title: Trends in in-hospital mortality among patients with stroke in China.
abstract: BACKGROUND
  The incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China.
  
  
  METHODS
  109 grade III class A hospitals were sampled by multistage stratified cluster sampling. All patients admitted to hospitals between 2007 and 2010 with a discharge diagnosis of stroke were included. Trends in in-hospital mortality among patients with stroke were assessed. Influence factors of in-hospital death after stroke were explored using multivariable logistic regression.
  
  
  RESULTS
  Overall stroke hospitalizations increased from 79,894 in 2007 to 85,475 in 2010, and in-hospital mortality of stroke decreased from 3.16% to 2.30% (P<0.0001). The percentage of severe patients increased while odds of mortality (2010 versus 2007) decreased regardless of stroke type: subarachnoid hemorrhage (OR 0.792, 95% CI = 0.636 to 0.987), intracerebral hemorrhage (OR 0.647, 95% CI = 0.591 to 0.708), and ischemic stroke (OR 0.588, 95% CI = 0.532 to 0.649). In multivariable analyses, older age, male, basic health insurance, multiple comorbidities and severity of disease were linked to higher odds of in-hospital mortality.
  
  
  CONCLUSIONS
  The mortality of stroke hospitalizations decreased likely reflecting advancements in stroke care and prevention. Decreasing of mortality with increasing of severe stroke patients indicated that we should pay more attention to rehabilitation and life quality of stroke patients. Specific individual and hospital-level characteristics may be targets for facilitating further declines.
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: He
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Wu
authors.affiliation: Center of Educational Technology, Second Military Medical University, Shanghai, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Luo
authors.affiliation: Department of Information, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Wang
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Xiu-Qiang
authors.initials: XQ
authors.lastname: Ma
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Yan-Fang
authors.initials: YF
authors.lastname: Zhao
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Xiang
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Ying-Yi
authors.initials: YY
authors.lastname: Qin
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Shun-Quan
authors.initials: SQ
authors.lastname: Wu
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Fei-Fei
authors.initials: FF
authors.lastname: Yu
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Jia
authors.initials: J
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002681:China; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality*