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Published on: May 22, 2019
Increasing comorbidity and health services utilization in older adults with prior stroke
Andrea Gruneir1, Lauren E Griffith2, Kathryn Fisher2
1From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada. gruneir@ualberta.ca.
Insights
Stroke survivors often have multiple chronic conditions, leading to increased healthcare use and costs, primarily for non-stroke-related issues. This highlights the need for comprehensive, community-based care strategies.
Area of Science:
- Gerontology
- Public Health
- Epidemiology
Background:
- Stroke is a leading cause of disability in older adults.
- Community-dwelling older adults often present with multiple chronic conditions (comorbidities).
- Understanding the burden of comorbidities on healthcare utilization and costs is crucial for effective resource allocation.
Purpose of the Study:
- To characterize comorbid chronic conditions in community-dwelling older adults with a history of stroke.
- To describe patterns of health services use among this population.
- To estimate the associated healthcare costs over a 5-year period.
Main Methods:
- Retrospective cohort study utilizing administrative data from Ontario, Canada.
- Inclusion of community-dwelling individuals aged 66+ with prior stroke (n=29,673).
- Analysis of 14 comorbid conditions, health services utilization (physician visits, ED visits, hospital admissions, home care), and costs, stratified by comorbidity count.
Main Results:
- High prevalence of comorbidities: 74.9% had 3+ conditions; hypertension (89.8%) and arthritis (65.8%) were most common.
- Health services use doubled with increasing comorbidity, mainly for non-stroke-related reasons.
- Healthcare costs escalated with comorbidity, with hospital admissions becoming the primary cost driver in complex cases.
Conclusions:
- Stroke survivors exhibit a high burden of comorbid conditions, significantly impacting healthcare utilization and costs.
- Non-stroke-related health issues are major drivers of increased service use and expenses.
- Patient-centered, community-based care is essential to manage diverse health needs and mitigate costly acute care utilization in stroke survivors.
Objective:
To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke.
Methods:
This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke- and non-stroke-related reasons.
Results:
A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, and dementia). Use of all health services doubled with increasing comorbidity and was largely attributed to non-stroke-related reasons. Total and per-patient costs increased with comorbidity. Main cost drivers shifted from physician and home care visits to hospital admissions with greater comorbidity.
Conclusions:
Our findings demonstrate the importance of community-based patient-centered care strategies for stroke survivors that address their range of health needs and prevent more costly acute care use.
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