Demographic and institutional predictors of stroke hospitalization mortality among adults in the United States

Abstract

Introduction Stroke remains a primary source of functional disability and inpatient mortality in the United States (US). Recent evidence reveals declining mortality associated with stroke hospitalizations in the US. However, data updating trends in inpatient mortality is lacking. This study aims to provide a renewed inpatient stroke mortality rate in a national sample and identify common predictors of inpatient stroke mortality. Methods In this cross-sectional study, we analyzed data from a nationwide database between 2010 and 2017. We included patient encounters for both ischemic (ICD9 433–434, ICD10 I630–I639) and hemorrhagic stroke (ICD9 430–432, ICD10 I600–I629). We performed an annual comparison of in-hospital stroke mortality rates, and a cross-sectional analytic approach of multiple variables identified common predictors of inpatient stroke mortality. Results Between 2010 and 2017, we identified 518,185 total stroke admissions (86.6% ischemic stroke and 13.4% hemorrhagic strokes). Stroke admissions steadily increased during the studied period, whereas we observed a steady decline in in-hospital mortality during the same time. The inpatient stroke mortality rate gradually declined from 4.8% in 2010 (95% CI 4.6–5.1) to 2.1% in 2017 (95% CI 2.0–2.1). Predictors of higher odds of dying from ischemic stroke were female (OR 1.059, 95% CI 1.015–1.105, p = 0.008), older age (OR 1.028, 95% CI 1.026–1.029, p < 0.001), and sicker patients (OR 1.091, 95% CI 1.089–1.093, p < 0.001). Predictors of higher odds of dying from hemorrhagic stroke were Hispanic ethnicity (OR 1.459, 95% CI 1.084–1.926, p < 0.001), older age (OR 1.021, 95% CI 1.019–1.023, p < 0.001), and sicker patients (OR 1.042, 95% CI 1.039–1.045, p < 0.001). All census regions and hospital types demonstrated improvements in in-hospital mortality. Conclusion This study identified a continuous declining rate in in-hospital mortality due to stroke in the United States, and it also identified demographic and hospital predictors of inpatient stroke mortality.

Stroke risk factors and outcomes in Trinidad and Tobago: The START study

“…[31] Our mortality rate is signi cantly higher than in developed countries, for example, the US, circa 2.1%. [32] It is also relatively high when compared to other developing countries, with the exception of some Caribbean islands (Martinique 22.8%, Barbados 13.1%) and sub-Saharan Africa (22%). [33], [34], [35] Our study showed that hemorrhagic stroke was a predictor of in-hospital mortality, and when classi ed by CT ndings, both IPH and SAH were predictors of in-hospital and three-month mortality.…”

“…[65] Additionally, data from the US found that in both ischemic and hemorrhagic stroke, there is a higher risk of death with older age. [32] There are, however, more strokes and stroke deaths in women than in men, thought to be largely related to a longer life expectancy for women. In some studies, stroke incidence among women surpasses that of men for those over 80 years of age.…”

Letter: Trends in In-Hospital Mortality and Neurological Deficit Rates Following Ischemic Stroke in Low- and Middle-Income Countries

“…A similar trend was noted in China between 2007 and 2010 5 and in the United States between 2010 and 2017. 6 There are several hypotheses that explain this trend, but it is likely that greater access technology played a role. Regardless of this change, LMICs still bear a greater burden from ischemic stroke.…”

Assessment of the dynamics of stroke morbidity and mortality in the Kyrgyz Republic

“…Уровень заболеваемости (инцидентности) у населения КР с 2005 г. по 2022 г. имеет выраженную тенденцию к снижению (темп снижения -10,4% по отношению к 2005 году). Динамика эпидемиологических показателей в ряде стран показала положительную тенденцию к снижению летальности и смертности от инсульта, что явилось результатом качественных изменений в системе оказания специализированной медицинской помощи, внедрения новых методов диагностики и лечения [2,9]. Согласно прогнозам исследователей, в период с 2020 по 2030 год заболеваемость ишемическим инсультом увеличится среди лиц обоего пола, всех возрастных групп, а также в некоторых странах.…”

“…Согласно прогнозам исследователей, в период с 2020 по 2030 год заболеваемость ишемическим инсультом увеличится среди лиц обоего пола, всех возрастных групп, а также в некоторых странах. Кроме того, страны с низким социо-демографическим индексом должны быть осведомлены о потенциальном увеличении стандартизированной по возрасту смертности и DALY в результате ишемического инсульта [9,10,11].…”