Journal Mobile Options
Table of Contents
Vol. 29, No. 3-4, 2007
Issue release date: February 2008

Declining US Stroke Hospitalization since 1997: National Hospital Discharge Survey, 1988–2004

Fang J. · Alderman M.H. · Keenan N.L. · Croft J.B.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background and Purpose: While age-adjusted stroke mortality in the United States has declined consistently during the last century, trends in stroke incidence and hospitalization are less known. This study examines trends in stroke hospitalization from 1988 to 2004. Methods: Stroke hospitalizations were estimated from the annual National Hospital Discharge Survey, 1988–2004. Stroke was defined as a first-listed diagnosis of ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) code 430–434 or 436–438. Trends in hospitalization rates were compared for groups defined by selected patient characteristics. Results: Stroke hospitalizations totaled 603,000 in 1988, peaked at 833,000 in 1997, then declined to 726,000 in 2004, a figure still higher than in 1988. Age-adjusted stroke hospitalization rates for men (per 100,000 population) increased from 287 in 1988 to 352 in 1997, but declined to 265 in 2004, and for women, rates were 252, 293 and 223 in the corresponding years. The majority of stroke hospitalizations in 2004 occurred at ages ≧65 years (69% in men and 78% in women). Decline in rates after 1997 occurred at ages 65–74 and ≧75 years. In 2004, 64% of strokes were classified as ischemic, 16% as hemorrhagic and 16% as ill-defined. Decline in hospitalization rates after 1997 were observed for ischemic and ill-defined, but not for hemorrhagic stroke. Between 1988 and 2004, the reporting of hypertension, diabetes and coronary heart disease as secondary diagnoses among stroke hospitalizations increased. Conclusions: Decline in stroke hospitalizations since 1997 was observed among men and women >65 years, who suffered ischemic or ill-defined stroke. Although long-term observation is needed to confirm this finding, the decline in stroke hospitalizations after 1997 suggests treatment of hypertension may have resulted in stroke prevention.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. American Heart Association: Heart Disease and Stroke Statistics – 2006 Update. Dallas, American Heart Association, 2006.
  2. Patel AT: Disability evaluation following stroke. Phys Med Rehabil Clin N Am 2001;12:613–619.
  3. Flick CL: Stroke rehabilitation. Stroke outcome and psychosocial consequences. Arch Phys Med Rehabil 1999;80:S21–S26.
  4. Kwakkel G, Wagenaar RC, Kollen BJ, Lankhorst GJ: Predicting disability in stroke – a critical review of the literature. Age Ageing 1996;25:479–489.
  5. Thom TJ, Epstein FH: Heart disease, cancer, and stroke mortality trends and their interrelations. An international perspective. Circulation 1994;90:574–582.
  6. Lanska DJ, Peterson PM: Geographic variation in the decline of stroke mortality in the United States. Stroke 1995;26:1159–1165.
  7. Fang J, Alderman MH: Trend of stroke hospitalization, United States, 1988–1997. Stroke 2001;32:2221–2226.
  8. Dennison CF, Pokras R: Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital Health Stat 2000;1:1–42.
  9. NCHS Definitions – Civilian Population. NCHS 2005. http://www.cdc.gov/nchs/datawh/nchsdefs/pop.htm#civ.
  10. Centers for Disease Control and Prevention: Achievements in public health, 1900–1999: decline in deaths from heart disease and stroke – United States, 1900–1999. MMWR Morb Mortal Wkly Rep 1999;48:649–656.
  11. Lanska DJ, Mi X: Decline in US stroke mortality in the era before antihypertensive therapy. Stroke 1993;24:1382–1388.
  12. Broderick JP: Stroke trends in Rochester, Minnesota, during 1945 to 1984. Ann Epidemiol 1993;3:476–479.
  13. McGovern PG, Burke GL, Sprafka JM, Xue S, Folsom AR, Blackburn H: Trends in mortality, morbidity, and risk factor levels for stroke from 1960 through 1990: the Minnesota Heart Survey. JAMA 1992;268:753–759.
  14. Kagan A, Popper J, Reed DM, MacLean CJ, Grove JS: Trends in stroke incidence and mortality in Hawaiian Japanese men. Stroke 1994;25:1170–1175.
  15. Cheng XM, Ziegler DK, Lai YH, et al: Stroke in China, 1986 through 1990. Stroke 1995;26:1990–1994.
  16. Thorvaldsen P, Davidsen M, Bronnum-Hansen H, Schroll M, Danish M; Study group: stable stroke occurrence despite incidence reduction in an aging population: stroke trends in the Danish Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) population. Stroke 1999;30:2529–2535.
