title: Examining vertebrobasilar artery stroke in two Canadian provinces.
abstract: METHODS
  Ecological study.
  
  
  OBJECTIVE
  To determine the annual incidence of hospitalized vertebrobasilar artery (VBA) stroke and chiropractic utilization in Saskatchewan and Ontario between 1993 and 2004. To determine whether at an ecological level, the incidence of VBA stroke parallels the incidence of chiropractic utilization.
  
  
  BACKGROUND
  Little is known about the incidence and time trends of VBA stroke diagnoses in the population. Chiropractic manipulation to the neck is believed to be a risk factor for VBA stroke. No study has yet found an association between chiropractic utilization and VBA diagnoses at the population level.
  
  
  METHODS
  All hospitalizations with discharge diagnoses of VBA stroke were extracted from administrative databases for Saskatchewan and Ontario. We included incident cases that were diagnosed between January 1993 and December 2004 for Saskatchewan and from April 1993 to March 2002 for Ontario. VBA cases that had previously been hospitalized for any stroke or transient ischemic attack (TIA) were excluded. Chiropractic utilization was measured using billing data from Saskatchewan Health and Ontario Health Insurance Plan. Denominators were derived from Statistics Canada's annual population estimates.
  
  
  RESULTS
  The incidence rate of VBA stroke was 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario. The annual incidence rate spiked dramatically with a 360% increase for Saskatchewan in 2000. There was a 38% increase for the 2000 incidence rate in Ontario. The rate of chiropractic utilization did not increase significantly during the study period.
  
  
  CONCLUSIONS
  In Saskatchewan, we observed a dramatic increase in the incidence rate in 2000 and there was a corresponding relatively small increase in chiropractic utilization. In Ontario, there was a small increase in the incidence rate; however, chiropractic utilization decreased. At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.
authors.affiliation: Centre of Research Expertise for Improved Disability Outcomes, University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Ontario, Canada. eboyle@uhnresearch.ca
authors.forename: Eleanor
authors.initials: E
authors.lastname: Boyle
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Grier
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
mesh_terms: D000328:Adult; D017677:Age Distribution; D015984:Causality; D002684:Chiropractic / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D026882:Manipulation, Chiropractic / Q000009:adverse effects* / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D019547:Neck Pain / Q000628:therapy; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012525:Saskatchewan / Q000453:epidemiology; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology; D014715:Vertebrobasilar Insufficiency / Q000453:epidemiology* / Q000503:physiopathology