Abstract
-
Objective
Hyperkalemia is a potentially life-threatening condition among patients presenting to the emergency department (ED). However, most epidemiological studies have focused on those with end-stage renal disease (ESRD), and recent large-scale data on the prevalence and management of hyperkalemia in non-ESRD ED patients remain limited.
-
Methods
This was a retrospective cohort study of adults (≥18 years) without ESRD who presented to the ED with hyperkalemia between January 1, 2016, and December 31, 2024. Patients were identified using ICD-10 codes from the Epic Cosmos database. The primary outcome was the incidence of hyperkalemia among all ED visits. Secondary outcomes included admission rates, cardiac arrest, hemodialysis, and administration of medications used to treat hyperkalemia. Data were analyzed using summary statistics and odds ratios with 95% confidence intervals.
-
Results
Among 246,235,769 ED visits, 803,186 (0.33%) had an ICD-10 code for hyperkalemia, and 539,033 (67.11%) of these patients were admitted to the hospital. Cardiac arrest occurred in 18,044 cases (2.25%). Sodium bicarbonate was administered in 38.75% of patients, calcium gluconate or chloride in 32.64%, sodium zirconium cyclosilicate in 24.68%, sodium polystyrene sulfonate in 23.12%, and patiromer in 3.04%. Only 2.99% received hemodialysis.
-
Conclusion
Among adult ED patients without ESRD, hyperkalemia was uncommon but clinically important, with two-thirds requiring admission and approximately 2% experiencing cardiac arrest. Sodium bicarbonate and calcium were frequently administered, while hemodialysis was rare.
-
Keywords: Hyperkalemia; Electrolytes; Emergency department
Capsule Summary
What is already known
Hyperkalemia is a life-threatening condition commonly seen in the emergency department. There are limited epidemiological data on hyperkalemia in patients without end-stage renal disease.
What is new in the current study
From 2016 to 2024, hyperkalemia had a low incidence among emergency department patients without end-stage renal disease, but exhibited a high rate of admission. Sodium bicarbonate was given most commonly, followed by calcium gluconate or chloride, sodium zirconium cyclosilicate, sodium polystyrene sulfonate, and patiromer.
INTRODUCTION
Hyperkalemia poses a significant risk of morbidity and mortality across all hospital settings, including the intensive care unit (ICU), general wards, and the emergency department (ED). Previous studies have demonstrated that patients with hyperkalemia experience worse outcomes, including higher 1-year rates of ED visits and hospital admissions compared with matched controls [
1,
2]. Despite its clinical importance, few studies have examined the incidence and management of hyperkalemia specifically in the ED setting.
Estimates of hyperkalemia incidence vary widely. A retrospective study using the Truven MarketScan database (2010–2014) reported that approximately 1.6% of the US population experienced hyperkalemia at least once in a given year [
3]. Among patients with chronic kidney disease or heart failure, the incidence increased to 6.4% [
3]. Another analysis using Medicare data reported an incidence of 2.6%–2.7% in the general population and 8.9%–9.3% among those with chronic kidney disease or heart failure during the same period [
1]. These discrepancies likely reflect differences in study populations and healthcare settings, as the distribution of risk factors for hyperkalemia is not uniform. Therefore, studying the epidemiology of hyperkalemia in the ED is essential to improving outcomes in this high-risk population.
Hyperkalemia carries a significant risk of morbidity and mortality (e.g., fatal dysrhythmia), underscoring the need for rapid identification and prompt treatment in the ED [
4]. One study found that early correction and normalization of potassium levels in the ED were associated with reduced mortality [
5]. Treatment options include agents that stabilize cardiac conduction (e.g., calcium), shift potassium intracellularly (e.g., nebulized β
2-agonists, insulin with glucose, bicarbonate), or enhance potassium elimination (e.g., loop diuretics, sodium polystyrene sulfonate, sodium zirconium cyclosilicate, dialysis). Given this wide range of therapies, treatment approaches can vary considerably. In a multicenter, prospective observational study across 14 US EDs, 43 distinct treatment combinations were used within the first 4 hours of presentation [
6].
Despite the importance of this condition, ED-specific data on the incidence and management of hyperkalemia are limited. Moreover, while most patients with end-stage renal disease (ESRD) undergo urgent or emergent hemodialysis, management strategies for those without ESRD are less well defined. Understanding the current epidemiology of hyperkalemia in non-ESRD patients is thus critical for optimizing resource utilization, evaluating adherence to evidence-based practices, and identifying opportunities for clinical improvement.
