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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Disparities in pediatric stroke-related mortality in the United States: Insights from the CDC WONDER database
Waleed Tariq1, Shahzaib Ahmed1, Sophia Ahmed2
1Department of Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan.
Insights
Pediatric stroke mortality decreased overall but increased from 2012. High-risk groups include males, infants, and African American children, necessitating targeted prevention and management strategies for childhood stroke.
Area of Science:
- Pediatric Neurology
- Public Health
- Epidemiology
Background:
- Stroke is a rare but significant cause of mortality in children.
- Persistent disparities in pediatric stroke-related mortality exist despite treatment advances.
Purpose of the Study:
- To analyze trends in pediatric stroke-related mortality in the United States over two decades (1999-2020).
- Identify demographic and geographic disparities in childhood stroke deaths.
Main Methods:
- Retrospective cross-sectional study using the CDC WONDER database.
- Calculated crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs).
- Analyzed trends using Joinpoint regression to determine annual percent changes (APCs).
Main Results:
- Overall decrease in AAMR from 1.26 (1999) to 1.02 (2020).
- Males, infants (<1 year), and Non-Hispanic Black or African American children showed higher mortality rates.
- Midwest and South regions, and large central metro areas exhibited higher AAMRs.
Conclusions:
- Mortality trends increased from 2012 onwards, highlighting specific high-risk pediatric populations.
- A comprehensive strategy involving prevention, early detection, and optimized care is crucial.
- Addressing disparities is key to mitigating pediatric stroke mortality.
Objective:
Stroke is a rare but significant cause of mortality among the pediatric age group. Despite advances in treatment, disparities in stroke-related mortality persist. We aim to analyze stroke-related mortality among pediatric age groups in the US for over two decades.
Methods:
This retrospective cross-sectional study utilized the CDC WONDER database for stroke-related mortality in children (≤ 14 years). Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Annual percent changes (APC) with 95 % confidence intervals (CI) were determined from Joinpoint regression (Joinpoint Regression Program V 5.2.0).
Results:
From 1999 to 2020, a total of 15,512 deaths in the United States pediatric-stroke-related mortality were reported. An overall decrease in AAMR was observed, from 1.26 in 1999 to 1.02 in 2020. Males had higher AAMR (1.28) than females throughout the period (1.03). Across regions, the Midwest had the highest AAMR (1.24), followed by the South (1.23), the West (1.17), and the Northeast (0.95). Non-Hispanic (NH) Black or African American group had the highest AAMR (1.97) followed by Hispanic or Latinos (1.08), NH Whites (1.00), and NH Asian or Pacific Islanders exhibited the lowest AAMR (0.94). The CMR per 100,000 was noted to be the highest for the <1 year age group (CMR: 8.14) while the 5-14 years group demonstrated the lowest crude rate (CMR: 0.56). Upon urbanization, the highest AAMR was observed in large central metro areas (1.23) while large fringe metro areas had the lowest AAMR (1.02). The highest AAMRs state-wise were observed in Alaska (1.79), South Dakota (1.77), and the District of Columbia (1.75).
Conclusion:
An increase in mortality trends was observed from 2012 onwards with males, infants, and African American children being the high-risk groups. A multifaceted approach, focusing on prevention, early recognition, and optimized management is required to mitigate pediatric-stroke-related mortality.
