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Neuroepidemiology. 2010;34(2):123-9. doi: 10.1159/000274804. Epub 2010 Jan 13.

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

Author information

1
Division of Chronic Disease Epidemiology, Yale University School of Medicine, New Haven,CT 06520-8034, USA.

Abstract

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.

PMID:
20068358
PMCID:
PMC2837886
DOI:
10.1159/000274804
[Indexed for MEDLINE]
Free PMC Article

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