From Vital and Health Statistics of the National Center for Health Statistics Number 94 � November 22, 1983 

Discharge Status of Inpatients 

Discharged From Short=Stay Hospitals: 

United States, 1965-61 

by Robert Pokras, Division of Health Care Statistics 

Introduction 

This report provides national estimates on the discharge 

status of patients discharged from non-Federal short-stay hos­

_	 pitals from 1965 through 1981. For this report discharge 

status is defined at two levels: alive and dead. The frequency 

and percent distribution of patients discharged alive and dead — are provided for each year from 1965 through 1981 (with 

“not stated” data also included); while other trend data are 

presented for the years 1965, 1970, 1975, and 1981 (with 

“not stated” data excluded). 

The statistics in this report are based on data collected 

through the National Hospital Discharge Survey (NHDS), 

a continuous survey conducted by the National Center for 

Health Statistics since 1965. The data for the survey are 

obtained from the face sheets of a sample of the medical 

records of inpatients discharged from a national sample of 

short-stay general and specialty hospitals in the United States. 

Various revisions of the International Classification of Diseases have been used in NHDS to code medical data since 

1965.The seventh revision] was used from 1965 through 

1968, the eighth revisionz covered the period 1970-78, and 

the ninth revision3 was used from 1979 through 1981. The 

survey design, data collection procedures, and estimation 

process are described briefly in Technical notes, and a more 

detailed report on the design of NHDS has been published.4 

Familiarity with the definitions used in NHDS is important 

for interpreting the data and for making comparisons with 

statistical data on hospital utilization that are available from 

other sources. For example, patients who are dead on arrival 

or who die in the emergency room of a hospital without 

being admitted to the hospital are not included in the scope 

of this survey. Definitions of the terms used in this report 

are presented in Technical notes. 

Information on the number and cause of deaths in the 

United States is collected by the Division of Vital Statistics 

of the National -Center for Health Statistics. Estimates in 

this report reflecting a deceased patient’s first-listed diagnosis 

do not necessarily reflect the underlying cause of death. 

Discharge status 1965-61 

The distribution of patients according to whether they 

were discharged alive or dead is quite consistent from 1965 

through 1981 (table 1). About 2.8 percent of all patients 

were discharged dead from short-stay hospitals in 1965, and 

about 2.5 percent were discharged dead in 1981. This demonstrates one of the most notable characteristics of the statistics 

in this report: their consistency overtime. 

Between 1965 and 1976 the number of patients with 

their discharge status not stated never exceeded 20 percent 

of the number of patients discharged dead. The abstract 

form used by NHDS to collect data was modified in 1977. 

This modification produced some ambiguity in coding the 

variable discharge status and resulted in an increase in the 

number of cases of discharge status not stated for the years 

1977–80. This was corrected, and in 1981 the number of 

patients with an unknown discharge status was reduced considerably. 

When discharge status is examined by age, the data 

bear out the expected, that the number of patients discharged 

dead is largest in the older age groups. This is true for 

males and females for each year presented in table 1. Patients 

65 years of age and over accounted for 58.8 percent of 

all patients discharged dead in 1965; this increased to 69.4 

percent in 1981. The distribution of deaths in hospitals by 

age was quite similar for both sexes in each of the years 

1965, 1970, 1975, and 1981 (table 2). 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service 
2 aduancedata 

Tebks 1. Number and percent dwtributiin of inpatients d~herged from short-atey hoepitela by diacherge statue: United Stetea, 1W5-S1 

[DischargesfromnemFsderalhospitals,excludingnewborninfants] 

Year of Discharge status 

discharge All discharges Alive Dead Not stated All discharges Alive Dead Not stated 

Number in thousands Percent distribution 

1981 38,544 36,905 982 657 100.0 95.7 2.5 1.7 

1980 . . . . . . . . . . . . . . 37,832 35,212 964 1,657 100,0 93.1 2.5 4.4 

1979 . . . . . . . . . . . . . . 36,747 33,812 924 2,011 100.0 92.0 2.5 5.5 

1978 . . . . . . . . . . . . . . 35,616 32,857 881 1,879 100,0 92.3 2.5 5,? 

