Vollmer Brandi L, Chen Xing, Kulick Erin R, Elkind Mitchell S V, Boehme Amelia K
Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
BMC Health Serv Res. 2021 Jan 22;21(1):84. doi: 10.1186/s12913-021-06064-5.
The incidence and prevalence of stroke among the young are increasing in the US. Data on healthcare utilization prior to stroke is limited. We hypothesized those < 45 years were less likely than those 45-65 years old to utilize healthcare in the 1 year prior to stroke.
Patients 18-65 years old who had a stroke between 2008 and 2013 in MarketScan Commercial Claims and Encounters Databases were included. We used descriptive statistics and logistic regression to examine healthcare utilization and risk factors between age groups 18-44 and 45-65 years. Healthcare utilization was categorized by visit type (no visits, inpatient visits only, emergency department visits only, outpatient patient visits only, or a combination of inpatient, outpatient or emergency department visits) during the year prior to stroke hospitalization.
Of those 18-44 years old, 14.1% had no visits in the year prior to stroke compared to 11.2% of individuals aged 45-65 [OR = 1.30 (95% CI 1.25,1.35)]. Patients 18-44 years old had higher odds of having preventive care procedures associated with an outpatient visit and lower odds of having cardiovascular procedures compared to patients aged 45-65 years. Of stroke patients aged 18-45 and 45-65 years, 16.8 and 13.2% respectively had no known risk for stroke.
Patients aged 45-65 were less commonly seeking preventive care and appeared to be seeking care to manage existing conditions more than patients aged 18-44 years. However, as greater than 10% of both age groups had no prior risk, further exploration of potential risk factors is needed.
在美国，年轻人中风的发病率和患病率正在上升。中风前医疗保健利用情况的数据有限。我们假设45岁以下的人在中风前1年比45 - 65岁的人更不可能利用医疗保健服务。
纳入2008年至2013年期间在MarketScan商业索赔和就诊数据库中发生中风的18 - 65岁患者。我们使用描述性统计和逻辑回归来研究18 - 44岁和45 - 65岁年龄组之间的医疗保健利用情况和风险因素。医疗保健利用情况根据中风住院前一年的就诊类型（无就诊、仅住院就诊、仅急诊就诊、仅门诊就诊或住院、门诊或急诊就诊的组合）进行分类。
在18 - 44岁的人群中，14.1%在中风前一年没有就诊，而45 - 65岁的人群中这一比例为11.2%[比值比（OR）= 1.30（95%置信区间1.25, 1.35）]。与45 - 65岁的患者相比，18 - 44岁的患者进行与门诊就诊相关的预防性护理程序的几率更高，而进行心血管程序的几率更低。在18 - 45岁和45 - 65岁的中风患者中，分别有16.8%和13.2%没有已知的中风风险。
45 - 65岁的患者寻求预防性护理的情况较少，而且似乎比18 - 44岁的患者更多地寻求治疗现有疾病的护理。然而由于两个年龄组中均有超过10%的人之前没有风险，因此需要进一步探索潜在的风险因素。
