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Trends in Hospital Admission for Stroke in Calgary

Published online by Cambridge University Press:  02 December 2014

T.S. Field ,
T.L. Green ,
K. Roy ,
J. Pedersen  and
M.D. Hill
T.S. Field
Affiliation:
Faculty of Medicine, Dalhousie University, Halifax, NS, Calgary, AB, Canada
T.L. Green
Affiliation:
Calgary Stroke Program, Department of Clinical Neuroscience, Calgary, AB, Canada
K. Roy
Affiliation:
Quality Improvement and Health Information, Calgary Health Region, Calgary, AB, Canada
J. Pedersen
Affiliation:
Quality Improvement and Health Information, Calgary Health Region, Calgary, AB, Canada
M.D. Hill
Affiliation:
Calgary Stroke Program, Department of Clinical Neuroscience, Calgary Health Region and the Department of Clinical Neurosciences, Department of Medicine and Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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Abstract

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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.

Conclusion:

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.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 3 , August 2004 , pp. 387 - 393
Copyright
Copyright © The Canadian Journal of Neurological 2004

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