Pulmonary hypertension surveillance--United States, 1980-2002.

PROBLEM/CONDITION: Pulmonary hypertension, which is listed on hospital records and death certificates as either primary (i.e., idiopathic) pulmonary hypertension or pulmonary hypertension secondary to another underlying condition or disease, is considered rare amongst the U.S. population. Limited reports have been published regarding surveillance data for this debilitating and often fatal condition. REPORTING PERIOD COVERED: 1980-2002. DESCRIPTION OF SYSTEMS: This report summarizes mortality data from the National Vital Statistic System (NVSS) and hospital discharge data from the National Hospital Discharge Survey (NHDS) for 1980-2002 and Medicare hospital claims data for 1990-2002. NVSS, maintained by CDC's National Center for Health Statistics (NCHS), compiles multiple cause of death information from official death certificates filed in the United States. NHDS, also conducted annually by NCHS, includes information on discharges from a sample of nonfederal, short-stay hospitals. Annual hospital claims and enrollment data for all Medicare beneficiaries aged > or =65 years are provided by the Center for Medicare and Medicaid Services. Because pulmonary hypertension might be reported secondary to other diseases, this report presents data for pulmonary hypertension as any contributing cause of death or any-listed hospital diagnosis. Since 1980, the numbers of deaths and hospitalizations, death rates, and hospitalization rates have increased for pulmonary hypertension, particularly among women and older adults. During 1980-2000, death rates were higher for men than women; however, by 2002, no difference in rate was observed because of increasing death rates among women and declining death rates among men. Hospitalization rates were higher for men than for women until 1995; after 1995, higher rates were observed among women. Death rates since 1985 and Medicare hospitalization rates throughout the reporting period 1990-2002 have been higher for blacks than for whites. In addition, two distinct geographic clusters were observed for the highest hospitalization rates in the Medicare population and the highest death rates for pulmonary hypertension, in the western United States and in the Appalachian region.
INTERPRETATION: Increases in mortality from and hospitalization for pulmonary hypertension might reflect increased physician awareness and changes in diagnosing and reporting this chronic disease. Although pulmonary hypertension historically has been considered a disease of women of childbearing age, it affects all ages and racial populations. Older women represent the majority of patients and decedents with this condition. More research is needed concerning cause, prevention, and treatment of pulmonary hypertension. Public health initiatives should include increasing physician awareness that early detection is needed to initiate prompt, effective disease management. Additional epidemiologic initiatives also are needed to ascertain prevalence and incidence of various pulmonary hypertension disease entities such as pulmonary arterial hypertension.