Two Decades of Stroke in the United States: A Healthcare Economic Perspective

Abstract

Background: Stroke is a leading cause of morbidity and mortality in the United States and has implications on the financial health of patients, families, and healthcare systems. Objective: This study aims to determine the economic perspective of stroke on the national healthcare system for the past two decades. Methods: This retrospective study of inpatient subjects from 2000 to 2020 with stroke was collected from the Healthcare Cost and Utilization Project (HCUP). We queried patients admitted primarily for ischemic or hemorrhagic stroke. Patients were evaluated for demographics, length of stay (LOS), mortality, and hospital charges. Statistical Z-testing with a significance of p<0.05 was conducted for the analysis. Results: During the study period, 12,158,747 stroke subjects were studied, with 51.9% female and a mean age of 70.08 (±0.16) years old. The mean rate of stroke discharges per 100,000 persons was 187.71 (±3.44), decreasing from 200 to 193 during the study (p=0.16). The mean percentage of deaths was 8.78% (±0.17), which decreased from 10.96% to 6.81% (p=0.00). The mean LOS was 6.28 days (±0.08), increased from 6.70 to 7.15 (p=0.00). During the study period, the aggregated national bill was $725 billion. The mean hospital charges-per-patient were $57,178 (±1,504), increasing from $19,647 to $121,765 per person during the study period (p=0.00), while mean hospital costs-per-stay were $15,781 (±330). These data closely conform to an exponential growth pattern, and forecasting per-patient charges for the next ten years demonstrates a cost of $287,836 by 2030. Conclusions: Our data show that the rate and mortality of stroke have decreased, but its charges and costs are increasing. The improvement in outcomes could be multifactorial such as establishment of comprehensive stroke centers and evolving treatment modalities. Ironically, the charges-per-patient increased more than sixfold with a national bill almost equal to the annual Medicare budget. Thus, the significance of preventive medicine, such as controlling hypertension, diabetes, and smoking cessation, cannot be understated. With such a dramatically increasing financial burden, improvements in mitigating risk factors, educational programs, and access to care may be a more cost-effective option.

Feasibility of Observing Cerebrovascular Disease Phenotypes with Smartphone Monitoring: Study Design Considerations for Real-World Studies

“…As cerebrovascular diseases (CeVDs), like transient ischemic attack (TIA) and stroke, increase the risk of subsequent CeVD diagnoses, especially stroke and dementia, the need to identify CeVD patients most at risk of worsening outcomes is critical [ 2 ]. In the U.S. alone, annual hospitalization and rehabilitation costs for stroke are projected to reach $184 billion by 2030, with some estimates accounting for indirect costs—like home care, follow-up consults, prescriptions, and lost earnings—to exceed $1 trillion by 2050 [ 3 , 4 ]. For post-stroke patients at risk of dementia, early detection of cognitive impairment (CI) could contribute to savings of $7 trillion in treatment and care costs [ 5 ].…”