From the Department of Neuroscience, Medical University of South Carolina (MUSC) Stroke Center, Charleston, SC (A.D.B., W.F., B.O., D.L.B., R.J.A., S.A.K., D.T.L.); Department of Health Science & Research, Medical University of South Carolina, Charleston (W.F., C.E., S.A.K.); and Ralph H. Johnson VA Medical Center, Charleston, SC (B.O., S.A.K.).
Stroke. 2014 Jul;45(7):1932-8. doi: 10.1161/STROKEAHA.114.004853.
Mounting evidence points to a decline in stroke incidence. However, little is known about recent patterns of stroke hospitalization within the buckle of the stroke belt. This study aims to investigate the age- and race-specific secular trends in stroke hospitalization rates, inpatient stroke mortality rates, and related hospitalization charges during the past decade in South Carolina.
Patients from 2001 to 2010 were identified from the State Inpatient Hospital Discharge Database with a primary discharge diagnosis of stroke (International Classification of Diseases, Ninth Revision codes: 430-434, 436, 437.1). Age- and race-stroke-specific hospitalization rates, hospital charges, charges associated with racial disparity, and 30-day stroke mortality rates were compared between blacks and whites.
Of the 84,179 stroke hospitalizations, 31,137 (37.0%) were from patients aged<65 years and 29,846 (35.5%) were blacks. Stroke hospitalization rates decreased in the older population (aged≥65 years) for both blacks and whites (P<0.001) but increased among the younger group (aged<65 years; P=0.004); however, this increase was mainly driven by a 17.3% rise among blacks (P=0.001), with no difference seen among whites (P=0.84). Of hospital charges totaling $2.77 billion, $453.2 million (16.4%) are associated with racial disparity (79.6% from patients aged<65 years). Thirty-day stroke mortality rates decreased in all age-race-stroke-specific groups (P<0.001).
The stroke hospitalization rate increased in the young blacks only, which results in a severe and persistent racial disparity. It highlights the urgent need for a racial disparity reduction in the younger population to alleviate the healthcare burden.
越来越多的证据表明中风发病率呈下降趋势。然而，对于中风带内中风住院的最新模式知之甚少。本研究旨在调查过去十年南卡罗来纳州中风住院率、住院中风死亡率和相关住院费用的年龄和种族特异性的变化趋势。
从 2001 年至 2010 年的州住院患者出院数据库中，根据主要出院诊断（国际疾病分类，第九修订版代码：430-434、436、437.1）确定中风患者。比较黑人和白人之间的年龄和种族特定的中风住院率、医院费用、与种族差异相关的费用以及 30 天中风死亡率。
在 84179 例中风住院患者中，31137 例（37.0%）年龄<65 岁，29846 例（35.5%）为黑人。黑人和白人的老年（≥65 岁）人群的中风住院率均下降（P<0.001），但年轻人群（<65 岁）的住院率上升（P=0.004）；然而，这一增长主要是由于黑人增长了 17.3%（P=0.001），白人则没有差异（P=0.84）。在 27.7 亿美元的总住院费用中，有 4532 万美元（16.4%）与种族差异有关（79.6%来自年龄<65 岁的患者）。所有年龄-种族-中风特定组的 30 天中风死亡率均下降（P<0.001）。
只有年轻黑人的中风住院率增加，导致严重且持续的种族差异。这突出表明，需要在年轻人群中减少种族差异，以减轻医疗保健负担。
