Context. Few reports have been published regarding surveillance data for pulmonary hypertension, a debilitating and often fatal condition. Aims. We report trends in pulmonary hypertension. Settings and Design. United States of America; vital statistics, hospital data. Methods and Material. We used mortality data from the National Vital Statistics System (NVSS) for 1999–2008 and hospital discharge data from the National Hospital Discharge Survey (NHDS) for 1999–2009. Statistical Analysis Used. We present age-standardized rates. Results. Since 1999, the numbers of deaths and hospitalizations as well as death rates and hospitalization rates for pulmonary hypertension have increased. In 1999 death rates were higher for men than for women; however, by 2002, no differences by gender remained because of the increasing death rates among women and the declining death rates among men; after 2003 death rates for women were higher than for men. Death rates throughout the reporting period 1999–2008 were higher for blacks than for whites. Hospitalization rates in women were 1.3–1.6 times higher than in men. Conclusions. Pulmonary hypertension mortality and hospitalization numbers and rates increased from 1999 to 2008. 1. Introduction Pulmonary hypertension (PH) is a disorder of the pulmonary vasculature that results in increased pulmonary arterial pressure and is defined as a mean pulmonary arterial pressure (mPAP) ≥25？mm？Hg at rest, the pressure being measured invasively with a pulmonary artery catheter [1–4]. Despite improvements in the diagnosis and management of PH over the past 2 decades with the introduction of targeted medical therapies leading to improved survival, the disease continues to have a poor long-term prognosis [5]. US death rates for PH as the underlying cause of death increased between 1979 and 1999 [6–8]. To assess more recent trends, this report describes national trends for all PH-related deaths and hospitalizations during 1999–2008. 2. Subjects and Methods To examine trends in PH mortality, we analyzed data from the Centers for Disease Control (CDC) National Vital Statistics System (NVSS). The NVSS classified diseases and conditions reported on death certificates during 1999–2010 according to the International Classification of Diseases, Tenth Revision (ICD-10) codes for deaths [9–19]. For this analysis, we considered PH-associated deaths, those with ICD-10 codes I27.0, I27.8, or I27.9 during 1999–2002 and ICD-10 codes I27.0, I27.2, I27.8, or I27.9 during 2003–2008, as any contributing cause of death (i.e., any of the possible 20 conditions,
References
[1]
D. B. Badesch, H. C. Champion, M. A. Gomez Sanchez et al., “Diagnosis and assessment of pulmonary arterial hypertension,” Journal of the American College of Cardiology, vol. 54, no. 1, supplement, pp. S55–S66, 2009.
[2]
G. Simonneau, N. Galiè, L. J. Rubin et al., “Clinical classification of pulmonary hypertension,” Journal of the American College of Cardiology, vol. 43, no. 12, supplement, pp. 5S–12S, 2004.
[3]
G. Simonneau, I. M. Robbins, M. Beghetti et al., “Updated Clinical Classification of Pulmonary Hypertension,” Journal of the American College of Cardiology, vol. 54, no. 1, supplement 1, pp. S43–S54, 2009.
[4]
N. F. Voelkel, R. A. Quaife, L. A. Leinwand et al., “Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure,” Circulation, vol. 114, no. 17, pp. 1883–1891, 2006.
[5]
V. V. McLaughlin, “Looking to the future: a new decade of pulmonary arterial hypertension therapy,” European Respiratory Review, vol. 20, no. 122, pp. 262–269, 2011.
[6]
K. K. Davis, D. E. Lilienfeld, and R. L. Doyle, “Increased mortality in African Americans with idiopathic pulmonary arterial hypertension,” Journal of the National Medical Association, vol. 100, no. 1, pp. 69–72, 2008.
[7]
A. Hyduk, J. B. Croft, C. Ayala, K. Zheng, Z.-J. Zheng, and G. A. Mensah, “Pulmonary hypertension surveillance–United States, 1980–2002,” MMWR Surveillance Summaries, vol. 54, no. 5, pp. 1–28, 2005.
[8]
D. E. Lilienfeld and L. J. Rubin, “Mortality from primary pulmonary hypertension in the United States, 1979–1996,” Chest, vol. 117, no. 3, pp. 796–800, 2000.
[9]
J. Link, C. Glazer, F. Torres, and K. Chin, “International classification of diseases coding changes lead to profound declines in reported idiopathic pulmonary arterial hypertension mortality and hospitalizations: implications for database studies,” Chest, vol. 139, no. 3, pp. 497–504, 2011.
[10]
S. Rich, E. Chomka, L. Hasara et al., “The prevalence of pulmonary hypertension in the United States. Adult population estimates obtained from measurements of chest roentgenograms from the NHANES II Survey,” Chest, vol. 96, no. 2, pp. 236–241, 1989.
[11]
R. N. Anderson, A. M. Mini？o, D. L. Hoyert, and H. M. Rosenberg, “Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates,” National Vital Statistics Reports, vol. 49, no. 2, pp. 1–32, 2001.
