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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

References

1.Hill, MD, Barber, PA, Demchuk, AM, et al.Building a “brain attack” team to administer thrombolytic therapy for acute ischemic stroke. Can Med Assoc J 2000;162:1589–1593.Google Scholar
2.Proctor, MC, Greenfield, LJ.Pulmonary embolism: diagnosis, incidence and implications. Cardiovasc Surg 1997;5:77–81.Google Scholar
3.Espino, JU, Wagner, MM.Accuracy of ICD-9-coded chief complaints and diagnoses for the detection of acute respiratory illness. Proc AMIA Symp 2001;164–168.Google Scholar
4.Marrie, TJ, Durant, H, Sealy, E.Pneumonia--the quality of medical records data. Med Care 1987;25:20–24.Google Scholar
5.Campbell, NR, McAlister, FA, Brant, R, et al for the Canadian Hypertension Education Process and Evaluation Committee. Temporal trends in antihypertensive drug prescriptions in Canada before and after introduction of the Canadian Hypertension Education Program. J Hypertens 2003; 21: 1591–1597.CrossRefGoogle ScholarPubMed
6.Hamilton, VH, Levinton, C, St-Pierre, Y, Grimard, F.The effect of tobacco tax cuts on cigarette smoking in Canada. Can Med Assoc J 1997; 156: 187–191.Google Scholar
7.Pessah-Rasmussen, H, Engström, G, Jerntorp, I, Janzon, L.Increasing stroke incidence and decreasing case fatality, 1989-1998. Stroke 2003;34:913–918.CrossRefGoogle ScholarPubMed
8.Thorvaldsen, P, Davidsen, M, Brønnum-Hansen, H, Schroll, M.Stable stroke occurrence despite incidence reduction in an aging population: stroke trends in the Danish monitoring trends and determinants in cardiovascular disease (MONICA) population. Stroke 1999;30:2529–2534.CrossRefGoogle Scholar
9.Heart and Stroke Foundation of Canada. Heart Disease and Stroke in Canada. Ottawa: Heart and Stroke Foundation of Canada; 1997.Google Scholar
10.Bata, IR, Eastwood, BJ, Gregor, RD, et al.Decreasing mortality from acute myocardial infarctions: effect of attack rates and case severity. J Clin Epidemiol 1997;50:787–791.Google Scholar
11.Samsa, GP, Matchar, DB, Goldstein, L, et al.Utilities for major stroke: results from a survey of preferences among persons at increased risk for stroke. Am Heart J 1998;136:703–713.Google Scholar
12.Solomon, NA, Glick, HA, Russo, CJ, Lee, J, Schulman, KA.Patient preferences for stroke outcomes. Stroke 1994;25:1721–1725.Google Scholar
13.Hillbom, M, Erila, T, Sotaniemi, K, et al.Enoxaparin vs heparin for prevention of deep-vein thrombosis in acute ischaemic stroke: a randomized, double-blind study. Acta Neurol Scand 2002;106:84–92.Google Scholar
14.Kelly, J, Rudd, A, Lewis, R, Hunt, BJ.Venous thromboembolism after acute stroke. Stroke 2001;32:262–267.CrossRefGoogle ScholarPubMed
15.Muir, KW, Watt, A, Baxter, G, Grosset, DG, Lees, KR.Randomized trial of graded compression stockings for prevention of deep-vein thrombosis after acute stroke. Q J Med 2000;93: 359–364.CrossRefGoogle ScholarPubMed
16.Wijdicks, EF, Scott, JP.Pulmonary embolism associated with acute stroke. Mayo Clin Proc 1997;72:297–300.Google Scholar
17.Dumas, R, Woitinas, F, Kutnowski, M, et al.A multicentre, double-blind, randomized study to compare the safety and efficacy of once-daily ORG 10172 and twice-daily low-dose heparin in preventing deep-vein thrombosis in patients with acute ischaemic stroke. Age Ageing 1994;23: 512–516.Google Scholar
18.Davies, JW, Semenciw, RM, Mao, Y.Cardiovascular disease mortality trends and related risk factors in Canada. Can J Cardiol 1988;4 (Suppl A):16A–20A.Google Scholar
19.Uemura, K, Pisa, Z.Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Stat Q 1988;38:155–168.Google Scholar
20.Bonneux, L, Looman, CWN, Barendregt, JJ, Van der Maas, PJ.Regression analysis of recent changes in cardiovascular mobility and mortality in the Netherlands. Br Med J 1997;314:789–792.Google Scholar
21.Abildstrom, SZ, Rasmussen, S, Rosen, M, Madsen, M.Trends in incidence and case fatality rates of acute myocardial infarction in Denmark and Sweden. Heart 2003;89:507–511.CrossRefGoogle ScholarPubMed
22.Messner, T, Lundberg, V.Trends in sudden cardiac death in the northern Sweden MONICA area 1985-99. J Intern Med 2003;253:320–328.Google Scholar
23.Sudlow, CLM, Warlow, CP.Comparable studies of the incidence of stroke and its pathological types: results from an international collaboration. Stroke 1997;28:491–499.Google Scholar
24.Korv, J, Roose, M, Kaasik, AE.Changed incidence and case-fatality rates of first-ever stroke between 1970 and 1993 in Tartu, Estonia. Stroke 1996;27:199–203.Google Scholar