We sought to address these gaps by using a large, national database to examine the epidemiology and management of hyperkalemia in US EDs. The objective of this study was to describe trends in incidence, admission rates, medication use, and hemodialysis among ED patients with hyperkalemia from 2016 to 2024.
METHODS
Ethics statement
The Rush University Medical Center Institutional Review Board classified this study as nonhuman subjects research; therefore, ethics review and informed consent were not required. This study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines [
7].
We conducted a retrospective cohort study of ED presentations with hyperkalemia over a 9-year period using the Cosmos research platform (Epic Systems Corp;
https://cosmos.epic.com/). The Cosmos dataset includes a diverse patient population that closely reflects the US Census, providing a representative sample of individuals seeking healthcare. All data were deduplicated and anonymized centrally by Epic. At the time of this study, the Cosmos dataset included approximately 300 million unique patients and more than 1,700 hospitals.
We queried Cosmos for International Classification of Diseases, 10th Revision (ICD-10) codes corresponding to hyperkalemia (
Suppl. 1) from January 1, 2016, through December 31, 2024. Inclusion criteria consisted of adult patients (≥18 years) who presented to the ED with an ICD-10 code for hyperkalemia and without a code indicating ESRD (
Suppl. 2). The primary outcome was the incidence of hyperkalemia. Secondary outcomes included rates of hospital admission, hemodialysis, and medications administered for hyperkalemia. Hemodialysis was identified using Current Procedural Terminology (CPT) codes 90935, 90937, 90945, and 90947. Medications included calcium gluconate or chloride, sodium bicarbonate, patiromer, sodium polystyrene sulfonate, and sodium zirconium cyclosilicate. Because albuterol, insulin, and loop diuretics have multiple indications, they were excluded from the analysis.
Demographic variables were based on patient self-reporting or hospital staff entry in the electronic health record. Sex was categorized as female, male, or “none of the above,” consistent with Epic definitions. “None of the above” could include X, other, or not reported. Race was defined as American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, White, or other race. “Other race” included unspecified or unlisted categories. Ethnicity was defined as Hispanic or Latino or not Hispanic or Latino. Insurance type was categorized as Medicaid, Medicare, private/other insurance, self-pay, or not reported.
Statistical analysis
Counts and percentages were used to summarize categorical variables. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with the following reference groups: age 18–29 years, female sex, White race, not Hispanic or Latino ethnicity, private/other insurance, and the Northeastern US region. To assess temporal trends, 2016 was used as the reference year for the subsequent 1-year intervals. All analyses were performed using R ver. 3.6.3 (R Foundation for Statistical Computing).
RESULTS
Among 246,235,769 adult ED visits over the 9-year period, 803,186 (0.33%) were identified with an ICD-10 code for hyperkalemia and no code for ESRD (
Fig. 1,
Table 1). The incidence of hyperkalemia among non-ESRD patients fluctuated over time, ranging from a low of 0.28% in 2016 to a peak of 0.35% during 2020–2022. Compared with ED patients in 2016, those in 2020–2022 had 1.27–1.28 times higher odds of hyperkalemia. Of the 803,186 patients, 539,033 (67.11%) were admitted to the hospital (
Table 2). The admission rate declined from 70.02% in 2016 to 65.51% in 2024. Compared to those without hyperkalemia, admission was significantly higher among patients with hyperkalemia (OR, 10.57; 95% CI, 10.52–10.62). A total of 18,044 patients (2.25%) with hyperkalemia experienced cardiac arrest. The incidence of cardiac arrest peaked in 2020 (2.66%) and reached a low of 1.94% in 2024. Compared with those without hyperkalemia, cardiac arrest was more frequent among those with hyperkalemia (OR, 9.05; 95% CI, 8.92–9.19).
Table 3 summarizes the demographic and clinical characteristics of non-ESRD patients with and without hyperkalemia. The likelihood of hyperkalemia increased with age, with most cases occurring in patients aged 65–74 years. Compared with those aged 18–29 years, the odds of hyperkalemia were 20.02 (95% CI, 19.71–20.33) for ages 65–74 years, 24.55 (95% CI, 24.17–24.94) for ages 75–84 years, and 27.13 (95% CI, 26.70–27.57) for ages ≥85 years. Hyperkalemia was also more common in males than females (OR, 1.49; 95% CI, 1.48–1.50) and more frequent among Asian and White patients, while it was less common in those identifying as Hispanic or Latino (OR, 0.71; 95% CI, 0.70–0.72). Patients covered by Medicare had higher rates of hyperkalemia. Regionally, hyperkalemia was most prevalent in the South (OR, 1.28; 95% CI, 1.27–1.29) and least prevalent in the West (OR, 0.94; 95% CI, 0.93–0.95), compared to the Northeast.
Trends in medication administration are demonstrated in
Fig. 2 and
Suppl. 3. Among patients with non-ESRD hyperkalemia, calcium gluconate or chloride was administered in 32.64% of cases, declining from a peak of 42.09% in 2019 to 23.08% in 2024. Sodium bicarbonate was used in 38.75% of cases and remained relatively stable over time (range, 36.42%–40.80%). Among potassium-excreting agents, sodium zirconium cyclosilicate was the most frequently used (24.68%), followed by sodium polystyrene sulfonate (23.12%) and patiromer (3.04%). After sodium zirconium cyclosilicate became available in 2019, its use increased annually, reaching 47.65% in 2024. In contrast, sodium polystyrene sulfonate use declined steadily from 48.56% in 2016 to 7.20% in 2024. Overall, 2.99% of patients received hemodialysis, with rates ranging from 2.32% in 2016 to 3.49% in 2020–2021.
DISCUSSION
Hyperkalemia is a known risk factor for all-cause mortality, cardiovascular events, hospitalizations, and ICU admissions [
4]. Its frequency varies considerably across populations, reflecting differences in predisposing risk factors, comorbidities, and healthcare access. Moreover, treatment availability and practice patterns differ among healthcare systems and hospital settings. Therefore, examining the epidemiology and management of hyperkalemia within a defined population is essential to improving patient outcomes. Large-scale, real-world, population-based studies in the ED are particularly valuable for understanding these trends. In this national cohort of over 246 million ED encounters across nine years, we found that hyperkalemia among patients without ESRD was relatively uncommon, occurring in approximately one in every 300 ED visits. Sodium bicarbonate was the most frequently administered medication, followed by calcium gluconate or chloride, sodium zirconium cyclosilicate, and sodium polystyrene sulfonate. Both patiromer and hemodialysis were rarely used. These findings may serve as a benchmark for ED clinicians to evaluate local management patterns and ensure that the standard of care is being delivered locally.
In our cohort, older patients, male patients, individuals of Asian or White race, and non-Hispanic/non-Latino patients had higher odds of hyperkalemia. This aligns with prior findings from the United Kingdom showing a twofold increase in hyperkalemia risk for each 10-year increase in age and a higher incidence in males than females [
8]. In contrast to some earlier studies, our data suggest that Black patients did not experience higher rates of hyperkalemia than White patients [
9,
10]. However, the association between race and hyperkalemia is complex. Racial differences are a poor proxy for biological or genetic differences and instead likely reflect differences in dietary habits, medication exposure, comorbid conditions, and socioeconomic determinants of health. As a large population-based observational study, we did not account for comorbidities (e.g., cardiac disease) or medication use (e.g., thiazide diuretics that lower potassium vs. renin-angiotensin-aldosterone system inhibitors that raise potassium) across racial and ethnic groups. Therefore, our data, without risk adjustment on the aforementioned factors, should not inform medical decision-making for individuals with hyperkalemia of different races.
The most serious complication of hyperkalemia is cardiac dysrhythmia. It is widely accepted that intravenous calcium should be promptly administered to stabilize the cardiac membrane potential when serum potassium exceeds 6.5 mmol/L (i.e., severe hyperkalemia) and electrocardiogram abnormalities are present (e.g., widened QRS complexes, sine wave pattern) [
11,
12]. Although our study did not differentiate between severe and nonsevere hyperkalemia, prior research indicates that severe hyperkalemia accounts for roughly 15% of ED presentations [
13,
14]. In our cohort, calcium chloride or gluconate was administered in approximately one-third of cases—substantially higher than the expected incidence of severe hyperkalemia. Two potential explanations exist. First, as ICD-10 coding sensitivity increases with disease severity, our dataset may have preferentially captured patients with severe hyperkalemia, for whom clinicians were more likely to document a diagnosis [
15,
16]. Second, calcium may have been administered in nonsevere cases as a precautionary measure. While generally safe, intravenous calcium can cause bradycardia, extravasation, and tissue necrosis. Future studies are warranted to assess the thresholds guiding calcium use in ED hyperkalemia management.
Patiromer, sodium polystyrene sulfonate, and sodium zirconium cyclosilicate are cation-exchange resins that enhance gastrointestinal potassium excretion. Patiromer exchanges potassium for calcium in the gut [
17]. Although it effectively lowers serum potassium among heart failure patients receiving renin-angiotensin-aldosterone system inhibitors in outpatient settings, only 3% of ED patients with hyperkalemia received it; its status as the least frequently used exchange resin reflects its limited role in acute management [
18]. Sodium polystyrene sulfonate, which exchanges potassium for sodium in the distal colon, has been used since 1958 as one of the earliest potassium binders [
19]. However, its use steadily declined in our study, from 49% in 2016 to 7% in 2024, as newer agents became available. Sodium zirconium cyclosilicate, a cation-exchange resin approved in 2018, exchanges potassium and ammonia for hydrogen and sodium ions in both the small and large intestines [
20,
21]. Unlike the variable onset of sodium polystyrene sulfonate, sodium zirconium cyclosilicate acts more rapidly, lowering serum potassium within one hour [
22]. Compared to placebo, it can reduce potassium by 0.72 mEq/L within 2 hours [
23]. Our data suggest that by 2024, it was the most common medication used to treat hyperkalemia in ED patients without ESRD, with an administration rate of 48%.
The administration of sodium bicarbonate facilitates intracellular potassium shifts and enhances urinary potassium excretion. However, its efficacy remains controversial, and potential adverse effects, including fluid overload, hypernatremia, and metabolic alkalosis, limit its use primarily to patients with metabolic acidosis and preserved kidney function [
24]. For instance, one ED-based study found no significant change in serum potassium after adding sodium bicarbonate to standard potassium-lowering regimens [
25]. Despite expert consensus statements citing insufficient evidence for its routine use, our findings indicate that bicarbonate administration was common and remained stable over time, with approximately 39% of patients receiving this therapy [
26].
In severe cases of hyperkalemia, hemodialysis may be necessary. Indications include inadequate response to standard medical therapy, as evidenced by persistent electrocardiographic abnormalities or serum potassium levels exceeding 6.0–6.5 mmol/L despite treatment. Hemodialysis remains the most rapid and effective method for reducing total body potassium, typically lowering serum levels by approximately 1 mmol/L within the first hour and by an additional 1 mmol/L over the subsequent 2 hours [
27]. Although dialysis is 8.5 times more likely to be performed in existing dialysis patients compared with nondialysis patients, our findings highlight that hemodialysis remains uncommon among non-ESRD ED patients [
28]. In our cohort, only 3% of hyperkalemic patients required hemodialysis. The hemodialysis rate fluctuated across the study period, increasing from 2.3% in 2016 to 3.5% in 2020–2021 before decreasing to 2.8% in 2024. One possible explanation is the impact of the COVID-19 pandemic, as COVID-19–associated acute kidney injury has been reported to be more frequent and severe than other viral-induced kidney injuries [
29].
This study has several strengths. With 246 million ED encounters and 803,186 hyperkalemia cases, it represents one of the largest epidemiologic analyses of hyperkalemia to date. Compared with prior large-scale studies utilizing datasets such as Medicare, Truven Health Analytics, the PINC AI Healthcare Database, and the Veterans Affairs system, our study is, to our knowledge, the first to use the Epic Cosmos dataset—a relatively new electronic health record–based data resource [
1,
29–
32]. The similarity in hyperkalemia incidence and treatment trends between Epic Cosmos and previous datasets supports the external validity of our findings and underscores the utility of Cosmos as one of the largest and most accessible platforms for population-level research. Diversifying data sources for large epidemiologic studies may yield novel insights into population health and clinical practice. Importantly, our study uniquely focused on ED patients without ESRD, an underrepresented cohort compared to patients in the ICU, general wards, or those with ESRD.
However, several limitations should be considered when interpreting our findings. First, the identification of hyperkalemia relied on ICD-10 codes, which have low sensitivity; studies using laboratory-defined hyperkalemia report incidence estimates up to seven times higher than code-based approaches [
15,
33]. Nevertheless, given the retrospective design and large sample size, administrative coding provided an efficient and standardized means of case identification consistent with prior population-based studies. Second, data on comorbidities and individual serum potassium levels were unavailable, precluding risk-adjusted analyses. Third, the incidence of hemodialysis was determined using CPT codes, and the indication for dialysis could not be confirmed as hyperkalemia alone. Some patients may have undergone dialysis for concurrent conditions. Similarly, the timing of cardiac arrest relative to hyperkalemia diagnosis was indeterminate, and some cases may have represented post-arrest hyperkalemia. Fourth, while the Cosmos dataset broadly reflects the demographic distribution of the US population, potential selection bias toward academic or integrated healthcare systems cannot be excluded. Fifth, because the unit of analysis was the ED encounter, repeat visits by the same patient could not be identified. Lastly, we performed a pooled analysis due to limited access to individual-level data, preventing assessment of between-hospital variation in incidence and management practices.
