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Nearly a third of Americans who die are in the hospital at the time and their last treatments cost the U.S. economy $20 billion, according to a report released on Wednesday.

The single biggest cause of hospital death was septicemia, an overwhelming infection of the blood, which killed 15 percent of patients, the team at the U.S. Agency for Healthcare Research and Quality found.

Eight percent died of respiratory failure, 6 percent died of stroke and 5 percent had fatal heart attacks in the hospital, according to the report, available at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb82.pdf.

“In 2007, it is estimated by the Centers for Disease Control that 2,423,995 people died in the United States. Of these, we estimate that 765,651 died in the hospital,” the agency’s Yafu Zhao and William Encinosa wrote.

“That is, 32 percent of all deaths in the U.S. in 2007 occurred in the hospital.”

Their analysis, using federal survey data, found that the average cost of a hospital stay that ended with the patient’s death was $26,035, compared to $9,447 for patients discharged alive.

Patients covered by Medicare, the federal health insurance plan for the elderly and disabled, accounted for 67 percent of in-hospital deaths and $12 billion in hospital costs.

Private insurance covered 20 percent of patients who died at a cost of $4 billion. Medicaid patients made up 2 percent and uninsured patients accounted for 3 percent and $630 million in costs.

“Overall, the costs of hospitalizations ending in death were $20 billion, which accounted for 5.2 percent of total in-patient hospital costs in the U.S. in 2007,” they wrote.

Zhao and Encinosa used their survey data, which covered 90 percent of U.S. hospitals, along with CDC data to calculate that 74 percent of infants who die are being treated in the hospital at the time.

“Among the elderly, 31 percent of deaths occurred in the hospital, while 34 percent of nonelderly deaths took place in the hospital,” they said.

People with painful, chronic bowel conditions such as Crohn’s disease and ulcerative colitis could see a glimmer of hope from new research.

Scientists say they’ve spotted a genetic flaw that could drive a rare childhood form of colitis, and the finding might have implications for the broader range of illnesses collectively known as inflammatory bowel disease (IBD).

Genetic analysis of nine children with a severe form of early-onset colitis found mutations of two genes producing cell receptors for interleukin-10, a protein that controls the body’s inflammatory response, according to a report published online Nov. 4 in the New England Journal of Medicine.

In one case, a bone marrow transplant eliminated a child’s disease, the report said.

About one million Americans have been diagnosed with IBD, which includes ulcerative colitis and Crohn’s disease. These conditions involve a persistent inflammation of the intestinal tract that can cause bouts of diarrhea, rectal bleeding and other symptoms.

The study is not the first to link interleukin-10 with IBD, noted study researcher Alejandro A. Schaffer, a staff scientist at the U.S. National Center for Biotechnology Information. Previous animal and human studies led to trials of interleukin-10 treatment for IBD patients that were not successful, he said.

But the new study shows that “there may be some subsets of adult patients who have insufficient amounts of interleukin-10,” Schaffer said. “We are suggesting that there might be a subset of patients worth identifying and treating differently.”

It’s not now possible to say how large that subset might be, he said.

“We’re very excited about this discovery,” said study lead author Dr. Erik-Oliver Glocker, a postdoctoral researcher at University College London in the United Kingdom.

The study, done at centers in Germany, the United Kingdom and the United States, identified two mutated genes for the molecules that allow interleukin-10 to act on cells. “These mutations have very severe consequences,” Glocker said. “If you have a mutation in the receptor, interleukin-10 doesn’t work and the entire immune system is off-balance.”

It took a lot of screening to find young people with this specific genetic flaw, Glocker said. The disease usually emerges later in life, and “in older patients, it could be different,” he said.

“There have been a lot of different genetic studies of Crohn’s disease, and they have always found genes that might be concerned,” Glocker said. “Maybe we can screen adult patients for the genes we have described and think of a similar treatment. If you have this mutation, you might be suitable for a bone marrow transplant.”

But adult IBD is a complex condition, genetically speaking, he added.

“The problem is that in Crohn’s disease patients, the cause of the disease is not well understood,” Glocker said. “In the patients we had, we know the genes and the functions of the genes and the proteins. And that makes treatment — a bone marrow transplant — much easier. We’re not sure that a transplant should be considered in adult Crohn’s patients.”

A number of variants of other genes have been detected in people with IBD, Schaffer said. “We’re not saying anything about those patients, unless they also have the interleukin-10 variant,” he said.

When your doctor asks you about any illnesses, injuries or past procedures, there’s no need to commit it all to memory if you keep a health journal.

The American Academy of Family Physicians suggests your journal include the following:
Any injuries you’ve had or illnesses for which you’ve been treated.
Any time you were hospitalized, including when and why.
Any allergies you have to foods, medications, household items, pollens, etc.
Any past surgeries or procedures.
All prescription and over-the-counter medications, vitamins or supplements taken. Be sure to include the dose and how often you take them.
Diseases, illnesses or health conditions that have affected immediate family members.