National Trends and Disparities in Hospitalization for Hypertensive Emergencies Among Medicare Beneficiaries, 1999–2019

ABSTRACT Importance In the last two decades, hypertension control in the U.S. population has not improved, and there are widening disparities. Less is known, however, about progress in reducing hospitalizations related to hypertensive emergencies. Objectives To describe trends in national hospitalization rates for hypertensive emergencies, overall and by demographic and geographical subgroups. Design, Setting and, Participants Serial cross-sectional analysis of Medicare fee-for-service beneficiaries aged 65 years or older between 1999 and 2019 using Medicare denominator and inpatient files. Main Outcome and Measures Trends in hospitalization for hypertensive emergencies, overall and by specific subgroups. Results The sample consisted of 397,238 individual Medicare fee-for-service beneficiaries. From 1999 through 2019, the annual hospitalization rates for hypertensive emergencies increased significantly from 51.5 to 125.9 per 100,000 beneficiary-years; this increase was most pronounced among the following subgroups: adults ≥85 years (66.8 to 274.1), females (64.9 to 160.1), Blacks (144.4 to 369.5), and Medicare-Medicaid insured (dual eligible, 93.1 to 270.0). Across all subgroups, Black adults had the highest hospitalization rate in 2019, and there was a significant increase in the differences in hospitalizations between Blacks and Whites from 1999 to 2019. Marked geographic variation was also present, with the highest hospitalization rates in the South (so-called “Stroke Belt”). Among 3,143 counties and county-equivalents included in the study, less than 1% of counties either had no change (n=7) or decreased (n=20) hospitalization rates since 1999. Among patients hospitalized for a hypertensive emergency, the observed 30-day all-cause mortality rate decreased from 2.6% to 1.7% and 30-day all-cause readmission rate decreased from 15.7% to 11.8%. Conclusions and Relevance Among Medicare fee-for-service beneficiaries aged 65 years or older, hospitalization rates for hypertensive emergencies increased substantially and significantly from 1999 to 2019. Black adults had the largest increase in hospitalization rates across age, sex, race, and dual-eligible strata. There was significant national variation, with the highest rates generally in the South. KEY POINTS Question How have hospitalization rate for hypertensive emergencies among US adults aged 65 years and older changed between 1999 and 2019 and are there any differences across demographic and geographical subgroups? Findings In this serial cross-sectional study that included 397,238 individual Medicare fee-for-service beneficiaries, there was a marked increase in hospitalization rates for hypertensive emergencies from 1999 to 2019, and this increase was most pronounced among Black adults across age, sex, race, and dual-eligible strata. Significant national variation was observed, with the highest hospitalization rates generally in the South. Meaning Between 1999 and 2019, hospitalization rates for hypertensive emergencies increased substantially and differences across demographic and geographic subgroups persisted.