As shown in , a total of 85,762 hospitalizations due to hip fractures (17,597 men and 66,674 women) were recorded in 2005 for people ≥ 65 years old (+12.9% compared to 2001). As summarized in , the majority of hospitalizations due to hip fractures occurred in patients ≥ 75 years old (n = 72,072; 15,285 men and 56,787 women; +13.6% compared to 2001), particularly among women of this age group (n = 56,787; +12.2% compared to 2001). Hospitalizations due to hip fractures in men ≥ 75 years old (n = 15,285) increased by a rate of 19.0% from 2001, thus representing the highest increase observed in the subgroup analyses. Patients ≥ 85 years old (n = 29,308; 5661 men and 23,647 women) accounted for 37% of overall fractures among members of the population ≥ 65 years old (data not presented). As shown in , hospital costs were 467 million Euros in 2005 (+25.2% compared to 2001), with rehabilitation costs reaching 532 million Euros in the same year (+27.0% compared to 2001). Pooling all data together, hospitalizations due to hip fractures in the elderly resulted in expenditures of approximately 6.8 billion Euros over the 5-year period (including both hospital and rehabilitation costs).
Number of hospitalizations due to hip fractures in the elderly Italian population (≥65 years old) by age group and sex (Italian Ministry of Health national hospitalization records, 2001–2005)
Estimated direct hospital and rehabilitation costs following hip fractures occurring in people aged ≥ 65 years (Italy 2001–2005)
The total hospitalizations for hemorrhagic and ischemic strokes (including TIA) were 187,883 in 2005 (97,941 men and 89,942 women), with a general increase of 5.1% when compared to 2001 (n = 178,703; men: 92,451; women: 86,252). This observed increase was due to a +19.4% rise in the number of ischemic and hemorrhagic strokes experienced by people ≥ 75 years old (12,198 additional hospital admissions in this age group occurred between 2001 and 2005). The total number of hospital admissions following hemorrhagic strokes was 30,263 in 2005 (men: 15,760; women: 14,503) and 27,613 in 2001 (men: 14,261; women: 13,352), showing a +9.6% increase over the 5-year period (). As shown in , the number of hospitalizations due to ischemic strokes and TIA was 109,707 (men: 59,065; women: 50,642), plus 47,913 (men: 23,116; women: 24,797) in 2005, and 95,613 (men: 51,614; women: 42,999) plus 55,477 (men: 26,576; women: 28,901) in 2001, respectively. Thus, while ischemic strokes increased by a rate of +14.7%, the number of hospitalizations that occurred as a result of TIA showed a −13.6% reduction over the 5-year period.
Number of hospitalizations following hemorrhagic or ischemic strokes and transient ischemic attacks, presented by age group and sex (Italian Ministry of Health national hospitalization records, 2001–2005)
When looking at the data by age group, the number of hospital admissions following TIA decreased in both younger and older patients, while there was a significant increase in patients over 75 years old with respect to both hemorrhagic and ischemic strokes. In 2005, the last year examined, among the subgroup of patients aged 45–64 years old, 20,589 men and 11,121 women (total: 31,710) were hospitalized following hemorrhagic or ischemic strokes (including TIA). In people aged 65–74, 31,988 hospital admissions among men and 20,640 hospitalizations among women were registered (total: 52,628), while in the oldest group (≥75) we recorded 45,364 and 58,181 hospitalizations (total: 103,545) following strokes in men and women, respectively. Men accounted for 52% of the total hospital admissions in 2005, but women ≥ 75 years old were the most represented affected population. The number of men hospitalized because of both hemorrhagic and ischemic strokes (including TIA) was always higher than women in each examined year, with the only exception being patients > 75 years old, where a higher number of hospital admissions among females versus males was always recorded both for hemorrhagic (8428 versus 7115 in 2005) and ischemic strokes (33,120 versus 26,498 in 2005), including TIA (16,633 versus 11,751 in 2005).
As shown in , the overall hospitalization costs sustained for strokes in adults ≥ 45 years of age decreased from 658 million Euros in 2001 to 640 million Euros in 2005 (−2.7%), with hemorrhagic and ischemic strokes showing an average cost per patient of 3515 Euros in 2005, and TIA generating costs of 3089 Euros per patient in the same year. Hospitalization costs totaled 3.3 billion Euros over the 5-year period, with people ≥ 75 year old accounting for about 60% of these expenditures (1.9 billion Euros). As summarized in , rehabilitation costs following strokes were estimated between 2.6 billion Euros in 2001 and about 3 billion Euros in 2005 (an increase of +13.6% over the 5 years), and rose from 1.3 billion Euros to 1.6 billion Euros (+19.3% in 5 years) when only data for patients ≥ 75 years old were examined. Total rehabilitation costs from 2001 to 2005 were estimated to be about 14 billion Euros, with people ≥ 75 years old accounting for 7.4 billion Euros. When considered together, hospitalization and rehabilitation costs reached a total of 3.6 billion Euros in 2005 alone. Rehabilitation costs per patient were estimated to be 15,733 Euros in the same year.
Estimated hospital and rehabilitation costs following strokes (including TIA, hemorrhagic and ischemic events) in the Italian population among those aged 45–100 years old
presents the number of AMI cases that occurred in adults between 2001 and 2005. The total number of hospitalizations due to AMI among patients ≥ 45 years old were 97,913 in 2001, 106,842 in 2002, 113,315 in 2003, 116,303 in 2004, and 117,750 in 2005, showing an increase in hospitalizations of 20.3% over the 5-year period. In 2005, 75,586 men and 42,164 women were hospitalized with a primary diagnosis of AMI, with an increase of 17.2% and 26.2%, respectively, over the 5-year period. The number of patients hospitalized that were ≥65 years old constantly increased over this period, rising from 65,275 in 2001 to 82,382 in 2005, with a corresponding increase of 26.2%. In the youngest age group (45–64 years old), a total of 29,925 AMI hospitalizations in men and 6443 hospitalizations in women were recorded during 2005. In the same year, among the subgroup aged 65–74, 21,621 men and 10,145 women were hospitalized for AMI, with the number of hospitalizations among the oldest group (≥75 years old) being 24,040 and 26,576 in men and women, respectively. The increasing rates across the 5-year period among men and women were 9.4% and 22.0% in the youngest age group, 14.3% and 17.5% in people aged 65–74, and 31.8% and 36.3% in the oldest subgroup, respectively. It should be noted that among AMI patients ≥ 75 years old, the number of women hospitalized was always higher than the number of men, while almost 5000 AMI hospitalizations per year involved people under 45 years old (data not shown).
Number of hospitalizations following acute myocardial infarction in the Italian population aged ≥ 45 years old
Overall hospitalization costs incurred for AMI admissions and treatment for adults ≥ 45 years of age ranged between 305 million Euros in 2001 and 370 million Euros in 2005 (), with an average cost of 3142 Euros per patient in the latter year. Rehabilitation costs following AMI were estimated at between 437 million Euros in 2001 and 525 million Euros in 2005 (an increase of 20.1% over the 5-year period), which rose from 291 million Euros to 368 million Euros (+26.5%) from 2001 to 2005, when only data for patients ≥ 65 years old were examined.
Total hospitalization and rehabilitation costs due to acute myocardial infarction (2001–2005) in the overall population (≥45 years old) and among the elderly (≥65 years old)
shows how the incidence of hip fractures among elderly people has increased between 2001 and 2005, and how the incidence of AMI and strokes occurring across the whole adult population also increased during this time; conversely, hospitalization due to TIA has decreased. shows that hospital costs incurred in 2005 by the national health care system for hip fragility fractures among the elderly were comparable to those associated with strokes (both hemorrhagic and ischemic), which occurred in the whole Italian adult population. These costs were higher than the costs resulting from AMI and TIA. Furthermore, rehabilitation costs following strokes reached about 3 billion Euros in 2005, but rehabilitative costs associated with hip fractures and AMI have been found to be comparable (about 530 million Euros in 2005).
Number of hospitalizations following hip fractures in elderly people (>65 years old) versus strokes (both hemorrhagic and ischemic), TIA, and AMI occurring in the whole adult population (Italy 2001–2005).
Estimated direct hospital costs following hip fractures in elderly people (>65 years old) versus strokes (both hemorrhagic and ischemic), TIA, and AMI occurring in the whole adult population in Italy between 2001 and 2005.