1977 . . . . . . . . . . . . . . 35,902 32,215 851 2,836 100.0 89.7 2.4 7.9 

1976 . . . . . . . . . . . . . . 34,372 33,416 852 103 100.0 97.2 2.5 0.3 

1975 . . . . . . . . . . . . . . 34,043 33,117 839 87 100.0 97.3 2.5 0.3 

1974 . . . . . . . . . . . . . . 33,018 32,081 847 90 100.0 97.2 2.6 0.3 

1973 . . . . . . . . . . . . . . 32,125 31,154 847 97 100.0 97.0 2,7 0.3 

1972 . . . . . . . . . . . . . . 31,627 30,803 680 144 100.0 98.8 2.8 0.5 

1971 . . . . . . . . . . . 29,459 28,460 833 166 100.0 96.6 2.8 0.6 

1970 . . . . . . . . . . . . . . 29,127 28,116 853 157 100.0 96.5 2.9 0.5 

1969 . . . . . . . . . . . . . . 28,529 27,502 867 160 100.0 96.4 3.0 0.6 

1968, . . . . . . . . . . . 28,070 27,086 860 124 100,0 96.5 3.1 0.4 

1987 . . . . . . . . . . . . . . 27,964 26,966 838 159 100.0 96.4 3.0 0.6 

lg~ . . . . . . . . . . . . . . 28,477 27,579 811 67 100,0 96.8 2.8 0.3 

1965, ..,.......,.. 29,100 28,246 818 35 100.0 97.1 2.6 0.1 

TM2. Number andperoent diatributionof inpetientadiechargedfro rnahort-atey hoapitele bydieohergestetu$ aq andege: UnitedSteteq 1965, 

1970,1975,end19Sl 

[Dischargesfromnon-Federalhospitals, excludicg nswborn infants] 

m 

Yearof discharge, Discharge status 

sex, and age All discharges Alive Dead Not stated Alidischarges Alive Dead Afot stated 

1965 Number in thousands Percent distribution 

Sothsexes, alleges, . . . . . . . . 29,100 28,246 818 35 100,0 100.0 100.0 100.0 

Under 15 years . . . . . . . . . . . . 4,580 4,504 69 7 15.7 15.9 8.5 19,1 

15+4 years . . . . . . . . . . . . 13,126 13,063 51 13 45.1 46.2 6.2 38.4 

4S84 years.........,,.. 6,702 6,476 217 8 23.0 22.9 26.5 23.6 

65 years and over, . . . . . . . 4,692 4,203 481 7 16,1 14.9 58.6 20.9 

Male, all ages . . . . . . . . . . . . . 11,330 10,866 430 14 100.0 100.0 100.0 100,0 

Under 15 years . . . . . . . . . . . 2,576 2,533 40 3 22.7 23.3 9.4 19.9 

15-44 years . . . . . . . . . . . . . 3,464 3,436 25 4 30.6 31.6 5.8 25.8 

45-64 years . . . . . . . . . . . . . 3,130 3,008 117 5 27,6 27,6 27.3 33.5 

65 years And over . . . . . . . . . 2,159 1,909 248 3 19.1 17.5 57.5 21.0 

Female, alleges, . . . . . . . . . . 17,721 17,313 387 21 100.0 100.0 100.0 100.0 

Under 15 years . . . . . . . . . . . 1,997 1,964 29 4 11.3 11.3 7.5 18.6 

15+4 yeara . . . . . . . . . . . . 9,846 9,610 26 9 54.4 55.5 6.7 43.2 

45-64 yeare . ., . .,..,..., 3,560 3,456 99 4 20.1 20.0 25.7 17.4 

65 years and over . . . . . . . . . 2,519 2,282 233 5 14.2 13.2 60.2 20.8 

1970 

Sothsexes, alleges ..,...... 29,127 28,116 853 157 100,0 100.0 100.0 100.0 

Under 15 years . . . . . . . . . . . . 3,873 3,833 24 16 13.3 13.6 2,8 10,3 

1544 years . . . . . . . . . . . . . . 12,664 12,528 62 75 43.5 44.6 7.2 47.7 

45+1 years . . . . . . . . . . . . . 6,893 6,445 211 38 23.0 22.9 24.6 23.1 

65 years and over .,....... 5,697 5,311 556 30 20.2 16.9 65.2 19.0 

Male, all ages . . . . . . . . . . . . . 11,431 10,921 451 58 100.0 100.0 100.0 100.0 

