HOSPITAL USE BY ADOLESCENTS AND YOUNG-ADULTS

This article provides a descriptive profile of hospital use by adolescents (10-14 and 15-18 years of age) and young adults (19-24 years) based on the 1987 National Hospital Discharge Survey. During 1987, nearly 5 million adolescents and young adult patients were discharged from short-stay hospitals. The discharge rate for adolescents was 56.5 per 1000 compared to 127.0 per 1000 for young adults. Two diagnostic categories-complications of pregnancy, childbirth, and the puerperium; and injury and poisoning-together accounted for 24% of discharges for patients aged 10-14 years, 51% for patients aged 15-18 years, and 65% for patients aged 19-24 years. Average length of stay varied substantially by age and diagnosis; that for adolescents averaged 1.1 days longer than that for young adults and for other age groups and was longest for mental disorders. Between 1980-1981 and 1986-1987, the rates of hospitalization for mental disorders increased markedly, particularly among adolescents aged 15-18 years with the diagnoses of adjustment reaction and disturbance of conduct, and psychosis, neurosis, and personality disorders. Hospitalizations for substance abuse increased most among young adults during this time period. Most adolescents and young adults relied on private health insurance as their primary payment source, followed by Medicaid. Still, there was no insurance coverage to pay for hospital bills for 729,000 discharges in 1987. Implications of these findings are discussed. Briefly, examining hospitalization patterns by narrower age intervals elucidates important differences by age, sex, diagnostic category, and expected source of payment. Prevention efforts to reduce injury and unintended pregnancies among adolescents and young adults could have a substantial impact on reducing hospitalizations among this age group. Finally, further research is needed to assess the effectiveness of short-term inpatient stays versus alternative therapeutic approaches for the growing number of adolescents and young adults with mental health disorders, including alcohol and drug abuse.