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Trends in the hospitalization of ischemic stroke in the United States, 1998-2007.
Int J Stroke. 2012 Apr; 7(3):195-201.IJ

Abstract

BACKGROUND

The late 1990s/early 2000s was a time of change in both the prevention and acute care of ischemic stroke, with primary prevention driven by increased utilization of antihypertensive, antiplatelet, anticoagulation, and lipid-lowering agents.

AIM

To examine whether ischemic stroke hospitalization rates and outcomes in the United States have changed.

METHOD

We retrospectively identified 894 169 hospitalizations with a primary diagnosis of ischemic stroke from 1 January 1998 through to 31 December 2007 in the Nationwide Inpatient Sample, the largest all-payer healthcare database in the United States. Annual, national case estimates were combined with US Census data to derive age-adjusted and age-specific population hospitalization rates. Temporal trends were tested using linear regression.

RESULTS

From 1998 through 2007, there were an estimated 4 382 336 ischemic stroke hospitalizations in the United States. Overall, the age-adjusted rate of ischemic stroke hospitalization decreased from 184 to 128 per 100 000 (P < 0·0001). Age-specific rates decreased among those 55+ years old (P < 0·0001), but increased among those 25-34 and 35-44 years old (P < 0·001 and P < 0·0001, respectively). Rates among those <25 and 45-54 years old were unchanged. In-hospital mortality decreased from 7·0% (standard error 0·1) to 5·4% (standard error 0·1) (P < 0·0001). Case proportion at the highest quintile of hospitals by annual caseload increased from 54·0% (standard error 2·1) to 61·8% (standard error 2·0) (P < 0·0001). Mean adjusted hospitalization costs increased from $9273 (standard deviation 199) to $10 524 (standard deviation 77) (P < 0·0001).

CONCLUSION

In 1998 through to 2007, the overall rate of ischemic stroke hospitalization in the United States decreased. However, rates among young adults increased. In-hospital mortality rates decreased over the study period.

Authors+Show Affiliations

Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22151527

Citation

Lee, Leslie K., et al. "Trends in the Hospitalization of Ischemic Stroke in the United States, 1998-2007." International Journal of Stroke : Official Journal of the International Stroke Society, vol. 7, no. 3, 2012, pp. 195-201.
Lee LK, Bateman BT, Wang S, et al. Trends in the hospitalization of ischemic stroke in the United States, 1998-2007. Int J Stroke. 2012;7(3):195-201.
Lee, L. K., Bateman, B. T., Wang, S., Schumacher, H. C., Pile-Spellman, J., & Saposnik, G. (2012). Trends in the hospitalization of ischemic stroke in the United States, 1998-2007. International Journal of Stroke : Official Journal of the International Stroke Society, 7(3), 195-201. https://doi.org/10.1111/j.1747-4949.2011.00700.x
Lee LK, et al. Trends in the Hospitalization of Ischemic Stroke in the United States, 1998-2007. Int J Stroke. 2012;7(3):195-201. PubMed PMID: 22151527.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in the hospitalization of ischemic stroke in the United States, 1998-2007. AU - Lee,Leslie K, AU - Bateman,Brian T, AU - Wang,Shuang, AU - Schumacher,H Christian, AU - Pile-Spellman,John, AU - Saposnik,Gustavo, Y1 - 2011/12/08/ PY - 2011/12/14/entrez PY - 2011/12/14/pubmed PY - 2012/9/14/medline SP - 195 EP - 201 JF - International journal of stroke : official journal of the International Stroke Society JO - Int J Stroke VL - 7 IS - 3 N2 - BACKGROUND: The late 1990s/early 2000s was a time of change in both the prevention and acute care of ischemic stroke, with primary prevention driven by increased utilization of antihypertensive, antiplatelet, anticoagulation, and lipid-lowering agents. AIM: To examine whether ischemic stroke hospitalization rates and outcomes in the United States have changed. METHOD: We retrospectively identified 894 169 hospitalizations with a primary diagnosis of ischemic stroke from 1 January 1998 through to 31 December 2007 in the Nationwide Inpatient Sample, the largest all-payer healthcare database in the United States. Annual, national case estimates were combined with US Census data to derive age-adjusted and age-specific population hospitalization rates. Temporal trends were tested using linear regression. RESULTS: From 1998 through 2007, there were an estimated 4 382 336 ischemic stroke hospitalizations in the United States. Overall, the age-adjusted rate of ischemic stroke hospitalization decreased from 184 to 128 per 100 000 (P < 0·0001). Age-specific rates decreased among those 55+ years old (P < 0·0001), but increased among those 25-34 and 35-44 years old (P < 0·001 and P < 0·0001, respectively). Rates among those <25 and 45-54 years old were unchanged. In-hospital mortality decreased from 7·0% (standard error 0·1) to 5·4% (standard error 0·1) (P < 0·0001). Case proportion at the highest quintile of hospitals by annual caseload increased from 54·0% (standard error 2·1) to 61·8% (standard error 2·0) (P < 0·0001). Mean adjusted hospitalization costs increased from $9273 (standard deviation 199) to $10 524 (standard deviation 77) (P < 0·0001). CONCLUSION: In 1998 through to 2007, the overall rate of ischemic stroke hospitalization in the United States decreased. However, rates among young adults increased. In-hospital mortality rates decreased over the study period. SN - 1747-4949 UR - https://www.unboundmedicine.com/medline/citation/22151527/Trends_in_the_hospitalization_of_ischemic_stroke_in_the_United_States_1998_2007_ L2 - https://journals.sagepub.com/doi/10.1111/j.1747-4949.2011.00700.x?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -