Stroke Incidence by Major Pathological Type and Ischemic Subtypes in the Auckland Regional Community Stroke Studies

Krishnamurthi, Rita; Barker‐Collo, Suzanne; Parag, Varsha; Parmar, Priya; Witt, Emma; Jones, Amy; Mahon, Susan; Anderson, Craig S.; Barber, P. Alan; Feigin, Valery L.

doi:10.1161/strokeaha.117.019358

Cited by 75 publications

(76 citation statements)

References 46 publications

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“…Suggested additional supplementary data collection also includes registration of recurrent TIA (because recurrent TIA has different management and prognostic significance); capture-recapture estimates to ascertain the completeness of stroke and TIA case ascertainment, 51,52 follow-up of stroke and TIA patients' functional status for at least 3 months (there is evidence that 3-month disability, as measured by the modified Rankin Scale pre-and post-stroke, is a strong independent predictor of long-term disability and mortality); 53,54 and collecting data on risk factors among stroke and TIA patients to allow firmer conclusions to be drawn about the factors impacting the trends in incidence and outcomes as well as to reflect on the effect of trends in health policy on stroke and TIA outcomes. 41,55 Complete, population-based case ascertainment, based on multiple overlapping sources of information (hospitals, outpatient clinics, general practitioners, death certificates) and high level of acute brain neuroimaging coverage, with an expert adjudication of the events is very important for the capture and diagnosis/classification of all new stroke and TIA cases 24 based on both old (clinical) and new stroke and TIA definitions. The new definitions of stroke and TIA require the use of DW-MRI for the precise distinction between TIA and ischemic stroke if the events are shorter than 24 hours, whereas for events lasting 24+ hours brain CT scanning is sufficient.…”

Section: Suggested Supplementary Data Collectionmentioning

confidence: 99%

“…39 NIHSS score can be obtained either prospectively (if clearly present in medical files) or retrospectively based on clinical data obtained from medical files. 40 Such subtype classification and severity scoring systems are recommended to be used as supplementary criteria for an 'ideal' stroke incidence and outcomes study.Although categorisation of different pathological types of stroke into various etiological and anatomical groups might be very challenging in population-based epidemiological studies, especially in resource-poor countries, there have been several such studies accomplished in the past [41][42][43][44][45][46][47][48][49][50]. For example, if possible, intracerebral hemorrhages should be classified into lobar, deep, and infratentorial hemorrhages; while subarachnoid hemorrhages should be classified into aneurysmal and non-aneurysmal hemorrhages.…”

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confidence: 99%

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Updated Criteria for Population-Based Stroke and Transient Ischemic Attack Incidence Studies for the 21st Century

Feigin

Norrving

Sudlow

et al. 2018

Stroke

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Section: Suggested Supplementary Data Collectionmentioning

confidence: 99%

mentioning

confidence: 99%

Updated Criteria for Population-Based Stroke and Transient Ischemic Attack Incidence Studies for the 21st Century

Feigin

Norrving

Sudlow

et al. 2018

Stroke

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“…Ischemic stroke (IS), primary intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) are major pathological types of stroke. Among them, IS has the highest number of cases (39).There is a gap in the utilization of health services among stroke patients covered by different health insurance schemes (40).…”

Section: Discussionmentioning

confidence: 99%

Disparities in the utilization of ischemic stroke inpatient services in China: the role of urban basic health insurance

Yang

Man

et al. 2019

Preprint

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Background As one major disease threatening human health, stroke has placed a heavy financial burden on patients worldwide. This study aims to confirm whether there are disparities and inequity in the utilization of inpatient health services for stroke inpatients covered by different health insurance schemes. Methods We conducted statistical analysis based on the data containing urban employee-based basic medical insurance scheme (UEBMI) and urban resident-based basic medical insurance scheme (URBMI) groups, supplied by the China Health Insurance Research Association (CHIRA). Descriptive analysis was the main method to finish this analysis. Results Of the 56485 inpatients who had been diagnosed with ischemic stroke, extracted from the CHIRA claimed database, 64.6% (36487) were covered by UEBMI and 35.4% (19998) were covered by URBMI; the mean age of UEBMI subgroup was slightly older than URBMI subgroup (68.64 and 67.45 years old). The annual frequency of hospitalization of UEBMI subgroup was 1.21 times and 1.15 times for URBMI subgroup. The average length of stay of UEBMI subgroup(13.93days) was longer than URBMI subgroup (10.82 days). The UEBMI group had a higher hospitalization costs but fewer out-of-pocket costs: for the UEBMI subgroup, the average hospitalization cost was RMB11187.64($1724.02), the average total out-of-pocket costs was RMB2646.42($407.81). While for the URBMI subgroup, the average hospitalization cost was RMB6402.27($986.59) and the average total out-of-pocket costs was RMB2746.10($423.17). All the above differences were significant(P<0.001). Meanwhile, patients with UEBMI had higher reimbursement rate (82.65% and 63.82%). Conclusions We found that there were nonnegligible disparities in the utilization of inpatient health services between UEBMI and URBMI as well as health inequity and financial protection inequity. Thus, our results call for a systemic strategy to improve the fragmented social health insurance system and narrow the gap in health insurance schemes in China.

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“…Ischemic stroke, primary intracerebral hemorrhage, and subarachnoid hemorrhage are major pathological types of stroke. Among them, ischemic stroke has the highest number of cases(35). To our knowledge, this is the first study using a large nation-wide Chinese health insurance claims database to show disparities in the utilization of ischemic stroke inpatient services under different urban basic health insurances schemes.…”

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confidence: 90%

Disparities in the utilization of ischemic stroke inpatient services in China: the role of urban health insurance

Yang

Man

Nicholas

et al. 2020

Preprint

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Background: As the second most common cause of death globally, strokes impose a significant financial burden on patients and a country’s health system. This study demonstrates the disparities in the utilization of inpatient health services for stroke patients covered by different urban basic health insurance schemes in China.Methods: We conducted statistical analysis based on the data containing urban employee-based basic medical insurance scheme (UEBMI) and urban resident-based basic medical insurance scheme (URBMI) groups, supplied by the China Health Insurance Research Association (CHIRA). Descriptive analysis was the main method to finish this study.Results: Of the inpatients (N=56485) who had been diagnosed with ischemic stroke, extracted from the CHIRA claimed database, 64.6% (36487) were covered by UEBMI and 35.4% (19998) were covered by URBMI. The annual frequency of hospitalization of UEBMI subgroup was 1.21 times and 1.15 times for URBMI subgroup. The average length of stay of UEBMI subgroup(13.93days) was longer than URBMI subgroup (10.82 days). The UEBMI group had higher hospitalization costs but fewer out-of-pocket costs: for the UEBMI subgroup, the average hospitalization cost was RMB11187.64($1724.02), the average total out-of-pocket costs was RMB2646.42($407.81). While for the URBMI subgroup, the average hospitalization cost was RMB6402.27($986.59) and the average total out-of-pocket costs was RMB2746.10($423.17). All the above differences were significant(P<0.001). Meanwhile, patients with UEBMI had higher reimbursement rate (82.65% and 63.82%) and lower self-paid ratio (23.65% and 42.89%).Conclusions: We found that there were nonnegligible disparities in the utilization of inpatient health services between UEBMI and URBMI. Thus, our results call for a systemic strategy to improve the fragmented social health insurance system and narrow the gap in health insurance schemes in China.

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Stroke Incidence by Major Pathological Type and Ischemic Subtypes in the Auckland Regional Community Stroke Studies

Cited by 75 publications

References 46 publications

Updated Criteria for Population-Based Stroke and Transient Ischemic Attack Incidence Studies for the 21st Century

Updated Criteria for Population-Based Stroke and Transient Ischemic Attack Incidence Studies for the 21st Century

Disparities in the utilization of ischemic stroke inpatient services in China: the role of urban basic health insurance

Disparities in the utilization of ischemic stroke inpatient services in China: the role of urban health insurance

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