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Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA.

Publication ,  Journal Article
Allen, NB; Holford, TR; Bracken, MB; Goldstein, LB; Howard, G; Wang, Y; Lichtman, JH
Published in: Neuroepidemiology
2010

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.

Duke Scholars

Published In

Neuroepidemiology

DOI

EISSN

1423-0208

Publication Date

2010

Volume

34

Issue

2

Start / End Page

123 / 129

Location

Switzerland

Related Subject Headings

  • White People
  • United States
  • Time Factors
  • Stroke
  • Sex Factors
  • Risk Factors
  • Regression Analysis
  • Recurrence
  • Racial Groups
  • Medicare
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Allen, N. B., Holford, T. R., Bracken, M. B., Goldstein, L. B., Howard, G., Wang, Y., & Lichtman, J. H. (2010). Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA. Neuroepidemiology, 34(2), 123–129. https://doi.org/10.1159/000274804
Allen, Norrina B., Theodore R. Holford, Michael B. Bracken, Larry B. Goldstein, George Howard, Yun Wang, and Judith H. Lichtman. “Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA.Neuroepidemiology 34, no. 2 (2010): 123–29. https://doi.org/10.1159/000274804.
Allen NB, Holford TR, Bracken MB, Goldstein LB, Howard G, Wang Y, et al. Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA. Neuroepidemiology. 2010;34(2):123–9.
Allen, Norrina B., et al. “Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA.Neuroepidemiology, vol. 34, no. 2, 2010, pp. 123–29. Pubmed, doi:10.1159/000274804.
Allen NB, Holford TR, Bracken MB, Goldstein LB, Howard G, Wang Y, Lichtman JH. Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA. Neuroepidemiology. 2010;34(2):123–129.
Journal cover image

Published In

Neuroepidemiology

DOI

EISSN

1423-0208

Publication Date

2010

Volume

34

Issue

2

Start / End Page

123 / 129

Location

Switzerland

Related Subject Headings

  • White People
  • United States
  • Time Factors
  • Stroke
  • Sex Factors
  • Risk Factors
  • Regression Analysis
  • Recurrence
  • Racial Groups
  • Medicare