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ORIGINAL ARTICLE Do Variations in Disease Prevalence Limit the Usefulness of Population-Based Hospitalization Rates for Studying Variations in Hospital Admissions? Michael Schwartz, PhD, * Eros A.

Because of significant variation in these population-based hospitalization rates across different regions and different years, these rates often represent only a portion (or none) of the total number of hospitalized persons. The objective of the current study is to examine variations in hospitalization for the same underlying illness, i.e., depression, as a function of differences in geographical regions and health care delivery systems. Methods: Analysis was performed in the 2002 Multiethnic Cohort Study using descriptive statistics using standard distributions, multivariable meta-regression, and conditional meta-regression methods. The results were compared between the two settings [e.g., the National Hospital Discharge Survey (NHS) and the Behavioral Risk Factor Surveillance System (BRASS)] and between regions within the U.S. Results: Of the 1.25 million persons with a depressive illness who were hospitalized in the NHS, 15% did not require transfer to a hospital in their own region. However, among persons hospitalized in the BRASS region, only 5% did not require transfer to a regional facility. Of the 1.06 million persons with a depressive illness who had received care in a hospital in the 2002 NHS, 24% of the hospitalized individuals did not require transfer to a hospital in their own region. Of all persons hospitalized, 22% of those from the Northeast, 25% of those from the Midwest, 26% of those from the South, and 28% of those from those in the West were discharged to a hospital in their own region. Conclusion: Hospitalization may be useful in studies of variations in age- and gender-adjusted hospitalization rates for the same underlying illness. Keywords: Depression, Hospitalization, Geographic Variation, Health Care Delivery Systems INTRODUCTION Depressive illness is one of the most prevalent chronic conditions affecting the US population.1–3 Among adults aged ?18 years who meet the DSM-IV criteria of major depressive disorder (MDD) and are in the process of being treated with one or more psychotropic medications, the lifetime prevalence of MDD is 5% to 10%, with a median age of 36.5 years.4,5 Among individuals with MDD, the risk of hospitalization in the next 12 months is 2.7 to 3.4 times greater than for those with MDD who are not taking pharmacological medications.6 As of May 2003, the rate was 28.7 cases per100,000 persons per year,7 up from 22.

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