Under 15 years........,.. 2,173 2,151 14 9 19.0 19.7 3.2 14.8 

1544 years . . . . . . . . . . . . . 3,488 3,434 33 19 30.5 31.4 7.3 33.5 

45-64 yeara . . . . . . . . . . . . . 3,104 2,971 117 16 27.2 27,2 28.0 27.5 

85 years and over . . . . . . . . . . 2,867 2,366 287 14 23.3 21.7 83.6 24.3 

Female, alleges.......,,.. 17,696 17,195 402 99 100.0 100.0 100.0 1LX3.o 

Under 15 years . . . . . . . . . . . . 1,699 1,662 10 8 9.6 9.8 2.4 7.6 

1544 yeare . . . . . . . . . . . . . 9,178 9,093 29 56 51.9 52.9 7.2 56.0 

45-64 yeara . . . . . . . . . . . . . . 3,588 3,474 94 20 20.3 20.2 23,3 20.5 

85 years and over......,,. 3,230 2,945 269 16 18.3 17.1 67.J 15.9 
advancedata 3 

‘We 2. Number and percent dtiributiin of inpatients dwharged from short-atsy hospitals by discharge atstus sex, and sge United StSte5 l~s, 

1970,1975, and 1981--Con. 

[Dischargesfrom non-Faderalhos+itals,excluding newtmrnintants] 

Year of discharge, Discharge status 

sex, and age All discharges Alive Dead Not stated A// discharges Alive Dead Not stated 

1975 Number in thousands Percent distribution 

Both sexes, alleges . . . . . . . . 34,043 33,117 839 67 100.0 100.0 100.0 100.0 

Under 15 years . . . . . . . . . . . . 3,826 3,799 18 9 11.2 11.5 2.1 10.5 

15-44 years . . . . . . . . . . . . 14,171 14,077 54 40 41.6 42.5 6.4 46.2 

45%4 years . . . . . . . . . . . . 8,391 8,168 206 17 24.6 24.7 24.6 19.4 

65 years and over . . . . . . . . . 7,654 7,073 561 21 22.5 21.4 66.9 23.9 

Male, all ages . . . . . . . . . . . . . 13,519 13,034 450 36 100.0 100.0 100.0 100.0 

Under 15 years . . . . . . . . . . . 2,143 2,126 11 6 15,9 16.3 2.5 16,4 

15-44 years . . . . . . . 4,107 4,063 31 13 30.4 31.2 7.0 35.5 

4$64 years . . . . . . . . . . . . . 3,870 3,743 120 7 28.6 26.7 26.7 20.1 

65 years And over, . . . . . . . . 3,399 3,102 287 10 25.1 23.8 63.9 28.0 

Female, all ages . . . . . . . . . . . . 20,523 20,083 390 51 100.0 100.0 100.0 100.0 

