title: Tracking stroke hospitalization clusters over time and associations with county-level socioeconomic and healthcare characteristics.
abstract: OBJECTIVE
  This study evaluated clustering of stroke hospitalization rates, patterns of the clustering over time, and associations with community-level characteristics.
  
  
  METHODS
  We used Medicare hospital claims data from 1995-1996 to 2005-2006 with a principal discharge diagnosis of stroke to calculate county-level stroke hospitalization rates. We identified statistically significant clusters of high- and low-rate counties by using local indicators of spatial association, tracked cluster status over time, and assessed associations between cluster status and county-level socioeconomic and healthcare profiles.
  
  
  RESULTS
  Clearly defined clusters of counties with high- and low-stroke hospitalization rates were identified in each time. Approximately 75% of counties maintained their cluster status from 1995-1996 to 2005-2006. In addition, 243 counties transitioned into high-rate clusters, and 148 transitioned out of high-rate clusters. Persistently high-rate clusters were located primarily in the Southeast, whereas persistently low-rate clusters occurred mostly in New England and in the West. In general, persistently low-rate counties had the most favorable socioeconomic and healthcare profiles, followed by counties that transitioned out of or into high-rate clusters. Persistently high-rate counties experienced the least favorable socioeconomic and healthcare profiles.
  
  
  CONCLUSIONS
  The persistence of clusters of high- and low-stroke hospitalization rates during a 10-year period suggests that the underlying causes of stroke in these areas have also persisted. The associations found between cluster status (persistently high, transitional, persistently low) and socioeconomic and healthcare profiles shed new light on the contributions of community-level characteristics to geographic disparities in stroke hospitalizations.
authors.affiliation: MSPH, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-72, Atlanta, GA 30341, USA. lschieb@cdc.gov
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Schieb
authors.forename: Lee R
authors.initials: LR
authors.lastname: Mobley
authors.forename: Mary
authors.initials: M
authors.lastname: George
authors.forename: Michele
authors.initials: M
authors.lastname: Casper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003153:Community Health Services / Q000191:economics* / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000191:economics* / Q000639:trends; D006766:Hospitals, County / Q000191:economics* / Q000639:trends; D006801:Humans; D008297:Male; D016344:Medicare Part A / Q000191:economics* / Q000639:trends; D012959:Socioeconomic Factors; D020521:Stroke / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D014481:United States / Q000453:epidemiology