Intraregional decline in case-fatality and hospital use after occlusive stroke in the Southeastern United States.
OBJECTIVE
To identify changes in mortality and hospital use among patients admitted for ischemic stroke in Alabama.


BACKGROUND
The decline in stroke mortality in the Southeast is greater than in other US regions. Whether this decline in a result of decreased incidence or improved case-fatality rates is unknown.


METHODS
We examined Medicare hospitalization data from approximately 625,000 beneficiaries and identified patients admitted for ischemic stroke between January 1992 and December 1994. The search was carried out using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes pertinent to all diagnoses related to ischemic stroke. Data relevant to mortality and length of stay (LOS) were collected, and comparisons were made of the average case-fatality rate and LOS in each of the 3 years.


RESULTS
No significant difference was found in the incidence of ischemic stroke during the 3 years. The number of admissions was 4438 for 1992, 4124 for 1993, and 4762 for 1994. Conversely, the average LOS showed a significant decline, with values of 10.05, 9,36, and 8.72 days, respectively (P<.0003). A significant decline in mortality, with average case-fatality rates of 11.72%, 11.56%, and 9.71%, respectively (P<.003), was also found.


CONCLUSIONS
These data suggest that the decline in stroke mortality in the Southeast is because of improved patient survival after stroke, rather than decreased incidence. Although several factors may be contributing to the decreased case-fatality rates, improved care of hospitalized stroke patients is likely of primary importance. Additionally, decreased mortality associated with decreased LOS suggests more efficient hospital use.
Potts
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DC
Neurology Consultants of Tuscaloosa, Tuscaloosa, AL, USA.
Gilliam
F
F
Gomez
C R
CR
Eugene Marsh
E
E
Mitchell
V L
VL
Sherrill
R
R