Saposnik Gustavo, Cote Robert, Phillips Stephen, Gubitz Gordon, Bayer Neville, Minuk Jeffrey, Black Sandra
South East Toronto Regional Stroke Center, Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Stroke. 2008 Aug;39(8):2310-7. doi: 10.1161/STROKEAHA.107.511402. Epub 2008 Jun 12.
The prevalence of stroke in elderly patients has been increasing in recent years. However, limited information is available about the burden of stroke in individuals over 80. We sought to evaluate differences in clinical outcomes in Canadians over 80 years old hospitalized for an acute ischemic stroke.
The authors conducted a multicenter cohort study including all hospital admissions for ischemic stroke identified from the Canadian Hospital Morbidity and Mortality Database from April 2003 to March 2004. The Hospital Morbidity and Mortality Database contains a national database that contains patient-level sociodemographic, diagnostic, procedural, and administrative information from across Canada. Multivariable analysis was performed using logistic regression. The primary outcome was 7-day case fatality and fatality at discharge. Secondary end points included intensive care unit admissions, medical complications, gender differences, length of hospital stay, and discharge disposition.
We analyzed 26,676 patients with ischemic stroke admitted to 606 hospitals across Canada. Mean age (SD) was 74+/-13 years. Overall, 10,171 (38%) were aged 80 years or older. Case fatality at discharge was 5.7% (age < 59), 8.6% (age 60 to 69), 13.4% (age 70 to 79), and 24.2% (age > or = 80; P<0.001). Patients aged 80 and over were less likely to be admitted to the intensive care unit (7.7% versus 15.3%; P<0.001) and discharged to their prestroke residence (47.2% for those over 80 versus 61.6% for patients younger than 80; P<0.001). Median length of stay was longer in those over 80 (10 days versus 7 days; P<0.0001). In the multivariable analysis for the older group, admission to the intensive care unit, low socioeconomic status, and admission to a nonacademic institution were associated with increased fatality after adjusting for covariates.
Aging of the population is a growing reality in Western societies and this translates into an increasing demand on healthcare systems. In our study, patients with stroke over 80 had higher risk-adjusted fatality, longer hospitalization, and were less likely to be discharged to their original place of residence. Strategies need to be implemented to facilitate equal access to specialized stroke care for the elderly.
近年来，老年患者中风的患病率一直在上升。然而，关于80岁以上人群中风负担的信息有限。我们试图评估因急性缺血性中风住院的80岁以上加拿大患者临床结局的差异。
作者进行了一项多中心队列研究，纳入了2003年4月至2004年3月期间从加拿大医院发病率和死亡率数据库中识别出的所有缺血性中风住院病例。医院发病率和死亡率数据库是一个全国性数据库，包含来自加拿大各地患者层面的社会人口统计学、诊断、程序和管理信息。使用逻辑回归进行多变量分析。主要结局是7天病死率和出院时的病死率。次要终点包括重症监护病房入院情况、医疗并发症、性别差异、住院时间和出院处置情况。
我们分析了加拿大606家医院收治的26676例缺血性中风患者。平均年龄（标准差）为74±13岁。总体而言，10171例（38%）年龄在80岁及以上。出院时病死率在年龄小于59岁的患者中为5.7%，60至69岁的患者中为8.6%，70至79岁的患者中为13.4%，80岁及以上的患者中为24.2%（P<0.001）。80岁及以上的患者入住重症监护病房的可能性较小（7.7%对15.3%；P<0.001），出院后回到中风前住所的可能性也较小（超过80岁的患者为47.2%对80岁以下患者的61.6%；P<0.001）。80岁以上患者的中位住院时间更长（10天对7天；P<0.0001）。在老年组的多变量分析中，入住重症监护病房、社会经济地位低以及入住非学术机构在调整协变量后与病死率增加相关联。
在西方社会中人口老龄化是一个日益严峻的现实，这对医疗保健系统的需求也在增加。在我们的研究中，80岁以上的中风患者经风险调整后的病死率更高，住院时间更长，出院后回到原居住地的可能性更小。需要实施相关策略，以便为老年人提供平等的专业中风护理服务机会。
