Clinical and Economic Burden of Stroke Among Young, Midlife, and Older Adults in the United States, 2002-2017

Abstract

Objective: To assess trends of stroke hospitalization rates, inpatient mortality, and health care resource use in young (aged 44 years), midlife (aged 45-64 years), and older (aged !65 years) adults. Patients and Methods: We studied the National Inpatient Sample database (January 1, 2002 to December 31, 2017 to analyze stroke-related hospitalizations. We identified data using the International Classification of Diseases, Ninth/Tenth Revision codes. Results: Of 11,381,390 strokes, 79% (n¼9,009,007) were ischemic and 21% (n¼2,372,383) were hemorrhagic. Chronic diseases were more frequent in older adults; smoking, alcoholism, and migraine were more prevalent in midlife adults; and coagulopathy and intravenous drug abuse were more common in young patients with stroke. The hospitalization rates of stroke per 10,000 increased overall (31.6 to 33.3) in young and midlife adults while decreasing in older adults. Although mortality decreased overall and in all age groups, the decline was slower in young and midlife adults than older adults. The mean length of stay significantly decreased in midlife and older adults and increased in young adults. The inflation-adjusted mean cost of stay increased consistently, with an average annual growth rate of 2.44% in young, 1.72% in midlife, and 1.45% in older adults owing to the higher use of health care resources. These trends were consistent in both ischemic and hemorrhagic stroke. Conclusion: Stroke-related hospitalization and health care expenditure are increasing in the United States, particularly among young and midlife adults. A higher cost of stay counterbalances the benefits of reducing stroke and mortality in older patients.

Patients Hospitalized for Ischemic Stroke and Intracerebral Hemorrhage in France: Time Trends (2008–2019), In-Hospital Outcomes, Age and Sex Differences

“…The increase in the rates of patients hospitalized for IS among people under 65 years has been documented elsewhere for earlier time periods in France and abroad using both administrative databases and population-based stroke registries [ 3 , 5 , 6 , 10 ]. In our study, this upward trend was still ongoing in both men and women aged 45–64 years and in men aged 18–34 and 35–44 years.…”

“…According to the Global Burden of Disease Study, a significant increase in stroke prevalence and incidence rates in terms of ischemic stroke (IS) was found in both men and women aged under 70 years between 1990 and 2019, with even faster increases observed from 2010 to 2019 [ 1 ]. A stable or increasing trend in stroke incidence among middle-aged people was recently observed in the USA, Canada, Australia, and European countries including France [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Several studies have predicted a substantial increase in the number of stroke cases in high-income countries by 2030 and 2050, associated with almost a doubling of healthcare costs related to stroke by then [ 1 , 11 , 12 , 13 ], as supported by projections from the Dijon Stroke Registry for France [ 14 ].…”

Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18

“…However, when these data are applied to an appropriate question with validated case definitions, high-quality and reliable conclusions can be inferred [ 52 , 54 ]. This is confirmed by the fact that authors from many different countries have used hospital discharge administrative data to assess trends, demographic and clinical characteristics, and outcomes of hospitalizations with stroke [ 64 – 71 ]. In the US the National Inpatient Sample database has provided data on the economic burden, prevalence of cardiovascular risk factors and trends over time for stroke [ 64 – 66 ].…”

“…This is confirmed by the fact that authors from many different countries have used hospital discharge administrative data to assess trends, demographic and clinical characteristics, and outcomes of hospitalizations with stroke [64][65][66][67][68][69][70][71]. In the US the National Inpatient Sample database has provided data on the economic burden, prevalence of cardiovascular risk factors and trends over time for stroke [64][65][66].…”

How Brain Infarction Links With the Microbiota–Gut–Brain Axis: Hints From Studies Focusing on the Risk Factors for Ischemic Stroke

“…For elder populations, the incidence of IS could significantly rise up (Kapral et al, 2017 ; Khan et al, 2021 ). According to a recent epidemiologic study, stroke happened to 7.6% of adults aged 60 and above (Teh et al, 2018 ).…”