294.7

904.4316.4

377

1,114

2,2277,221

178330

25.415.9

22.914.9

27.916.8

76

1338

7,592

29,57119,136

659

1,124

835

781.2

411.7

243.1

670.1

385.0225.3

892.3

438.4260.8

749.2

396.1238.8

645.0

370.0221.6

853.3

422.2256.0

140

501258

1,735

5,3842,935

303

394287

22.7

19.015.5

18.1

17.013.4

27.2

21.117.7

Page 22 National Health Statistics Reportsn Number 84n September 28, 2015
mission rates among noninstitutionalized Medicare FFS beneficiaries aged 65 and over during the year after the NHIS interview, by selected

006—Con.

mber of discharges during the year

following the NHIS interview Discharge rates per 1,000 persons

Live discharge1 rates

per 1,000 persons Number of readmissions

Readmission rate per 100

live discharges1

95% confidence

interval

95% confidence

interval

95% confidence

interval

mple

ze

Number (in

thousands)

Standard

error (in

thousands) Rate

Lower

bound

Upper

bound Rate

Lower

bound

Upper

bound

Sample

size

Number (in

thousands)

Standard

error (in

thousands) Rate

Lower

bound

Upper

bound

37

67

32,338

23,730

1,152

1,041

402.5

294.0

377.6

272.5

427.4

315.6

387.1

286.2

362.6

265.1

411.6

307.4

551

346

6,232

3,808

447

378

20.0

15.3

18.1

13.2

21.9

17.4

9818

22,60333,395

727822

677.8264.4

641.7254.8

713.8273.9

648.5257.8

613.5248.5

683.4267.1

740748

4,6544,774

275227

21.514.5

19.813.5

23.215.5

4286

7,936

48,133

421

1,159

509.4331.1

465.1320.0

553.6342.3

494.4320.0

450.7309.2

538.2330.8

273

1,218

1,4987,949

173336

19.217.0

16.1

16.0

22.217.9

0127

35,66820,401

976707

331.9381.0

319.2360.1

344.7402.0

320.9368.5

308.4348.1

333.5388.8

869622

5,6963,752

288251

16.318.9

15.217.1

17.520.6

and 59).

on an inpatient claim.

tion using age groups 65–74, 75–84, and 85 and over.

eparately and missing or unknown responses for poverty level, education, and marital status.

ool equivalency diploma.

sing, or getting around inside the home.

vey, 2000–2005 linked to 2000–2006 Medicare data and NCHS 2011 Linked Mortality Files.

National Health Statistics Reportsn Number 84n September 28, 2015 Page 23
U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 5419

Hyattsville, MD 20782–2064

FIRST CLASS MAIL
 

POSTAGE & FEES PAID
 

CDC/NCHS
 

PERMIT NO. G-284
 

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

For more NCHS NHSRs, visit:

http://www.cdc.gov/nchs/products/nhsr.htm.

National Health Statistics Reports n Number 84 n September 28, 2015

Acknowledgments

The authors would like to acknowledge NCHS staff Maria Owings (retired), Alan Simon, and Anita Bercovitz for their contributions to this report.

Suggested citation

Gorina Y, Pratt LA, Kramarow EA, Elgaddal N.

Hospitalization, readmission, and death

experience of noninstitutionalized Medicare

fee-for-service beneficiaries aged 65 and over.

National health statistics reports; no 84.

Hyattsville, MD: National Center for Health

Statistics. 2015.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate Director

for Science

Office of Analysis and Epidemiology

Irma E. Arispe, Ph.D., Director
 

Makram Talih, Ph.D., Associate Director
 

for Science
 

For e-mail updates on NCHS publication releases, subscribe online at: http://www.cdc.gov/nchs/govdelivery.htm.
 

For questions or general information about NCHS: Tel: 1–800–CDC–INFO (1–800–232–4636) • TTY: 1–888–232–6348
 

Internet: http://www.cdc.gov/nchs • Online request form: http://www.cdc.gov/info
 

DHHS Publication No. 2015–1250 • CS259078