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Comparative Study
. 2019 Apr;28(4):890-899.
doi: 10.1016/j.jstrokecerebrovasdis.2018.12.005. Epub 2018 Dec 21.

Geographic Disparities in the Incidence of Stroke among Patients with Atrial Fibrillation in the United States

J'Neka S Claxton  1 , Pamela L Lutsey  2 , Richard F MacLehose  2 , Lin Y Chen  3 , Tené T Lewis  4 , Alvaro Alonso  4
Affiliations
Comparative Study

Geographic Disparities in the Incidence of Stroke among Patients with Atrial Fibrillation in the United States

J'Neka S Claxton et al. J Stroke Cerebrovasc Dis. 2019 Apr.

Abstract

Aim: To determine whether regional variation in stroke incidence exists among individuals with AF.

Methods: Using healthcare utilization claims from 2 large US databases, MarketScan (2007-2014) and Optum Clinformatics (2009-2015), and the 2010 US population as the standard, we estimated age-, sex-, race- (only in Optum) standardized stroke incidence rates by the 9 US census divisions. We also used Poisson regression to examine incidence rate ratios (IRR) of stroke and the probability of anticoagulation prescription fills across divisions.

Results: Both databases combined included 970,683 patients with AF who experienced 15,543 strokes, with a mean follow-up of 23 months. In MarketScan, the age- and sex-standardized stroke incidence rate was highest in the Middle Atlantic and East South Central divisions at 3.8/1000 person-years (PY) and lowest in the West North Central at 3.2/1000 PY. The IRR of stroke and the probability of anticoagulation fills were similar across divisions. In Optum Clinformatics, the age-, sex-, and race-standardized stroke incidence rate was highest in the East North Central division at 5.0/1000 PY and lowest in the New England division at 3.3/1000 PY. IRR of stroke and the probability of anticoagulation fills differed across divisions when compared to New England.

Conclusions: These findings suggest regional differences in stroke incidence among AF patients follow a pattern that differs from the hypothesized trend found in the general population and that other factors may be responsible for this new pattern. Cross-database differences provide a cautionary tale for the identification of regional variation using health claims data.

Keywords: Atrial fibrillation; epidemiology; geographic disparities; health services research; stroke; stroke incidence.

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Figures

Figure 1.
Figure 1.
Standardized stroke incidence rates by U.S. Census Bureau divisions in MarketScan, 2007-2014. A. Age- and sex-standardized rates. B. Age-standardized rates for women. C. Age-standardized rates for men.
Figure 2.
Figure 2.
Standardized stroke incidence rates by U.S. Census Bureau divisions in Optum Clinformatics®, 2009-2015 A. Age-,sex-, and race- standardized rates. B,C. Age- standardized rates for women and men, respectively. D,E. Age- and sex-standardized rates for non-whites and whites, respectively.
See this image and copyright information in PMC

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