Document Detail


Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA.
MedLine Citation:
PMID:  20068358     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-01-13
Journal Detail:
Title:  Neuroepidemiology     Volume:  34     ISSN:  1423-0208     ISO Abbreviation:  Neuroepidemiology     Publication Date:  2010  
Date Detail:
Created Date:  2010-02-18     Completed Date:  2010-05-07     Revised Date:  2011-07-22    
Medline Journal Info:
Nlm Unique ID:  8218700     Medline TA:  Neuroepidemiology     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  123-9     Citation Subset:  IM    
Copyright Information:
Copyright 2010 S. Karger AG, Basel.
Affiliation:
Division of Chronic Disease Epidemiology, Yale University School of Medicine, New Haven,CT 06520-8034, USA.
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MeSH Terms
Descriptor/Qualifier:
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:
1R36HS016959-01A1/HS/AHRQ HHS; R01NS043322/NS/NINDS NIH HHS
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