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. 2021 Apr 8;5(2):431-441.
doi: 10.1016/j.mayocpiqo.2021.01.015. eCollection 2021 Apr.

Clinical and Economic Burden of Stroke Among Young, Midlife, and Older Adults in the United States, 2002-2017

Safi U Khan  1 , Muhammad Zia Khan  1 , Muhammad U Khan  1 , Muhammad Shahzeb Khan  2 , Mamas A Mamas  3   4 , Muhammad Rashid  3 , Ron Blankstein  5 , Salim S Virani  6   7 , Michelle C Johansen  8 , Michael D Shapiro  9 , Michael J Blaha  10 , Miguel Cainzos-Achirica  11   12 , Farhaan S Vahidy  11 , Khurram Nasir  11   12
Affiliations

Clinical and Economic Burden of Stroke Among Young, Midlife, and Older Adults in the United States, 2002-2017

Safi U Khan et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Objective: To assess trends of stroke hospitalization rates, inpatient mortality, and health care resource use in young (aged ≤44 years), midlife (aged 45-64 years), and older (aged ≥65 years) adults.

Patients and methods: We studied the National Inpatient Sample database (January 1, 2002 to December 31, 2017) to analyze stroke-related hospitalizations. We identified data using the International Classification of Diseases, Ninth/Tenth Revision codes.

Results: Of 11,381,390 strokes, 79% (n=9,009,007) were ischemic and 21% (n=2,372,383) were hemorrhagic. Chronic diseases were more frequent in older adults; smoking, alcoholism, and migraine were more prevalent in midlife adults; and coagulopathy and intravenous drug abuse were more common in young patients with stroke. The hospitalization rates of stroke per 10,000 increased overall (31.6 to 33.3) in young and midlife adults while decreasing in older adults. Although mortality decreased overall and in all age groups, the decline was slower in young and midlife adults than older adults. The mean length of stay significantly decreased in midlife and older adults and increased in young adults. The inflation-adjusted mean cost of stay increased consistently, with an average annual growth rate of 2.44% in young, 1.72% in midlife, and 1.45% in older adults owing to the higher use of health care resources. These trends were consistent in both ischemic and hemorrhagic stroke.

Conclusion: Stroke-related hospitalization and health care expenditure are increasing in the United States, particularly among young and midlife adults. A higher cost of stay counterbalances the benefits of reducing stroke and mortality in older patients.

Keywords: AAPC, average annual percent change; HCUP, Healthcare Cost and Utilization Project; ICD-9/10-CM, International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification; LOS, length of stay; NIS, Nationwide Inpatient Sample.

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Figures

Figure 1
Figure 1
Contribution of young, midlife, and older adults in stroke and cost burden in United States.
Figure 2
Figure 2
Trends in: (A) stroke rates per 10,000 US hospitalizations in entire cohort, young, midlife, and older adults; (B) inpatient mortality in entire cohort, young, midlife, and older adults admitted with stroke; (C) length of stay in entire cohort, young, midlife, and older adults admitted with stroke; and (D) mean adjusted cost of stay in entire cohort, young, midlife, and older adults admitted with stroke.
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