[12]
G. R. Bramer, “International statistical classification of diseases and related health problems. Tenth revision,” World Health Statistics Quarterly, vol. 41, no. 1, pp. 32–36, 1988.
[13]
E. Weitzenblum, “Chronic cor pulmonale,” Circulation, vol. 27, no. 4, pp. 594–615, 1963.
[14]
“MANUAL of the international statistical classification of diseases, injuries, and causes of death. Addendum 1. Supplementary interpretations and instructions for coding causes of death,” Bulletin of the World Health Organization. Supplement, vol. 7, supplement 6, pp. 1–55, 1953.
[15]
“The international conference for the tenth revision of the International Classification of Diseases. Strengthening of Epidemiological and Statistical Services Unit. World Health Organization, Geneva,” World Health Statistics Quarterly, vol. 43, no. 4, pp. 204–245, 1990.
[16]
R. N. Anderson and H. M. Rosenberg, “Age standardization of death rates: implementation of the year 2000 standard,” National Vital Statistics Reports, vol. 47, no. 3, pp. 1–16, 20, 1998.
[17]
R. J. Klein and C. A. Schoenborn, “Age adjustment using the 2000 projected U.S. population,” Healthy People 2000 Statistical Notes, no. 20, pp. 1–9, 2001.
[18]
Centers for Disease Control and Prevention, National Center for Health Statistics, Underlying Cause of Death 1999–2009 on CDC WONDER Online Database, 2012, http://wonder.cdc.gov/ucd-icd10.html.
[19]
National Center for Health Statistics, National Vital Statistics System, US Department of Health and Human Services, CDC, National Center for Health Statistics, Hyattsville, Md, USA, 2009, http://www.cdc.gov/nchs/nvss.htm.
[20]
W. R. Simmons and G. A. Schnack, Development of the Design of the NCHS Hospital Discharge Survey. Vital Health Statistics, series 2, no. 39, DHEW publication no. (HRA) 77-1199, Human Resources Administration, Rockville, Md, USA, 1977, http://www.cdc.gov/nchs/data/series/sr_02/sr02_039.pdf.
[21]
L. J. Kozak, Underreporting of Race in the National Hospital Discharge Survey, Advance data no. 265, US Department of Health and Human Services, CDC, National Center for Health Statistics, Hyattsville, Md, USA, 1995, http://www.cdc.gov/nchs/data/ad/ad265.pdf.
[22]
US Department of Health and Human Services. The International Classification of Diseases, Ninth Revision, Clinical Modification, DHHS publication no. (PHS) 91-1260, US Department of Health and Human Services, CDC, National Center for Health Statistics, Health Care Financing Administration, Hyattsville, Md, USA, 4th edition, 1991.
[23]
D. Mukerjee, D. St George, B. Coleiro et al., “Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach,” Annals of the Rheumatic Diseases, vol. 62, no. 11, pp. 1088–1093, 2003.
[24]
R. A. Israel, H. M. Rosenberg, and L. R. Curtin, “Analytical potential for multiple cause-of-death data,” The American Journal of Epidemiology, vol. 124, no. 2, pp. 161–179, 1986.
[25]
D. B. Badesch, G. E. Raskob, C. G. Elliott et al., “Pulmonary arterial hypertension: baseline characteristics from the REVEAL registry,” Chest, vol. 137, no. 2, pp. 376–387, 2010.
[26]
A. E. Frost, D. B. Badesch, R. J. Barst et al., “The changing picture of patients with pulmonary arterial hypertension in the United States: how REVEAL differs from historic and non-US contemporary registries,” Chest, vol. 139, no. 1, pp. 128–137, 2011.
[27]
G. E. D'Alonzo, R. J. Barst, S. M. Ayres et al., “Survival in patients with primary pulmonary hypertension: results from a national prospective registry,” Annals of Internal Medicine, vol. 115, no. 5, pp. 343–349, 1991.
[28]
K. M. Flegal, D. Carroll, B. K. Kit, and C. L. Ogden, “Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010,” Journal of the American Medical Association, vol. 307, no. 5, pp. 491–497, 2012.
[29]
M. Humbert, O. Sitbon, A. Chaouat et al., “Survival in patients with idiopathic, familial, and anorexigen-associated pulmonary arterial hypertension in the modern management era,” Circulation, vol. 122, no. 2, pp. 156–163, 2010.
[30]
A. T. Geronimus, J. Bound, T. A. Waidmann, M. M. Hillemeier, and P. B. Burns, “Excess mortality among blacks and whites in the United States,” The New England Journal of Medicine, vol. 335, no. 21, pp. 1552–1558, 1996.
[31]
E. D. Austin, T. Lahm, J. West et al., “Gender, sex hormones and pulmonary hypertension,” Pulmonary Circulation, vol. 3, no. 2, pp. 294–314, 2013.