  17. Jamrozik K, Broadhurst R, Hankey G, Burvill P, Anderson C: Trends in the incidence, severity and short-term outcome of stroke in Perth, Western Australia. Stroke 1999;30:2105–2111.
  18. Kubo M, Kiyohari Y, Ninomiya T, et al: Decreasing incidence of lacunar vs other types of cerebral infarction in a Japanese population. Neurology 2006;66:1539–1544.
  19. Sivenius J, Tuomilehto P, Immonen-Raiha P, et al: Continuous 15-year decrease in incidence and mortality of stroke in Finland: the FINSTROKE Study. Stroke 2004;35:420–425.
  20. Rothwell PM, Coull AJ, Giles MF, et al: Change in stroke incidence, mortality, case-fatality, severity and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet 2004;363:1925–1933.
  21. Anderson CS, Carter KN, Hackett ML, Feigin V, Barber PA, Broad JB, Bonita R, Auckland Regional Community Stroke (ARCOS) Study Group: Trends in stroke incidence in Auckland, New Zealand, during 1981 to 2003. Stroke 2005;36:2087–2093.
  22. Carandang R, Seshadri S, Beiser A, Kelly-Hayes M, Kase CS, Kannel WB, Wolf PA: Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA 2006;296:2939–2946.
  23. Gillum RF: Cerebrovascular disease morbidity in the United States, 1970–1983: age, sex, region, and vascular surgery. Stroke 1986;17:656–661.
  24. Howard G, Craven TE, Sanders L, Evans GW: Relationship of hospitalized stroke rate and in-hospital mortality to the decline in US stroke mortality. Neuroepidemiology 1991;10:251–259.
  25. Fang J, Alderman M: Trend of stroke hospitalization, United States 1988–1997. Stroke 2001;32:2221–2226.
  26. Field TS, Green TL, Roy K, Pedersen J: Trends in hospital admission for stroke in Calgary. Can J Neurol Sci 2004;31:387–393.
  27. Sturgeon JD, Folsom AR: Trends in hospitalization rate, hospital case fatality, and mortality rate of stroke by subtype in Minneapolis-St. Paul, 1980–2002. Neuroepidemiology 2007;28:39–45.
  28. Haberman S, Capildeo R, Rose FC: The changing mortality of cerebrovascular disease. Q J Med 1978;47:71–88.
  29. Wolf PA, D’Agostino RB, O’Neal MA, Sytkowski P, Kase CS, Belanger AJ, Kannel WB: Secular trends in stroke incidence and mortality: the Framingham Study. Stroke 1992;23:1551–1555.
  30. McGovern PG, Shahar E, Sprafka JM, Pankow JS: The role of stroke attack rate and case fatality in the decline of stroke mortality: the Minnesota Heart Survey. Ann Epidemiol 1993;3:483–487.
  31. McGovern PG, Pankow JS, Burke GL, Shahar E, Sprafka JM, Folsom AR, Blackburn H: Trends in survival of hospitalized stroke patients between 1970 and 1985: the Minnesota Heart Survey. Stroke 1993;24:1640–1648.
  32. McGruder HF, Croft JB, Zheng ZJ: Characteristics of an ‘ill-defined’ diagnosis for stroke: opportunities for improvement. Stroke 2006;37:781–789.
  33. Lanska DJ: Length of hospital stay for cerebrovascular disease in the United States: professional activity study, 1963–1991. J Neurol Sci 1994;127:214–220.
  34. Jencks SF, Williams DK, Kay TL: Assessing hospital-associated deaths from discharge data: the role of length of stay and comorbidities. JAMA 1988;260:2240–2246.
  35. Mouradian MS, Hussain MS, Lari H, Salam A, Senthilselvan A, Dean N, Shuaib A: The impact of a stroke prevention clinic in diagnosing modifiable risk factors for stroke. Can J Neurol Sci 2005;32:496–500.
  36. Elkind MS: Implications of stroke prevention trials: treatment of global risk. Neurology 2005;65:17–21.
  37. Okumura K, Ohya Y, Maehara A, Wakugami K, Iseki K, Takishita S: Effects of blood pressure levels on case fatality after acute stroke. J Hypertens 2005;23:1217–1223.
  38. Iezzoni LI, Foley SM, Daley J, Hughes J, Fisher ES, Heeren T: Comorbidities, complications, and coding bias: does the number of diagnosis codes matter in predicting in-hospital mortality? JAMA 1992;267:2197–2203.
  39. Leibson CL, Naessens JM, Brown RD, Whisnant JP: Accuracy of hospital discharge abstracts for identifying stroke. Stroke 1994;25:2348–2355.
  40. Goldstein LB: Accuracy of ICD-9-CM coding for the identification of patients with acute ischemic stroke: effect of modifier codes. Stroke 1998;29:1602–1604.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50