Department of Medicine, University of California, Los Angeles, Los Angeles, CA.
National Bureau of Economic Research, Cambridge, MA.
Med Care. 2019 Apr;57(4):262-269. doi: 10.1097/MLR.0000000000001079.
The main purpose of this study was to determine whether there were temporal differences in the rates of first stroke hospitalizations and 30-day mortality after stroke between black and white Medicare enrollees.
We used a 20% sample of Medicare beneficiaries aged 65 years or older and described the annual rate of first hospitalization for ischemic and hemorrhagic strokes from years 1988 to 2013, as well as 30-day mortality after stroke hospitalization. We used linear tests of trend to determine whether stroke rates changed over time, and tested the interaction term between race and year to determine whether trends differed by race.
We identified 1,009,057 incident hospitalizations for ischemic strokes and 147,817 for hemorrhagic strokes. Annual stroke hospitalizations decreased significantly over time for both blacks and whites, and in both stroke subtypes (P-values for all trend <0.001). Reductions in stroke rates were comparable between blacks and whites: among men, the odds ratio for the interaction term for race by year was 1.008 [95% confidence interval (CI), 1.004-1.012] for ischemic and 1.002 (95% CI, 0.999-1.004) for hemorrhagic; for women, it was 1.000 (95% CI, 0.997-1.004) for ischemic and 1.003 (95% CI, 1.001-1.006) for hemorrhagic. Both black men and women experienced greater improvements over time in terms of 30-day mortality after strokes.
Rates of incident hospitalizations for ischemic and hemorrhagic strokes fell significantly over a 25-year period for both black and white Medicare enrollees. Black men and women experienced greater improvements in 30-day mortality after both ischemic and hemorrhagic stroke.
本研究的主要目的是确定医疗保险参保黑人与白人患者首次卒中住院率及卒中后 30 天死亡率是否存在时间差异。
我们使用了医疗保险受益人的 20%抽样数据，年龄为 65 岁或以上，描述了 1988 年至 2013 年期间每年缺血性和出血性卒中首次住院的发生率，以及卒中住院后 30 天的死亡率。我们使用线性趋势检验来确定卒中率是否随时间变化，并检验种族与年份之间的交互项，以确定趋势是否因种族而异。
我们确定了 1009057 例缺血性卒中和 147817 例出血性卒中住院事件。无论是黑人还是白人，卒中住院人数均随时间显著下降，且两种卒中亚型均如此（所有趋势 P 值<0.001）。黑人和白人之间的卒中发生率下降幅度相当：男性中，种族与年份交互项的比值比为缺血性卒中 1.008（95%置信区间[CI]，1.004-1.012），出血性卒中 1.002（95% CI，0.999-1.004）；女性中，缺血性卒中为 1.000（95% CI，0.997-1.004），出血性卒中为 1.003（95% CI，1.001-1.006）。黑人群体中，无论男性还是女性，卒中后 30 天死亡率随时间的改善都更为显著。
在 25 年期间，医疗保险参保的黑人和白人患者的缺血性和出血性卒中的发病率显著下降。黑人群体中，无论男性还是女性，缺血性和出血性卒中后 30 天死亡率的改善都更为显著。