Among ED patients without ESRD, hyperkalemia is an uncommon but important condition, with two-thirds requiring admission and approximately 2% experiencing cardiac arrest. This study demonstrates evolving trends in the management of hyperkalemia. Calcium and sodium bicarbonate administration is common and relatively stable, whereas the use of sodium polystyrene sulfonate is decreasing and the use of sodium zirconium cyclosilicate is increasing. Finally, hemodialysis remains rare in this population.
NOTES
-
Author contributions
Conceptualization: all authors; Investigation: all authors; Project administration: all authors; Supervision: MG; Visualization: all authors; Writing–original draft: all authors; Writing–review & editing: all authors. All authors read and approved the final manuscript.
-
Conflicts of interest
Michael Gottlieb is an editorial board member of this journal, but was not involved in the peer reviewer selection, evaluation, or decision process of this article. The authors have no other conflicts of interest to declare.
-
Funding
The authors received no financial support for this study.
-
Data availability
Data analyzed in this study are available from Epic Cosmos (Epic Systems Corp) and from the corresponding author upon reasonable request.
SUPPLEMENTARY MATERIAL
Suppl. 3.
Trends in the management of hyperkalemia for emergency department patients without end-stage renal disease.
ceem-25-149-Suppl-3.pdf
Fig. 1.Flow diagram of included participants.
Fig. 2.Trends in the management of hyperkalemia for emergency department patients without end-stage renal disease.
Table 1.Trends in hyperkalemia diagnoses among ED patients without end-stage renal disease (2016–2024)
Table 1.
|
Year |
No. of ED visits |
No. of hyperkalemia cases (%) |
OR (95% CI) |
|
2016 |
15,639,453 |
43,049 (0.28) |
1 (Reference) |
|
2017 |
19,185,136 |
53,272 (0.28) |
1.01 (1.00–1.02) |
|
2018 |
22,940,713 |
65,942 (0.29) |
1.04 (1.03–1.05) |
|
2019 |
25,346,345 |
75,643 (0.30) |
1.08 (1.07–1.09) |
|
2020 |
23,936,742 |
84,507 (0.35) |
1.28 (1.27–1.29) |
|
2021 |
28,666,708 |
100,619 (0.35) |
1.28 (1.27–1.29) |
|
2022 |
32,198,528 |
112,109 (0.35) |
1.27 (1.26–1.28) |
|
2023 |
37,110,092 |
127,752 (0.34) |
1.25 (1.24–1.26) |
|
2024 |
41,212,052 |
140,293 (0.34) |
1.24 (1.23–1.25) |
|
All years |
246,235,769 |
803,186 (0.33) |
NA |
Table 2.Trends in admission, dialysis, and cardiac arrests among emergency department patients with hyperkalemia (2016–2024)
Table 2.
|
Year |
No. of hyperkalemia cases |
No. of patients (%) |
|
Inpatient admission |
Hemodialysis |
Cardiac arrest |
|
2016 |
43,049 |
30,142 (70.02) |
998 (2.32) |
940 (2.18) |
|
2017 |
53,272 |
36,893 (69.25) |
1,317 (2.47) |
1,208 (2.27) |
|
2018 |
65,942 |
44,942 (68.15) |
1,740 (2.64) |
1,413 (2.14) |
|
2019 |
75,643 |
50,500 (66.76) |
2,112 (2.79) |
1,706 (2.26) |
|
2020 |
84,507 |
58,107 (68.76) |
2,948 (3.49) |
2,245 (2.66) |
|
2021 |
100,619 |
67,767 (67.35) |
3,507 (3.49) |
2,636 (2.62) |
|
2022 |
112,109 |
74,901 (66.81) |
3,592 (3.20) |
2,520 (2.25) |
|
2023 |
127,752 |
83,880 (65.66) |
3,825 (2.99) |
2,660 (2.08) |
|
2024 |
140,293 |
91,901 (65.51) |
3,977 (2.84) |
2,716 (1.94) |
|
All years |
803,186 |
539,033 (67.11) |
24,016 (2.99) |
18,044 (2.25) |
Table 3.Clinical demographics of non–end-stage renal disease patients with and without hyperkalemia in emergency departments
Table 3.
