Comparison of hospital admissions for cerebrovascular disease in Michigan and North Carolina.

Hospital admission rates and death rates for cerebrovascular disease differ markedly between states. Hospital admission data were analyzed: (a) to ascertain why death rates from this disease group are lower in Michigan than in North Carolina and (b) to clarify whether hospital care in either state has inadequacies that can be corrected quickly. Among both whites and blacks of the same age, case-fatality ratios were higher in North Carolina than in Michigan. Subarachnoid and cerebral hemorrhages were diagnosed more often in the southern state. For both areas, the records showed a marked underreporting of hypertension and diabetes mellitus as secondary conditions in the hospital admissions; elevated blood pressures were about equally common in each state but were treated more vigorously in Michigan. Secondary diagnoses of respiratory disease and use of anti-infective agents were reported more frequently in North Carolina. In contrast, diabetes mellitus was more prevalent in Michigan admissions. Some reasons for these findings are advanced, particularly as they relate to diagnostic and treatment patterns. Finally, the need for more detailed research is emphasized to create guidelines for better hospital care of cerebrovascular disease.