Variations in the incidence, management and outcome of stroke in residents under the age of 75 in two health districts of southern England.
BACKGROUND
The aim of the study was to determine the incidence, outcome and health service resources consumed by stroke care in defined populations.


METHODS
Patients under the age of 75 experiencing their first stroke between August 1989 and July 1991 were assessed at the onset, and at three and 12 months after their stroke. The settings were West Lambeth (WL) and Tunbridge Wells (TW) health authorities in southern England. The main outcome measures used were: age- and sex-specific incidence rates, hospital admission rates, length of stay and use of rehabilitation services. Functional disability was assessed using the Barthel scale.


RESULTS
Four hundred and fifty-six strokes were registered. The annual incidence rates/1000 population aged under 75 years old [with 95% confidence interval (CI)] were 0.77 (0.67-0.87) in WL and 0.66 (0.58-0.75) in TW. The age- and sex-standardized incidence ratios were significantly higher in WL (126; 95% CI 110-144) than in TW (84%; 95% CI 74-95) (p < 0.001). There were independent associations of incidence with age group (p < 0.001), sex (p < 0.001) and ethnic group (p < 0.001). One year case-fatality was 36% (80/225). At one year, 11% (14) of surviving patients were moderately to severely disabled and 23% (28) mildly disabled. Seventy-one percent (326) of patients were admitted to hospital and the average health service cost per case was pound 3800 in WL and pound 2650 in TW, 93% of the cost being for in-patient care.


CONCLUSIONS
The study has demonstrated a significantly increased incidence of stroke in an inner-city district compared with a district in rural southern England. It has also established ethnic group as a significant independent risk factor for stroke in the United Kingdom. The cost of care to the health services is considerable, and largely reflects nursing costs in hospital rather than effective treatment packages for stroke.
Wolfe
C D
CD
Department of Public Health Medicine, United Medical School, Guy's Hospital, London.
Taub
N A
NA
Bryan
S
S
Beech
R
R
Warburton
F
F
Burney
G J
GJ
D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000191:economics / Q000453:epidemiology* / Q000534:rehabilitation; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics*; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics*; D012047:Rehabilitation Centers / Q000191:economics; D016896:Treatment Outcome