Trends in One-Year Recurrent Ischemic Stroke among the Elderly in the USA: 1994-2002
Trends in One-Year Recurrent Ischemic Stroke among the Elderly in the USA: 1994-2002
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DOI：
10.1159/000319028
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发表时间：
2010-01-01
影响因子：
2.9
通讯作者：
Lichtman, Judith H.
中科院分区：
文献类型：
--
作者：
Allen, Norrina B.;Holford, Theodore R.;Lichtman, Judith H.
背景和目的：美国每年发生795，000例中风，其中超过20%是复发事件。关于该国中风复发率如何随着时间的推移而变化，人们知之甚少。我们的目的是确定1994年至2002年美国各郡老年人1年缺血性卒中复发率的全国趋势。研究方法：1994-1996年、1997-1999年和2000-2002年，美国各县确定了所有按服务收费的医疗保险受益人中缺血性卒中事件（ICD-9433、434、436）后一年的卒中复发率。贝叶斯时空泊松模型用于确定随时间推移的卒中复发率的县特异性趋势，并对人口统计学、病史和共病情况进行风险调整。结果如下：该分析包括超过250万受益人（56%为妇女;平均年龄：78岁; 87%为白色; 1994-1996年n = 957，933; 1996-1999年n = 838，330; 2000-2002年n = 895，916），总计3，118个美国县。在调整了患者人口统计学和合并症的变化后，1994-1996年（13.2%）至2000-2002年（12.6%; p趋势）的卒中复发率下降了4.5
Background and Purpose: Of the 795,000 strokes occurring in the USA each year, over 20% are recurrent events. Little is known about how the rates of recurrent stroke in the country have changed over time. Our objective was to determine national trends in 1-year recurrent ischemic stroke rates by US county among the elderly from 1994 to 2002. Methods: One-year recurrent stroke rates following incident ischemic stroke (ICD-9433, 434, 436) among all fee-for-service Medicare beneficiaries were determined by US county for 1994-1996, 1997-1999, and 2000-2002. Bayesian spatiotemporal Poisson modeling was used to determine county-specific trends in recurrent stroke rates over time with risk adjustment for demographics, medical history and comorbid conditions. Results: The analysis included more than 2.5 million beneficiaries (56% women; mean age: 78 years; 87% white; n = 957,933 for 1994-1996; n = 838,330 for 1996-1999; n = 895,916 for 2000-2002) aggregated to all 3,118 US counties. After adjustment for changing patient demographics and comorbidities, there was a 4.5% decrease in recurrent stroke rates from 1994-1996 (13.2%) to 2000-2002 (12.6%; p for trend