|
Demographic |
Total (n=246,235,769) |
No. of patients (%) |
P-value |
|
With hyperkalemia (n=803,186) |
Without hyperkalemia (n=245,432,583) |
|
Age (yr) |
|
|
|
<0.001 |
|
18–29 |
49,941,634 (20.28) |
17,195 (2.14) |
49,924,439 (20.34) |
|
|
30–39 |
41,306,142 (16.78) |
27,346 (3.40) |
41,278,796 (16.82) |
|
|
40–49 |
34,732,241 (14.11) |
46,117 (5.74) |
34,686,124 (14.13) |
|
|
50–64 |
53,402,392 (21.69) |
187,662 (23.36) |
53,214,730 (21.68) |
|
|
65–74 |
30,655,774 (12.45) |
209,922 (26.14) |
30,445,852 (12.40) |
|
|
75–84 |
23,102,653 (9.38) |
193,716 (24.12) |
22,908,937 (9.33) |
|
|
≥85 |
13,094,929 (5.32) |
121,227 (15.09) |
12,973,702 (5.29) |
|
|
Not reported |
4 (<0.01) |
1 (<0.01) |
3 (<0.01) |
|
|
Sex |
|
|
|
<0.001 |
|
Female |
138,369,621 (56.19) |
372,355 (46.36) |
137,997,266 (56.23) |
|
|
Male |
107,815,979 (43.79) |
430,768 (53.63) |
107,385,211 (43.75) |
|
|
None of the above |
50,169 (0.02) |
63 (0.01) |
50,106 (0.02) |
|
|
Racea)
|
|
|
|
<0.001 |
|
American Indian or Alaskan native |
3,604,359 (1.46) |
9,400 (1.17) |
3,594,959 (1.46) |
|
|
Asian |
5,674,122 (2.30) |
21,417 (2.67) |
5,652,705 (2.30) |
|
|
Black or African American |
61,696,059 (25.06) |
179,867 (22.39) |
61,516,192 (25.06) |
|
|
Native Hawaiian or other Pacific Islander |
1,244,057 (0.51) |
3,526 (0.44) |
1,240,531 (0.51) |
|
|
White |
168,094,068 (68.27) |
580,454 (72.27) |
167,513,614 (68.25) |
|
|
Other |
32,234,149 (13.09) |
80,207 (9.99) |
32,153,942 (13.10) |
|
|
Not reported |
2,791,537 (1.13) |
5,574 (0.69) |
2,785,963 (1.14) |
|
|
Ethnicity |
|
|
|
<0.001 |
|
Hispanic or Latino |
26,123,341 (10.61) |
58,483 (7.28) |
26,064,858 (10.62) |
|
|
Not Hispanic or Latino |
209,786,481 (85.20) |
719,576 (89.59) |
209,066,905 (85.18) |
|
|
Not reported |
10,325,947 (4.19) |
25,127 (3.13) |
10,300,820 (4.20) |
|
|
Insurancea)
|
|
|
|
<0.001 |
|
Medicaid |
53,958,654 (21.91) |
158,785 (23.57) |
53,799,869 (21.92) |
|
|
Medicare |
49,998,773 (20.31) |
307,896 (45.70) |
49,690,877 (20.25) |
|
|
Private/other |
167,954,676 (68.21) |
472,925 (70.20) |
167,481,751 (68.24) |
|
|
Self-pay |
16,016,010 (6.50) |
10,601 (1.57) |
16,005,409 (6.52) |
|
|
Not reported |
7,980,843 (3.24) |
10,370 (1.54) |
7,970,473 (3.25) |
|
|
US Census region |
|
|
|
<0.001 |
|
Midwest |
72,637,879 (29.50) |
245,432 (30.56) |
72,392,447 (29.50) |
|
|
Northeast |
43,412,239 (17.63) |
123,501 (15.38) |
43,288,738 (17.64) |
|
|
South |
100,319,934 (40.74) |
357,130 (44.46) |
99,962,804 (40.73) |
|
|
West |
26,777,485 (10.87) |
67,944 (8.46) |
26,709,541 (10.88) |
|
|
Not reported |
3,088,232 (1.25) |
9,179 (1.14) |
3,079,053 (1.25) |
|
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, Robert Hlavin1
