Trends in In-Hospital Mortality Among Patients With Stroke in China

PLoS One. 2014 Mar 20;9(3):e92763. doi: 10.1371/journal.pone.0092763. eCollection 2014.

Abstract

Background: The incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China.

Methods: 109 grade III class A hospitals were sampled by multistage stratified cluster sampling. All patients admitted to hospitals between 2007 and 2010 with a discharge diagnosis of stroke were included. Trends in in-hospital mortality among patients with stroke were assessed. Influence factors of in-hospital death after stroke were explored using multivariable logistic regression.

Results: Overall stroke hospitalizations increased from 79,894 in 2007 to 85,475 in 2010, and in-hospital mortality of stroke decreased from 3.16% to 2.30% (P<0.0001). The percentage of severe patients increased while odds of mortality (2010 versus 2007) decreased regardless of stroke type: subarachnoid hemorrhage (OR 0.792, 95% CI = 0.636 to 0.987), intracerebral hemorrhage (OR 0.647, 95% CI = 0.591 to 0.708), and ischemic stroke (OR 0.588, 95% CI = 0.532 to 0.649). In multivariable analyses, older age, male, basic health insurance, multiple comorbidities and severity of disease were linked to higher odds of in-hospital mortality.

Conclusions: The mortality of stroke hospitalizations decreased likely reflecting advancements in stroke care and prevention. Decreasing of mortality with increasing of severe stroke patients indicated that we should pay more attention to rehabilitation and life quality of stroke patients. Specific individual and hospital-level characteristics may be targets for facilitating further declines.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cause of Death
  • China
  • Female
  • Hospital Mortality*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Odds Ratio
  • Risk Factors
  • Stroke / epidemiology
  • Stroke / mortality*

Grant support

This study was funded by the key discipline construction of Evidence-based Public Health in Shanghai No 12GWZX0602, 2 national "Eleven Five" "Significant new drugs creation" special science and technology major (2008ZX09312-007, 2009ZX09312-025), the foundation of Faculty of Health Service, Second Military Medical University (2013wk02), the foundation of Second Military Medical University (2012JS11). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.