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. 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

Norrina B Allen  1 , Theodore R Holford, Michael B Bracken, Larry B Goldstein, George Howard, Yun Wang, Judith H Lichtman
Affiliations

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

Norrina B Allen et al. Neuroepidemiology. 2010.

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.

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Figures

Fig. 1
Fig. 1
Smoothed, age-adjusted 1-year recurrent ischemic stroke rates by US county, 20002003, by race/ethnicity (a) and gender (b).
Fig. 2
Fig. 2
Risk-standardized 1-year recurrent ischemic stroke rates by US county, 20002003.
See this image and copyright information in PMC

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