Relationship of hospitalized stroke rate and in-hospital mortality to the decline in US stroke mortality.
Data from the National Hospital Discharge Survey was used to estimate the admission rate and in-hospital mortality for US stroke patients from 1970 to 1987. Over this period the hospital admission rate increased from 5.0 per 1,000 population to 5.5 per 1,000, while the in-hospital mortality fell from 18.6 to 10.0% of discharges. When patients experiencing general or late effects or transient ischemic attacks were excluded, the hospital admission rate increased from 2.8 to 4.8 per 1,000 and in-hospital mortality fell from 26 to 12% of discharges. Admission rates increased from 1970 to 1987 for both hemorrhagic strokes and cerebral infarctions, but fell for ill-defined cerebrovascular events, presumably reflecting increased use of computed tomography and magnetic resonance imaging during this period. Mortality for hemorrhagic strokes decreased from 45 to 30% of discharges, mortality for infarctions decreased from 24 to 13% and mortality for ill-defined events fell from 24 to 17%. There are several limitations with the use of the National Hospital Discharge Survey data to estimate changes in hospital admission rates and in-hospital mortality. However, these data suggest a greater role for decreasing case fatality in explaining nationwide declines in stroke mortality rates than has generally been acknowledged.
Howard
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Department of Public Health Science, Bowman Gray School of Medicine, Wake Forest University, Winston Salem, N.C.
Craven
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TE
Sanders
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Evans
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GW
D000208:Acute Disease; D002543:Cerebral Hemorrhage / Q000401:mortality; D002544:Cerebral Infarction / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D014481:United States