Nationwide trends in in-hospital mortality among patients with stroke

Abstract

Background and purpose: Recent data suggest declining overall deaths attributable to stroke. However, little is known about time trends in mortality during stroke hospitalization, which may reflect a stroke's direct effects, medical complications, or care quality. This study assessed nationwide patterns in hospital deaths after experiencing an acute stroke.

Methods: Data were obtained from all US states that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 2006 with a discharge diagnosis of stroke (identified by the International Classification of Diseases, Ninth Revision procedure codes) were included. Time trends in the proportion of stroke hospitalizations that resulted in death were assessed. Independent predictors of in-hospital mortality after stroke were evaluated using multivariable logistic regression.

Results: Between 1997 and 2006, overall stroke hospitalizations lessened from 1 351 293 in 1997 to 1998 to 1 202 449 in 2005 to 2006, whereas percentage stroke hospitalizations that resulted in death decreased from 11.5% in 1997 to 1998 to 10.3% in 2005 to 2006 (P<0.0001). Odds of mortality decreased regardless of stroke type: ischemic stroke (OR 0.89, 95% CI=0.86 to 0.92), subarachnoid hemorrhage (OR 0.85, 95% CI=0.78 to 0.92), and intracerebral hemorrhage (OR 0.90, 95% CI=0.86 to 0.94). In multivariable analyses, older age, female sex, non-Medicare insurance, and multiple comorbidities were independently linked to higher odds of in-hospital mortality.

Conclusions: The percentage of stroke hospitalizations resulting in death decreased over the last decade likely reflecting advancements in acute stroke care. However, specific individual/hospital-level characteristics may be targets for facilitating further declines.