Trends in one-year recurrent ischemic stroke among the elderly in the USA: 1994-2002.
OBJECTIVE
Of the 795,000 strokes occurring in the USA each year, over 20% are recurrent events. Little is known about how the rates of recurrent stroke in the country have changed over time. Our objective was to determine national trends in 1-year recurrent ischemic stroke rates by US county among the elderly from 1994 to 2002.


METHODS
One-year recurrent stroke rates following incident ischemic stroke (ICD-9 433, 434, 436) among all fee-for-service Medicare beneficiaries were determined by US county for 1994-1996, 1997-1999, and 2000-2002. Bayesian spatiotemporal Poisson modeling was used to determine county-specific trends in recurrent stroke rates over time with risk adjustment for demographics, medical history and comorbid conditions.


RESULTS
The analysis included more than 2.5 million beneficiaries (56% women; mean age: 78 years; 87% white; n = 957,933 for 1994-1996; n = 838,330 for 1996-1999; n = 895,916 for 2000-2002) aggregated to all 3,118 US counties. After adjustment for changing patient demographics and comorbidities, there was a 4.5% decrease in recurrent stroke rates from 1994-1996 (13.2%) to 2000-2002 (12.6%; p for trend <0.0001). The geographic and temporal patterns were not uniform; the recurrent stroke rates decreased within sections of the Southeast (the 'stroke belt'), but increased in counties in the middle and western sections of the USA.


CONCLUSIONS
The overall recurrent ischemic stroke rates declined by almost 5% from 1994 to 2002, but temporal patterns varied markedly by region. Additional research is needed to identify the reasons for this geographic disparity.
Allen
Norrina B
NB
Division of Chronic Disease Epidemiology, Yale University School of Medicine, New Haven, CT 06520-8034, USA.
Holford
Theodore R
TR
Bracken
Michael B
MB
Goldstein
Larry B
LB
Howard
George
G
Wang
Yun
Y
Lichtman
Judith H
JH
D000368:Aged; D000369:Aged, 80 and over; D018588:Fee-for-Service Plans / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology