Intraregional decline in case-fatality and hospital use after occlusive stroke in the Southeastern United States

Daniel C. Potts, Frank Gilliam, Camilo R. Gomez, E. Eugene Marsh, Victoria L. Mitchell, Robert Sherrill

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)344-348
Number of pages5
JournalJournal of Stroke and Cerebrovascular Diseases
Volume8
Issue number5
DOIs
StatePublished - Sep 1 1999

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Southeastern United States
Stroke
Mortality
Length of Stay
Incidence
International Classification of Diseases
Medicare
Hospital Mortality
Hospitalization

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Potts, Daniel C. ; Gilliam, Frank ; Gomez, Camilo R. ; Eugene Marsh, E. ; Mitchell, Victoria L. ; Sherrill, Robert. / Intraregional decline in case-fatality and hospital use after occlusive stroke in the Southeastern United States. In: Journal of Stroke and Cerebrovascular Diseases. 1999 ; Vol. 8, No. 5. pp. 344-348.
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abstract = "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.",
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Intraregional decline in case-fatality and hospital use after occlusive stroke in the Southeastern United States. / Potts, Daniel C.; Gilliam, Frank; Gomez, Camilo R.; Eugene Marsh, E.; Mitchell, Victoria L.; Sherrill, Robert.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 8, No. 5, 01.09.1999, p. 344-348.

Research output: Contribution to journalArticle

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AU - Gilliam, Frank

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AU - Eugene Marsh, E.

AU - Mitchell, Victoria L.

AU - Sherrill, Robert

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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.

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