TY - JOUR
T1 - Intraregional decline in case-fatality and hospital use after occlusive stroke in the Southeastern United States
AU - Potts, Daniel C.
AU - Gilliam, Frank
AU - Gomez, Camilo R.
AU - Eugene Marsh, E.
AU - Mitchell, Victoria L.
AU - Sherrill, Robert
N1 - Funding Information:
The analysis on which this publication is based was prepared under contract #500-38, entitled Ischemic Stroke, Diagnosis, Treatment and Prevention, sponsored by the Healthcare Financing Administration, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of reported in the southeast. 1,5q~N evertheless, recently published data indicate that the southeast experienced a greater decline in stroke (primarily ischemic stroke) mortality than all other US regions from 1970 to 1989. s It is not the Department of Health and Human Services, nor does mention of names, commercial products, or organizations imply endorsement by the United States Government. The authors assume full responsibility for the accuracy and completeness of the article, which is a direct result of the Healthcare Quality Improvement Program of the Healthcare Financing Administration, which has encouraged identification of quality projects derived from analysis of patterns of care, and therefore required part of this contractor.
PY - 1999/9
Y1 - 1999/9
N2 - Objective: To identify changes in mortality and hospital use among patients admitted for ischemic stroke in Alabama. Background: The decline in stroke mortality in the Southeast is greater than in other US regions. Whether this decline in a result of decreased incidence or improved case-fatality rates is unknown. Methods: We examined Medicare hospitalization data from approximately 625,000 beneficiaries and identified patients admitted for ischemic stroke between January 1992 and December 1994. The search was carried out using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes pertinent to all diagnoses related to ischemic stroke. Data relevant to mortality and length of stay (LOS) were collected, and comparisons were made of the average case-fatality rate and LOS in each of the 3 years. Results: No significant difference was found in the incidence of ischemic stroke during the 3 years. The number of admissions was 4438 for 1992, 4124 for 1993, and 4762 for 1994. Conversely, the average LOS showed a significant decline, with values of 10.05, 9,36, and 8.72 days, respectively (P<.0003). A significant decline in mortality, with average case-fatality rates of 11.72%, 11.56%, and 9.71%, respectively (P<.003), was also found. Conclusion: These data suggest that the decline in stroke mortality in the Southeast is because of improved patient survival after stroke, rather than decreased incidence. Although several factors may be contributing to the decreased case-fatality rates, improved care of hospitalized stroke patients is likely of primary importance. Additionally, decreased mortality associated with decreased LOS suggests more efficient hospital use.
AB - Objective: To identify changes in mortality and hospital use among patients admitted for ischemic stroke in Alabama. Background: The decline in stroke mortality in the Southeast is greater than in other US regions. Whether this decline in a result of decreased incidence or improved case-fatality rates is unknown. Methods: We examined Medicare hospitalization data from approximately 625,000 beneficiaries and identified patients admitted for ischemic stroke between January 1992 and December 1994. The search was carried out using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes pertinent to all diagnoses related to ischemic stroke. Data relevant to mortality and length of stay (LOS) were collected, and comparisons were made of the average case-fatality rate and LOS in each of the 3 years. Results: No significant difference was found in the incidence of ischemic stroke during the 3 years. The number of admissions was 4438 for 1992, 4124 for 1993, and 4762 for 1994. Conversely, the average LOS showed a significant decline, with values of 10.05, 9,36, and 8.72 days, respectively (P<.0003). A significant decline in mortality, with average case-fatality rates of 11.72%, 11.56%, and 9.71%, respectively (P<.003), was also found. Conclusion: These data suggest that the decline in stroke mortality in the Southeast is because of improved patient survival after stroke, rather than decreased incidence. Although several factors may be contributing to the decreased case-fatality rates, improved care of hospitalized stroke patients is likely of primary importance. Additionally, decreased mortality associated with decreased LOS suggests more efficient hospital use.
UR - http://www.scopus.com/inward/record.url?scp=77949825074&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77949825074&partnerID=8YFLogxK
U2 - 10.1016/S1052-3057(99)80009-3
DO - 10.1016/S1052-3057(99)80009-3
M3 - Article
C2 - 17895184
AN - SCOPUS:77949825074
SN - 1052-3057
VL - 8
SP - 344
EP - 348
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 5
ER -