Under 15 years . . . . . . . . . . . . 1,682 1,672 7 3 8.2 8.3 1.7 6.4 

15-44 years . . . . . . . . . . . . 10,064 10,014 23 27 49.0 49.9 5.8 53.6 

45-64 yeara . . . . . . . . . . . . . 4,522 4,425 87 10 22.0 22.0 22.2 19.0 

65 years and over . . . . . . . . . 4,256 3,971 274 11 20.7 19.8 70.3 21.1 

1981 

Both sexes, all ages 38,544 36,905 982 657 100.0 100.0 100.0 100.0 

Under 15 years . . . . . . . . . . . . 3,733 3,631 33 69 9.7 9.8 3.3 11.5 

15-44 years . . . ...,..... 15,725 15,393 57 276 40.8 41.7 5.8 41.9 

45-64 years . . . . . . . . . . . . . 8,677 8,309 211 157 22.5 22.5 21.5 22.8 

65 years And over . . . . . . . . . 10,408 9,571 681 156 27.0 25.9 69.4 23.7 

,~Male, alleges, .,..... 15,379 14,626 500 253 100.0 100.0 100.0 100.0 

Under 15 years . . . . . . . . . . . . 2,101 2,049 17 35 13.7 14.0 3.4 13.9 

1541 years . . . . . . . . . . . . . 4,672 4,563 31 78 30.4 31.2 6.2 31.0 

45-64 years . . . . . . . . . . . . . 4,098 3,924 107 67 26.7 26.8 21.5 26.7 

65 years and over . . . . . . . . . 4,507 4,091 344 72 29.3 28.0 68.9 28.4 

Female, all agee . . . . . . . . . . . . 23,165 22,279 482 404 100.0 100.0 100.0 100.0 

Under 15 years . . . . . . . . . . . 1,632 1,582 16 24 7.0 7.1 3.2 7.3 

1544 years . . . . . . . . . . . . . 11,053 10,830 26 197 47.7 48.6 5.4 49.8 

45-84 yeare . . . . . . . . . . . . . 4,579 4,386 104 89 19.8 19.7 21.6 22.0 

65 years and over . . . . . . . . . 5,901 5,480 337 84 25.5 24.6 69.8 20.8 

The two most common causes of death in the United a disease of the circulatory system and that 25.0 percent 

States are cancer and heart disease. Although data from had a first-listed diagnosis of cancer. 

NHDS on diagnoses do not necessarily reflect cause of death, There is an interesting relationship between a patient’s 

a first-listed diagnosis of cancer or of a disease of the circula- discharge status, whether or not the patient had surgery, 

tory system accounts for a relatively large proportion of and the patient’s length of stay in the hospital. Figure 1 

patients discharged dead. Data relating diagnosis and discharge indicates that patients discharged alive had similar lengths 

status across years of the survey are not directly comparable of stay whether they had surgery or not. However, patients 

because of changes in the diagnostic classification system discharged dead had a longer length of stay on the average 

used to code data. The changes instituted in 1970 and 1979 than patients discharged alive; furthermore, patients dismake comparisons across decades imprecise. Nonetheless, charged dead who had surgery had the longest average lengths 

diseases of the circulatory system and cancer ranked first of stay. This phenomenon was fairly consistent for the years 

and second, respectively, as the most frequent diagnoses 1965, 1970, 1975, and 1981, as presented in figure 1. This 

Y 

for patients discharged dead from 1965 through 1981. The 

most recent NHDS data, for 1981, indicated that 39.1 percent 

pattern was examined in a previous report5 using 1979 data 

that revealed this relationship also to be consistent across 

of all patients discharged dead had as a first-listed diagnosis patient age. 
4 adwncedata 

25r IN Inpatients without surgery 

.-

c 

Alive’ Dead Alive Dead Alive Dead Alive Dead 

1965 1970 1975 1961 

NOTE: Dischargesfrom non-Federal hospitals, excluding newborn infants, 

1-

Fgure 1. Average length of stay in short-stay hospitats for inpstienta with surgery and for inpatients without surgery, by dischsrge status United Stateq 

1985, 1970, 1975, and 1981 

D


—
acklncedata 5 

References 

a National Center for Health Statistics: International Ckmzjication 

of Diseases, Adapted for Indexing Hospital Records by Diseases 

and Operations. PHS Pub. No. 719 (Rev.). Public Health Service. 

Washington. U.S. Government Printing Office, Dec. 1962. 

2 National Center for Health Statistics: Eighth Revision hterna~ional 

(Xz@ication of Diseases, Adapted for Use in the United Staies, 

Vols. 1 and 2. PHS Pub. No. 1693. Public Health Service. 

Washington. U.S. Government Printing Office, 1967 and 1968. 

3 U.S. Public Health Service and Health Care Financing Administration: International Class;jication of Diseases, 9th Revision, Clinical 

Modz@ation, Vol. 3. DHHS Pub. No. (PHS) 80-1260. Public 

Health Service. Washington. U.S. Government Printing Office, Sept. 

1980. 

