Stroke and the "Stroke Belt" in Dialysis: Contribution of Patient Characteristics to Ischemic Stroke Rate and Its Geographic Variation
Stroke and the "Stroke Belt" in Dialysis: Contribution of Patient Characteristics to Ischemic Stroke Rate and Its Geographic Variation
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DOI：
10.1681/asn.2012111077
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发表时间：
2013-12-01
影响因子：
13.6
通讯作者：
Shireman, Theresa I.
中科院分区：
文献类型：
--
作者：
Wetmore, James B.;Ellerbeck, Edward F.;Shireman, Theresa I.
普通人群中风发病率存在地理差异，其中南方的发病率高于美国其他地区。 ESRD 是中风的一个潜在危险因素，但透析患者中风风险是否存在区域差异尚不清楚。 2000 年至 2005 年的医疗保险索赔被用来确定 265,685 名透析患者的大队列中的缺血性中风事件。生成泊松广义线性混合模型来确定与中风相关的因素，并通过生成观察到的预期 (O/E) 调整后的中风发生率比率来确定各州中风发生率的地理变异性。年龄较大、女性、非裔美国人种和西班牙裔、失业状况、糖尿病、高血压、中风病史和永久性心房颤动与缺血性中风呈正相关，而体重指数>30 kg/m(2)与中风呈负相关（P1.0均位于南部：北卡罗来纳州、密西西比州和俄克拉荷马州。区域性努力加强中风带的一级预防或更好地对透析患者进行中风迹象教育，以便他们可能会及时寻求治疗，这可能会改善透析患者的中风护理和结果。
Geographic variation in stroke rates is well established in the general population, with higher rates in the South than in other areas of the United States. ESRD is a potent risk factor for stroke, but whether regional variations in stroke risk exist among dialysis patients is unknown. Medicare claims from 2000 to 2005 were used to ascertain ischemic stroke events in a large cohort of 265,685 incident dialysis patients. A Poisson generalized linear mixed model was generated to determine factors associated with stroke and to ascertain state-by-state geographic variability in stroke rates by generating observed-to-expected (O/E) adjusted rate ratios for stroke. Older age, female sex, African American race and Hispanic ethnicity, unemployed status, diabetes, hypertension, history of stroke, and permanent atrial fibrillation were positively associated with ischemic stroke, whereas body mass index >30 kg/m(2) was inversely associated with stroke (P1.0 were all in the South: North Carolina, Mississippi, and Oklahoma. Regional efforts to increase primary prevention in the stroke belt or to better educate dialysis patients on the signs of stroke so that they may promptly seek care may improve stroke care and outcomes in dialysis patients.