Trends in 1-Year Recurrent Ischemic Stroke in the US Medicare Fee-for-Service Population.
Trends in 1-Year Recurrent Ischemic Stroke in the US Medicare Fee-for-Service Population.
复制标题
美国医疗保险按服务收费人群一年复发性缺血性中风的趋势。
DOI：
10.1161/strokeaha.122.039438
复制
发表时间：
2022
期刊：
影响因子：
8.3
通讯作者：
Lichtman,JudithH
中科院分区：
文献类型：
--
作者：
Leifheit,EricaC;Wang,Yun;Goldstein,LarryB;Lichtman,JudithH
背景在过去的几十年里，中风的二级预防和对医疗服务的关注已经取得了重要的进展。然而，关于美国卒中复发趋势的数据有限。我们检查了2001年至2017年因缺血性卒中住院的医疗保险受益人中1年复发的国家和地区模式。方法这项队列研究包括2001年至2017年所有年龄≥65岁的按服务收费的医疗保险受益人，他们出院时主要诊断为缺血性卒中。随访时间长达1年，直至2018年。考克斯模型用于评估1年复发性缺血性卒中的时间趋势，调整人口统计学和临床特征。我们绘制了复发率图，并将持续高复发县确定为在以下≥5个时期内卒中复发率处于最高六分位数的县：2001-2003年、2004-2006年、2007-2009年、2010-2012年、2013-2015年、结果共有3 638 346名受益人因脑卒中出院，平均年龄79. 0 ± 8. 1岁，女性占55. 2%，白色占85. 3%。全国1年复发性卒中率从2001-2003年的11.3%降至2016-2017年的7.6%（相对降低，33.5% [95%CI，32.5%-34.5%]）。从2001年到2017年，复发率调整后每年下降2.3%（95%CI，2.2%-2.4%），包括所有年龄、性别和人种亚组的下降。2001-2003年县级复发率范围为5.5%至14.0%，2016-2017年为0.2%至8.9%。有76个县，集中在美国中南部，在整个研究中复发率最高。这些县的人口比例较高的黑人居民和无保险的成年人，更大的财富不平等，更差的一般健康状况，并减少预防性检测率相比，与其他country.ConclusionsRecurrent缺血性中风下降，随着时间的推移，整体和跨人口亚组，但是，有持续较高的复发率的地理区域。这些发现可以为高危人群和社区提供二级预防干预机会。
BackgroundThere have been important advances in secondary stroke prevention and a focus on healthcare delivery over the past decades. Yet, data on US trends in recurrent stroke are limited. We examined national and regional patterns in 1-year recurrence among Medicare beneficiaries hospitalized for ischemic stroke from 2001 to 2017.MethodsThis cohort study included all fee-for-service Medicare beneficiaries aged ≥65 years who were discharged alive with a principal diagnosis of ischemic stroke from 2001 to 2017. Follow-up was up to 1 year through 2018. Cox models were used to assess temporal trends in 1-year recurrent ischemic stroke, adjusting for demographic and clinical characteristics. We mapped recurrence rates and identified persistently high-recurrence counties as those with rates in the highest sextile for stroke recurrence in ≥5 of the following periods: 2001–2003, 2004–2006, 2007–2009, 2010–2012, 2013–2015, and 2016–2017.ResultsThere were 3 638 346 unique beneficiaries discharged with stroke (mean age 79.0±8.1 years, 55.2% women, 85.3% White). The national 1-year recurrent stroke rate decreased from 11.3% in 2001–2003 to 7.6% in 2016–2017 (relative reduction, 33.5% [95% CI, 32.5%–34.5%]). There was a 2.3% (95% CI, 2.2%–2.4%) adjusted annual decrease in recurrence from 2001 to 2017 that included reductions in all age, sex, and race subgroups. County-level recurrence rates ranged from 5.5% to 14.0% in 2001–2003 and from 0.2% to 8.9% in 2016–2017. There were 76 counties, concentrated in the South-Central United States, that had the highest recurrence throughout the study. These counties had populations with a higher proportion of Black residents and uninsured adults, greater wealth inequity, poorer general health, and reduced preventive testing rates as compared with other counties.ConclusionsRecurrent ischemic strokes decreased over time overall and across demographic subgroups; however, there were geographic areas with persistently higher recurrence rates. These findings can inform secondary prevention intervention opportunities for high-risk populations and communities.