Regional Differences in Hospital Costs of Acute Ischemic Stroke in China: Analysis of Data From the Chinese Acute Ischemic Stroke Treatment Outcome Registry

Lu, Yuxuan; Shen, Zhiyuan; Sun, Wei; Liu, Ran; Lyu, Fan; Shu, Junlong; Tai, Liwen; Li, Guozhong; Chen, Hui‐Sheng; Zhang, Guiru; Zhang, Lei; Sun, Xuwen; Qiu, Jianxian; Wei, Yan; Jin, Haiqiang; Huang, Yining

doi:10.3389/fpubh.2021.783242

Cited by 4 publications

(4 citation statements)

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“…Secondary hospitals (with more than 100 beds) were defined as regional hospitals that are county centered, provide urgent and preventative medical services to multiple communities for over 10,0000 patients and perform certain teaching and research tasks ( 26 ). NIHSS scores were ascertained on the date of admission, and patients were divided into mild (0–5), moderate ( 6–10 ) and severe (> 10) groups ( 29 ). The Charlson Comorbidity Index was the primary evaluation method for the number of comorbidities, and patients were divided into two groups: a group with 1 comorbidity and a group with 2 or more comorbidities.…”

Section: Methodsmentioning

confidence: 99%

“…Then, logistic regression was conducted for mortality between AIS patients with weekend and weekday admissions, modified by sex, age, payment type, medical history, location (urban and rural), in-hospital complications, geographic region, hospital level, ICU admission, NIHSS score at admission and thrombolysis. These confounding variables were selected based on a previous study that illustrated differences in mortality by patient variance and distinct Chinese hospital characteristics ( 29 , 30 ). SPSS (version 27.0) software was used for statistical analysis.…”

Section: Methodsmentioning

confidence: 99%

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Effect of weekend versus weekday admission on the mortality of acute ischemic stroke patients in China: an analysis of data from the Chinese acute ischemic stroke treatment outcome registry

Huang

Sun

et al. 2023

Front. Neurol.

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BackgroundDue to disparities in medical resources in rural and urban areas as well as in different geographic regions in China, the effect of weekend versus weekday admission on the outcomes of acute ischemic stroke (AIS) patients is unknown. Our aim was to investigate whether the outcomes of AIS patients differ according to the day of admission in China.MethodsThe data were extracted from the Chinese Acute Ischemic Stroke Treatment Outcome Registry (CASTOR), a multicenter prospective study database of patients diagnosed with AIS. The chi-square test (χ2) and logistic regression were used to assess mortality for weekday and weekend admissions among AIS patients stratified by rural or urban status and geographic region (including the eastern, northeastern, central, and western regions).ResultsIn total, 9,256 patients were included in this study. Of these patients, 57.2% were classified as urban, and 42.8% were classified as rural. A total of 6,760 (73%) patients were admitted on weekdays, and 2,496 (27%) were admitted on weekends. There was no significant difference in the mortality rate among patients admitted on weekends compared with those admitted on weekdays in urban (7.5% versus 7.4%) or rural areas (8.8% versus 8.1%; p > 0.05). The mortality rate was the highest among patients admitted on weekends and weekdays (11.6% versus 10.3%) in the northeastern area, without statistical significance before and after adjusting for the patients’ background characteristics (p > 0.05). In addition, regression analysis revealed that the mortality of patients admitted on weekdays was more likely to be influenced by regional subgroup, hospital level and intravenous thrombolysis than that of patients admitted on weekends.ConclusionThe weekend effect was not observed in the mortality of patients with AIS regardless of rural–urban status or geographic region in China.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effect of weekend versus weekday admission on the mortality of acute ischemic stroke patients in China: an analysis of data from the Chinese acute ischemic stroke treatment outcome registry

Huang

Sun

et al. 2023

Front. Neurol.

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“…Another report showed that factors affecting inpatient costs were age, day of the week of discharge, LOS, stroke subtype, other neurological disorders, renal failure, fluid and electrolyte disorders, and total number of comorbidities [ 21 ]. Moreover, LOS was an important common factor for hospital costs in different regions in China, and further studies should be encouraged to identify the appropriate and optimal LOS strategies for different diseases [ 22 ]. Medical insurance type is another noteworthy factor affecting healthcare expenditures.…”

Section: Introductionmentioning

confidence: 99%

How health risk factors affect inpatient costs among adults with stroke in China: the mediating role of length of stay

