title: Trends in the hospitalization of ischemic stroke in the United States, 1998-2007.
abstract: BACKGROUND
  The late 1990s/early 2000s was a time of change in both the prevention and acute care of ischemic stroke, with primary prevention driven by increased utilization of antihypertensive, antiplatelet, anticoagulation, and lipid-lowering agents.
  
  
  OBJECTIVE
  To examine whether ischemic stroke hospitalization rates and outcomes in the United States have changed.
  
  
  METHODS
  We retrospectively identified 894 169 hospitalizations with a primary diagnosis of ischemic stroke from 1 January 1998 through to 31 December 2007 in the Nationwide Inpatient Sample, the largest all-payer healthcare database in the United States. Annual, national case estimates were combined with US Census data to derive age-adjusted and age-specific population hospitalization rates. Temporal trends were tested using linear regression.
  
  
  RESULTS
  From 1998 through 2007, there were an estimated 4 382 336 ischemic stroke hospitalizations in the United States. Overall, the age-adjusted rate of ischemic stroke hospitalization decreased from 184 to 128 per 100 000 (P < 0·0001). Age-specific rates decreased among those 55+ years old (P < 0·0001), but increased among those 25-34 and 35-44 years old (P < 0·001 and P < 0·0001, respectively). Rates among those <25 and 45-54 years old were unchanged. In-hospital mortality decreased from 7·0% (standard error 0·1) to 5·4% (standard error 0·1) (P < 0·0001). Case proportion at the highest quintile of hospitals by annual caseload increased from 54·0% (standard error 2·1) to 61·8% (standard error 2·0) (P < 0·0001). Mean adjusted hospitalization costs increased from $9273 (standard deviation 199) to $10 524 (standard deviation 77) (P < 0·0001).
  
  
  CONCLUSIONS
  In 1998 through to 2007, the overall rate of ischemic stroke hospitalization in the United States decreased. However, rates among young adults increased. In-hospital mortality rates decreased over the study period.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Leslie K
authors.initials: LK
authors.lastname: Lee
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bateman
authors.forename: Shuang
authors.initials: S
authors.lastname: Wang
authors.forename: H Christian
authors.initials: HC
authors.lastname: Schumacher
authors.forename: John
authors.initials: J
authors.lastname: Pile-Spellman
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D014481:United States / Q000453:epidemiology; D055815:Young Adult