25.Sarti, C, Stegmayr, B, Tolonen, H, et al, for the WHO MONICA Project. Changes in mortality from stroke caused by changes in stroke event rates of case fatality? Stroke 2003; 34: 1833–1841.Google Scholar
26.Broderick, JP.Stroke trends in Rochester, Minnesota, during 1945 to 1984. Ann Epidemiol 1993;3:476–479.Google Scholar
27.McGovern, PG, Burke, GL, Sprafka, JM, et al.Trends in mortality, morbidity and risk factor levels for stroke from 1960 through 1990: The Minnesota Heart Survey. JAMA 1992;752–759.Google Scholar
28.Field, TS, Hill, MD.Stroke, chinook and the weather. Stroke 2002;33:1751–1778.Google Scholar
29.Yiannakoulias, N, Svenson, LW, Hill, MD, et al.Regional comparison of inpatient and outpatient patterns of cerebrovascular disease diagnosis in the province of Alberta. Chronic Dis Can 2003;24:9–16.Google Scholar
30.Canadian Stroke Network. Facts Sheet. 2003. Available from: URL: http://www.canadianstrokenetwork.ca/media/downloads/fact.she et.e.pdfGoogle Scholar
31.Mayo, NE, Neville, D, Kirkland, S, et al.Hospitalization and case-fatality rates for stroke in Canada from 1982 through 1991. The Canadian Collaborative Study Group of Stroke Hospitalizations. Stroke 1996;27:1215–1220.Google Scholar
32.Ostbye, T, Levy, AR, Mayo, NE.Hospitalization and case-fatality rates for subarachnoid hemorrhage in Canada from 1982 through 1991. The Canadian Collaborative Study Group of Stroke Hospitalizations. Stroke 1997;28:793–798.Google Scholar
33.Broderick, JP, Viscoli, CM, Brott, T, et al.Major risk factors for aneurismal subarachnoid hemorrhage in the young are modifiable. Stroke 2003;34:1375–1381.CrossRefGoogle Scholar
34.Statistics, Canada. “Smoking.” The Canada e-Book. Ottawa: Statistics Canada; 2001. Available from: URL: http://142.206.72.67/02/02b/02b_007a_e.htm. Accessed August 2003.Google Scholar
35.Willinsky, RA.Detachable coils to treat intracranial aneurysms. Can Med Assoc J 1999; 161: 1136.Google Scholar
36.Lozier, AP, Connolly, ES Jr, Lavine, SD, Solomon, RA.Guglielmi detachable coil embolization of posterior circulation aneurysms: a systematic review of the literature. Stroke 2002;33:2509–2518.Google Scholar
37.Willinsky, RA.Detachable coils to treat intracranial aneurysms. Can Med Assoc J 1999;161:1136.Google Scholar
38.Mayo, NE, Goldberg, MS, Levy, AR, Danys, I, Korner-Bitensky, N.Changing rates of stroke in the province of Quebec, Canada: 1981-1988. Stroke 1991;22:590–595.Google Scholar
39.Wardlaw, JM, del Zoppo, G, Yamaguchi, T.Thrombolysis for acute ischaemic stroke. The Cochrane Library 1999; Issue 4.Google Scholar
40.Vallee, JN, Aymard, A, Vicaut, E, Reis, M, Merland, JJ.Endovascular treatment of basilar tip aneurysms with Guglielmi detachable coils: Predictors of immediate and long-term results with multivariate analysis 6-year experience. Radiology 2003;226:867–879.CrossRefGoogle Scholar
41.Molyneux, A, Kerr, R, Stratton, I, et al.International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002;360:1267–1274.Google Scholar
42.The National Institute of Neurological Disorders and Stroke rtPA Stroke Study Group. Tissue plasminogen activator for acute ischaemic stroke. New Eng J Med 1995;333:1581–1587.Google Scholar
43.Stroke Unit Trialists’ Collaboration. How do stroke units improve patient outcomes? A collaborative systematic review of the randomised trails of organised inpatient (stroke unit) care after stroke. Br Med J 1997;314:1151–1159.Google Scholar
44.Levy, AR, O’Brien, BJ, McMullen, E, et al.Rapid increase in statins newly dispensed to Ontario seniors between 1994 and 2000. Can J Cardiol 2003; 9: 665–669.Google Scholar
45.Broderick, JP.Stroke trends in Rochester, Minnesota, during 1945 to 1984. Ann Epidemiol 1993;3:476–479.Google Scholar
46.McGovern, PG, Burke, GL, Sprafka, JM, et al.Trends in mortality, morbidity and risk factor levels for stroke from 1960 through 1990: The Minnesota Heart Survey. JAMA 1992;268:752–759.CrossRefGoogle ScholarPubMed
47.Lemesle, M, Milan, C, Faivre, J, et al.Incidence trends of ischemic stroke and transient ischemic attacks in a well-defined French population from 1985 through 1994. Stroke 1999;30:371–377.Google Scholar
48.Truelsen, T, Prescott, E, Gronbaek, M, Schnohr, P, Boysen, G.Trends in stroke incidence: the Copenhagen city heart study. Stroke 1997;28:1903–1907.Google Scholar
49.Brown, RD, Whisnant, JP, Sick, JD, O’Fallon, WM, Wiebers, DO.Stroke incidence, prevalence and survival: secular trends in Rochester, Minnesota, through 1989. Stroke 1996; 27:373–380.Google Scholar