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Trends in hospital admission for stroke in Calgary
Insights
While age-adjusted stroke rates remained stable, the total number of stroke admissions increased significantly between 1994 and 2002. This trend was accompanied by a decline in in-hospital stroke mortality.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Stroke incidence has historically declined but recent trends suggest stabilization or increase.
- Investigated time trends in stroke occurrence, morbidity, and mortality in the Calgary Health Region.
Purpose of the Study:
- To analyze temporal trends in stroke occurrence and in-hospital outcomes.
- To model and extrapolate future stroke trends based on observed data.
Main Methods:
- Included all hospital admissions for stroke (ICD-9/ICD-10) from 1994-2002.
- Recorded stroke type, admission date, demographics, outcomes, and complications.
- Utilized Poisson and linear regression for trend analysis and future projections.
Main Results:
- Observed 11,642 stroke events; 15.1% died in hospital, 5.1% had complications.
- Stroke admission rates remained stable, but total admissions increased due to intracerebral hemorrhage and ischemic stroke.
- In-hospital mortality declined overall, driven by reductions across all stroke types.
Conclusions:
- Age-adjusted stroke rates were stable, but absolute admissions rose, with decreasing in-hospital mortality.
- Further research is needed to understand the factors contributing to reduced in-hospital stroke mortality.
Background:
Stroke incidence has fallen since 1950. Recent trends suggest that stroke incidence may be stabilizing or increasing. We investigated time trends in stroke occurrence and in-hospital morbidity and mortality in the Calgary Health Region.
Methods:
All patients admitted to hospitals in the Calgary Health Region between 1994 and 2002 with a primary discharge diagnosis code (ICD-9 or ICD-10) of stroke were included. In-hospital strokes were also included. Stroke type, date of admission, age, gender, discharge disposition (died, discharged) and in-hospital complications (pneumonia, pulmonary embolism, deep venous thrombosis) were recorded. Poisson and simple linear regression was used to model time trends of occurrence by stroke type and age-group and to extrapolate future time trends.
Results:
From 1994 to 2002, 11642 stroke events were observed. Of these, 9879 patients (84.8%) were discharged from hospital, 1763 (15.1%) died in hospital, and 591 (5.1%) developed in-hospital complications from pneumonia, pulmonary embolism or deep venous thrombosis. Both in-hospital mortality and complication rates were highest for hemorrhages. Over the period of study, the rate of stroke admission has remained stable. However, total numbers of stroke admission to hospital have faced a significant increase (p=0.012) due to the combination of increases in intracerebral hemorrhage (p=0.021) and ischemic stroke admissions (p=0.011). Sub-arachnoid hemorrhage rates have declined. In-hospital stroke mortality has experienced an overall decline due to a decrease in deaths from ischemic stroke, intracerebral hemorrhage and sub-arachnoid hemorrhage.
Conclusions:
Although age-adjusted stroke occurrence rates were stable from 1994 to 2002, this is associated with both a sharp increase in the absolute number of stroke admissions and decline in proportional in-hospital mortality. Further research is needed into changes in stroke severity over time to understand the causes of declining in-hospital stroke mortality rates.
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01:15Ischemic Stroke l: Introduction
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