| Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA. | |
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MedLine Citation:
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PMID: 20068358 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: While geographic disparities in stroke mortality are well documented, there are no data describing geographic variation in recurrent stroke. Accordingly, we evaluated geographic variations in 1-year recurrent ischemic stroke rates in the USA with adjustment for patient characteristics. METHODS: One-year recurrent stroke rates for ischemic stroke (International Classification of Diseases, 9th Revision codes 433, 434 and 436) following hospital discharge were calculated by county for all fee-for-service Medicare beneficiaries from 2000 to 2002. The rates were standardized and smoothed using a bayesian conditional autoregressive model that was risk-standardized for patients' age, gender, race/ethnicity, prior hospitalizations, Deyo comorbidity score, acute myocardial infarction, congestive heart failure, diabetes, hypertension, dementia, cancer, chronic obstructive pulmonary disease and obesity. RESULTS: The overall 1-year recurrent stroke rate was 9.4% among 895,916 ischemic stroke patients (mean age: 78 years; 56.6% women; 86.6% White, 9.7% Black and 1.2% Latino/Hispanic). The rates varied by geographic region and were highest in the South and in parts of the West and Midwest. Regional variation was present for all racial/ethnic subgroups and persisted after adjustment for individual patient characteristics. CONCLUSIONS: Almost 1 in 10 hospitalized ischemic stroke patients was readmitted for an ischemic stroke within 1 year. There was heterogeneity in recurrence patterns by geographic region. Further work is needed to understand the reasons for this regional variability. |
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Authors:
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Norrina B Allen; Theodore R Holford; Michael B Bracken; Larry B Goldstein; George Howard; Yun Wang; Judith H Lichtman |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2010-01-13 |
Journal Detail:
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Title: Neuroepidemiology Volume: 34 ISSN: 1423-0208 ISO Abbreviation: Neuroepidemiology Publication Date: 2010 |
Date Detail:
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Created Date: 2010-02-18 Completed Date: 2010-05-07 Revised Date: 2011-07-22 |
Medline Journal Info:
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Nlm Unique ID: 8218700 Medline TA: Neuroepidemiology Country: Switzerland |
Other Details:
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Languages: eng Pagination: 123-9 Citation Subset: IM |
Copyright Information:
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Copyright 2010 S. Karger AG, Basel. |
Affiliation:
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Division of Chronic Disease Epidemiology, Yale University School of Medicine, New Haven,CT 06520-8034, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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African Americans Age Factors Aged Bayes Theorem Brain Ischemia / epidemiology* Cohort Studies Continental Population Groups European Continental Ancestry Group Female Geography Hispanic Americans Humans Male Medicare Recurrence Regression Analysis Risk Factors Sex Factors Stroke / epidemiology* Time Factors United States / epidemiology |
| Grant Support | |
ID/Acronym/Agency:
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1R36HS016959-01A1/HS/AHRQ HHS; R01NS043322/NS/NINDS NIH HHS |
| Comments/Corrections | |
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