Caro J Jaime, Migliaccio-Walle Kristen, Ishak Khajak J, Proskorovsky Irina, O'Brien Judith A
Caro Research Institute, Concord, MA, USA.
BMC Health Serv Res. 2006 Aug 14;6:99. doi: 10.1186/1472-6963-6-99.
Documentation of the hospitalizations rates following a stroke provides the inputs required for planning health services and to evaluate the economic efficiency of any new therapies.
Hospitalization rates by cause were examined using administrative data on 18,695 patients diagnosed with ischemic stroke (first or subsequent, excluding transient ischemic attack) in Saskatchewan, Canada between 1990 and 1995. Medical history was available retrospectively to January 1980 and follow-up was complete to March 2000. Analyses evaluated the rate and timing of all-cause and cardiovascular hospitalizations within discrete periods in the five years following the index stroke. Cardiovascular hospitalizations included patients with a primary diagnosis of ischemic stroke, transient ischemic attack, myocardial infarction, stable or unstable angina, heart failure or peripheral arterial disease.
One-third (36%) of patients were identified by a hospitalized stroke. Mean age was 70.5 years, 48.0% were male, half had a history of stroke or a transient ischemic attack at the time of their index stroke. Three-quarters of the patients (72.7%) were hospitalized at least once during a mean follow-up of 4.6 years, accruing CAD $24 million in the first year alone. Of all hospitalizations, 20.4% were related to cardiovascular disease and 1.6% to bleeds. In the month following index stroke, 12.5% were admitted, an average of 1.04 times per patient hospitalized. Strokes accounted for 33% of all hospitalizations in the first month. The rate diminished steadily throughout the year and stabilized in the second year when approximately one-third of patients required hospitalization, at a rate of about one hospitalization for every two patient-years. Mean lengths of stay ranged from nine days to nearly 40 days. Close-fitting Weibull functions allow highly specific probability estimates. Other cardiovascular risk factors significantly increased hospitalization rates.
After stroke, there are frequent hospitalizations accounting for substantial additional costs. Though these rates drop after one year, they remain high over time. The number of other cardiovascular causes of hospitalization confirms that stroke is a manifestation of disseminated atherothrombotic disease.
中风后住院率的记录为卫生服务规划和评估任何新疗法的经济效率提供了所需的信息。
利用1990年至1995年期间加拿大萨斯喀彻温省18695例诊断为缺血性中风（首次或再次发作，不包括短暂性脑缺血发作）患者的行政数据，按病因检查住院率。病史可追溯至1980年1月，随访至2000年3月。分析评估了首次中风后五年内不同时间段内全因和心血管疾病住院的发生率和时间。心血管疾病住院患者包括主要诊断为缺血性中风、短暂性脑缺血发作、心肌梗死、稳定或不稳定型心绞痛、心力衰竭或外周动脉疾病的患者。
三分之一（36%）的患者因中风住院。平均年龄为70.5岁，48.0%为男性，一半患者在首次中风时患有中风或短暂性脑缺血发作史。四分之三（72.7%）的患者在平均4.6年的随访期间至少住院一次，仅第一年就产生了2400万加元的费用。在所有住院病例中，20.4%与心血管疾病有关，1.6%与出血有关。在首次中风后的一个月内，12.5%的患者入院，每位住院患者平均入院1.04次。中风占第一个月所有住院病例的33%。该比率在全年稳步下降，并在第二年稳定下来，此时约三分之一的患者需要住院，每两个患者年的住院率约为一次。平均住院时间从九天到近40天不等。拟合良好的威布尔函数可进行高度精确的概率估计。其他心血管危险因素显著增加住院率。
中风后频繁住院导致大量额外费用。虽然这些比率在一年后下降，但随着时间的推移仍保持在高位。其他导致住院的心血管病因数量证实中风是弥漫性动脉粥样硬化血栓形成疾病的一种表现。