Cao,

Li,

Tang

et al. 2024

BMC Geriatr

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Background As stroke has become the leading cause of death and disability in China, it has induced a heavy disease burden on society, families, and patients. Despite much attention within the literature, the effect of multiple risk factors on length of stay (LOS) and inpatient costs in China is still not fully understood. Aim To analyse the association between the number of risk factors combined and inpatient costs among adults with stroke and explore the mediating effect of LOS on inpatient costs. Methods A retrospective cross-sectional study was conducted among stroke patients in a tertiary hospital in Nantong City from January 2018 to December 2019. Lifestyle factors (smoking status, exercise), personal disease history (overweight, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation), family history of stroke, and demographic characteristics were interviewed by trained nurses. Inpatient costs and LOS were extracted from electronic medical records. Hierarchical multiple linear regression models and mediation analysis were used to examine the direct and indirect effects of the number of risk factors combined for stroke on inpatient costs. Results A total of 620 individuals were included, comprising 391 ischaemic stroke patients and 229 haemorrhagic stroke patients, and the mean age was 63.2 years, with 60.32% being male. The overall mean cost for stroke inpatients was 30730.78 CNY ($ 4444.91), and the average length of stay (LOS) was 12.50 days. Mediation analysis indicated that the greater number of risk factors was not only directly related to higher inpatient costs (direct effect = 0.16, 95%CI:[0.11,0.22]), but also indirectly associated with inpatient cost through longer LOS (indirect effect = 0.08, 95% CI: [0.04,0.11]). Furthermore, patients with high risk of stroke had longer LOS than those in low-risk patients, which in turn led to heavier hospitalization expenses. Conclusions Both the greater number of risk factors and high-risk rating among stroke patients increased the length of stay and inpatient costs. Preventing and controlling risk behaviors of stroke should be strengthened.

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“… 24 Numerous studies have evaluated the impact of different chronic diseases on health care utilization or costs in an effort to quantify the health and economic burden of chronic diseases. 25 - 29 Existing studies, however, lack representation of the older populations and do not allow for intuitive diseases comparisons due to differences in study populations, timing, and methodologies. 11 , 20 , 30 Consequently, the data from a longitudinal survey of the older person were utilized in this study.…”

Section: Introductionmentioning

confidence: 99%

Individual-Level Health Care Costs Attributable to Noncommunicable Diseases: A Longitudinal Study Based on the Older Adults in China

Zhao,

et al. 2023

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Noncommunicable chronic diseases among the elderly population represent a significant economic burden in China. However, previous disease-related health cost studies lacked representation of older adults and comparability of the burden of multiple chronic diseases. The objective of this study was to determine the fraction of health care costs attributable to the 6 most prevalent chronic diseases and comorbidities in the sample of older adults. This study employed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with 3 waves in 2011, 2014, and 2018, and included 18 349 observations in total. Outpatient costs, inpatient costs, and total health care costs were included in this study. Based on a 2-part random effects model, the effect of chronic disease on health service utilization was first explored by constructing a dummy variable for whether or not to utilize health care, followed by estimation of attributable costs in the population with health care utilization. Among the older adults in the sample, hypertension, heart disease, cataracts, arthritis, stroke or Cerebrovascular disease (CVD) and chronic lung disease are the 6 most prevalent chronic conditions. The costs attributable to the 6 chronic diseases mentioned above were 36.00% of outpatient costs, 55.92% of inpatient costs, and 45.05% of total health care costs for older adults. Of these, heart disease, stroke or CVD, and chronic lung disease accounted for 22.11%, 13.24%, and 10.56% of total health care costs, respectively. Moreover, the proportion of health care costs attributable to chronic diseases was higher for older adults who were male, lived in urban areas, and had a lower level of education. The proportion of health care costs attributable to chronic diseases is substantial among older adults in China. Health care costs associated with chronic diseases can be decreased with well-targeted interventions and comprehensive access to health services.

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Regional Differences in Hospital Costs of Acute Ischemic Stroke in China: Analysis of Data From the Chinese Acute Ischemic Stroke Treatment Outcome Registry

Cited by 4 publications

References 37 publications

Effect of weekend versus weekday admission on the mortality of acute ischemic stroke patients in China: an analysis of data from the Chinese acute ischemic stroke treatment outcome registry

Effect of weekend versus weekday admission on the mortality of acute ischemic stroke patients in China: an analysis of data from the Chinese acute ischemic stroke treatment outcome registry

How health risk factors affect inpatient costs among adults with stroke in China: the mediating role of length of stay

Individual-Level Health Care Costs Attributable to Noncommunicable Diseases: A Longitudinal Study Based on the Older Adults in China

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