4 National Center for Health Statistics, W .R. Simmons: Development 

of the design of the NCHS Hospital Discharge Survey. Vital and 

Health Statistics. PHS Pub. No. 1000-Series l-No. 39. Public Health 

Service. Washington. U.S. Government Prhting Office, Sept. 1970. 

— 

— 

5 National Center for Health Statistics, Robert Pokras: Surgical 

and nonsurgical procedures in short-stay hospitals, United States, 

1979. Vital and Health Statistics. Series 13-No. 70. DHHS Pub. 

No. (PHS) 83-1731. Public Health Service. Washington. U.S. Government Printing OffIce, Feb. 1983. 

6 National Center for Health Statistics, M.G. Sirken: Utilization 

of short-stay hospitals, summary of nonmedical statistics, United 

States, 1965. Vital and Health Statistics. PHS Pub. No. 1000-Senes 

13-No. 2. Public Health Service. Washington. U.S. Government 

Printing Office, Aug. 1967. 

7 National Center for Health Statistics, M.J. Witkin: Utilization 

of short-stay hospitals by characteristics of discharged patients, 

United States, 1965. Vital and Health Statistics. PHS Pub. No, 

1000-Series 13-No. 3. Public Health Service. Washington. U.S. 

Government Printing Off]ce, Dec. 1967. 
6 

Technical notes 

Survey methoddogy 

sourceof data 

The National Hospital Discharge Survey (NHDS) encompasses patients discharged from short-stay hospitals, exclusive 

of military and Veterans Administration hospitals, located 

in the 50 States and the District of Columbia. Only hospitals 

with six beds or more and an average length of stay of 

less than 30 days for all patients are included in the survey. 

Discharges of newborn infants are excluded from this report. 

The universe of the sufiey consisted of 6,965 short-stay 

hospitals contained in the 1963 Master Facility Inventory 

of Hospitals and Institutions. New hospitals were sampled 

for inclusion in the survey in 1972, 1975, 1977, and 1981. 

Sample design 

All hospitals with 1,000 beds or more in the universe 

of short-stay hospitals were selected with certainty in the 

sample. All hospitals with fewer than 1,000 beds were 

stratified, the primary strata being 24 size-by-region classes. 

Within each of these 24 primary strata, the allocation of 

the hospitals was made through a controlled selection technique so that hospitals in the sample would be properly 

distributed with regard to type of ownership and geographic 

division. Sample hospitals were drawn with probabilities ranging from certainty for the largest hospitals to 1 in 40 for 

the smallest hospitals. 

Sample discharges were selected within the hospitals 

using the daily listing sheet of discharges as the sampling 

frame. These discharges were selected by a random technique, 

usually on the basis of the terminal digit or digits of the 

patient’s medical record number, a number assigned when 

the patient was admitted to the hospital. The within-hospital 

sampling ratio for selecting sample discharges varied inversely 

with the probability of selection of the hospital. 

Data collection and estimation 

The sample selection and the transcription of information 

from the hospital records for abstract forms were performed 

by the hospital staff or by representatives of the National 

Center for Health” Statistics or by both. The data were 

abstracted from the face sheets of the medical records. All 

discharge diagnoses were listed on the abstract in the order 

of the principal one, or the first-listed one if the principal 

one was not identified, followed by the order in which all 

other diagnoses were entered on the face sheet of the medical 

record. 

Statistics produced by NHDS are derived by a complex 

estimating procedure. The basic unit of estimation is the 

sample inpatient discharge abstract. The estimating procedure 

used to produce essentially unbiased national estimates in 

NHDS has three principal components: inflation by reciprocals 

of the probabilities of sample selection, adjustment for non-response, and ratio adjustment to fixed totals. These components 

of estimation are described in appendix I of two earlier 

publications.6’7 

Sampling errors and rounding of numbers 

The standard error is a measure of the sampling variability 

that occurs by chance because only a sample, rather than 

an entire universe, is surveyed. The relative standard error 

of the estimate is obtained by dividing the standard error 

by the estimate itself and is expressed as a, percent of the 

estimate. Table I shows relative standard errors for discharges 

and first-listed diagnoses for 1981. The standard errors for 

average lengths of stay are shown in table II. Standard errors 

for each year from 1965 through 1981 are not presented, 

both in order to save space and because they are relatively 

similar from year to year. Therefore, while these tables provide 

a general idea of sampling variability, more precise values 

can be provided by NHDS. 

