We performed this study to determine whether or not mortality rate of shock states in large metropolitan areas are lower than in the non-metropolitan areas.
We studied all the hospitalizations within the State of Illinois with the diagnosis of shock, both primary and secondary, using the Illinois Health Care Cost Containment Council Database for 2001 and the ICD-9M codes for stock diagnosis. We excluded anaphylactic, neurogenic, and obstetric shocks. Data collection included patient’s geographic area, incidence of shock, age, gender, length of hospitalization, and outcome. The data was categorized into admissions from the Chicago metropolitan statistical area (CMSA), other metropolitan areas (OMSA), non-metropolitan (rural) areas (NMA) and unknown areas (UNKA) and was analyzed using SPSS statistical software.
From a population of 12,419,293 and hospitalization of 1,130,995 we found 5933 diagnoses of shock. Of these, 4038 were from CMSA, 912 from OMSA, 828 from NMA, a rate of 357, 336 and 336 per 100,000 discharges respectively and 155 from UNKA. The rate for CMSA was significantly higher (P≤ 0.01). Two hundred thirteen of 5933 (3.6%) were 0-17 years of age, 2024/5933 (34.1%) were 18-64 and 3696/5933 (62.3%) were 65 or older. One thousand five hundred ninety four of 5933 (26.9%) were hospitalized for 0-2 days, 2183/5933 (36.8%) for 3-9 days and 2156/5933 (36.3%) for 10 days or longer. There were 2711(45.7%) deaths; the mortality of 1875/4038 (46.4%) in the CMSA was significantly higher than the 395/972 (43.3%) in the OMSA and the 352/828 (42.5%) in the NMA (P=0.02). Of the 2711 deaths, 1336 (49.3%) occurred during the first two days of hospitalization. Of the 3696 patients who were 65 years or older, 1453 (48.3%) died.
Metropolitan areas have higher mortality rates from shock than non-metropolitan (rural) areas. About half of the shock deaths occur within the first two days of hospitalization. Elderly patients have higher incidence and mortality.
Early aggressive therapy of shock in the elderly may improve survival.
S.K. Appavu, None.