Estimates have been rounded to the nearest thousand, 

For this reason detailed figures within tables do not always 

add to the totals. Percents and average lengths of stay were 

calculated from original, unrounded figures and will not necessarily agree precisely with percents or average lengths of 

stay calculated from rounded data. 

Tests of aignificanee 

In this report, the determination of statistical inference -

is based on the two-tailed Bonferroni test for multiple comparisons. Terms relating to differences such as “higher” and 

“less” indicate that the differences are statistically significant. 

Terms such as “similar” or “no difference” mean that no 

statistically significant difference exists between the estima;es 

Table 1. Approxfmete rele6ve standard errors of estimated number of 

d-herges, 19S1 

Relative Size of 

estimate error 

10,000 . . . . . . . . . . . . . . . . . . . . . . . . 16.3


50,000 . . . . . . . . . . . . . . . . . . . . . . . . 10.2


100,000 . . . . . . . . . . . . . . . . . 8.5


300,000 . . . . . . . . . . . . . . . . . . 6.6


500,000 . . . . . . . . . . . . . . . . . . 5.9


1,000,000, . . . . . . . . . . . . . . . . . . . . . . . 5.1


4,000,000. . . . . . . . . . . . . . . . . . . . . 4.0


Teble Il. Approximate atendsrd errors of average lengths of stay, t 981 

Average /ength of stay 

Number of discharges in days 

2 6 10 20 

Standard error in days 

10,000 . . . . . . . . . . . . 0.7 1.2 1.7 2.2 

50,000 . . . . . . . . . . . . 0.3 0.7 1.0 1.4 ,/-

100,000 . . . . . . . . . . . . 0.3 0.6 0.9 1.2 

500,000 . . . . . . . . . . . . 0.2 0.5 0.6 0.9 

1,000,000. . . . . . . . . . . 0.2 0.5 0.6 0.7 

5,000,000. . . . . . . . . . . 0.2 0.5 0.6 ‘“ 

NOTE: A list of references follows the text. 
---

� 

aduarNxdab 7 

being compared. A lack of comment on the difference between 

any two estimates does not mean that the difference was 

[ested and found to be not significant. 

Definition of terms 

Patient—A person who is formally admitted to the inpatient service of a short-stay hospital for observation, care, 

diagnosis, or treatment. In this report the number of patients 

refers to the number of discharges during the year, including 

any multiple discharges of the same individual from one 

or more short-stay hospitals. 

Average length of stay—The total number of patient days 

accumulated at time of discharge by patients discharged during 

the year divided by the number of patients discharged. 

First-listed diagnosis—The coded diagnosis identified as 

the principal diagnosis or listed first on the face sheet of 

the medical record. The number of first-listed diagnoses is 

equivalent to the number of discharges. 

Symbols 

Data not available 

. . . Catego~ not applicable 

Quantity zero 

0.(3 Quantity more than zero but less than 

0.05 

z	 Quantity more than zero but less than 

500 where numbers are rounded to 

thousands 

Figure does not meet standards of reliability or precision (more than 30-percent 

relative standard error) 

#	 Figure suppressed to comply with confidentiality requirements 
8 aCkwxMa 

Recent Issues of Advance Data From VW and Health Statistics 

No. 93. Utilization of Short-Stay Hospitals by Adolescents: United 

States, 1980 (Issued September 14, 1983) 

No. 92. Americans Needing Help to Function at Home (Issued 

September 14, 1983) 

No. 91. An Overview of the 1980 National Master Facility Inventory 

Survey of Nursing and Related Care Homes (Issued August 11, 

1983) 

Suggested Ctition 

National Center for Health Statistics, R. Pokras: Dischar e 

status of inpatients discharged from short-stay hospitas, Y

United States, 1965-81. Advance Data From vital 

and Hea/th Statistics, No. 94. DHHS Pub. No. (PHS) 

84-1250. Public Health Service, Hyattsviile, Md., 

NOV. 22, 1983. 

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