title: Persistent racial disparity in stroke hospitalization and economic impact in young adults in the buckle of stroke belt.
abstract: OBJECTIVE
  Mounting evidence points to a decline in stroke incidence. However, little is known about recent patterns of stroke hospitalization within the buckle of the stroke belt. This study aims to investigate the age- and race-specific secular trends in stroke hospitalization rates, inpatient stroke mortality rates, and related hospitalization charges during the past decade in South Carolina.
  
  
  METHODS
  Patients from 2001 to 2010 were identified from the State Inpatient Hospital Discharge Database with a primary discharge diagnosis of stroke (International Classification of Diseases, Ninth Revision codes: 430-434, 436, 437.1). Age- and race-stroke-specific hospitalization rates, hospital charges, charges associated with racial disparity, and 30-day stroke mortality rates were compared between blacks and whites.
  
  
  RESULTS
  Of the 84,179 stroke hospitalizations, 31,137 (37.0%) were from patients aged<65 years and 29,846 (35.5%) were blacks. Stroke hospitalization rates decreased in the older population (aged≥65 years) for both blacks and whites (P<0.001) but increased among the younger group (aged<65 years; P=0.004); however, this increase was mainly driven by a 17.3% rise among blacks (P=0.001), with no difference seen among whites (P=0.84). Of hospital charges totaling $2.77 billion, $453.2 million (16.4%) are associated with racial disparity (79.6% from patients aged<65 years). Thirty-day stroke mortality rates decreased in all age-race-stroke-specific groups (P<0.001).
  
  
  CONCLUSIONS
  The stroke hospitalization rate increased in the young blacks only, which results in a severe and persistent racial disparity. It highlights the urgent need for a racial disparity reduction in the younger population to alleviate the healthcare burden.
authors.affiliation: From the Department of Neuroscience, Medical University of South Carolina (MUSC) Stroke Center, Charleston, SC (A.D.B., W.F., B.O., D.L.B., R.J.A., S.A.K., D.T.L.); Department of Health Science & Research, Medical University of South Carolina, Charleston (W.F., C.E., S.A.K.); and Ralph H. Johnson VA Medical Center, Charleston, SC (B.O., S.A.K.).
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Boan
authors.affiliation: From the Department of Neuroscience, Medical University of South Carolina (MUSC) Stroke Center, Charleston, SC (A.D.B., W.F., B.O., D.L.B., R.J.A., S.A.K., D.T.L.); Department of Health Science & Research, Medical University of South Carolina, Charleston (W.F., C.E., S.A.K.); and Ralph H. Johnson VA Medical Center, Charleston, SC (B.O., S.A.K.). feng@musc.edu.
authors.forename: Wuwei Wayne
authors.initials: WW
authors.lastname: Feng
authors.affiliation: From the Department of Neuroscience, Medical University of South Carolina (MUSC) Stroke Center, Charleston, SC (A.D.B., W.F., B.O., D.L.B., R.J.A., S.A.K., D.T.L.); Department of Health Science & Research, Medical University of South Carolina, Charleston (W.F., C.E., S.A.K.); and Ralph H. Johnson VA Medical Center, Charleston, SC (B.O., S.A.K.).
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.affiliation: From the Department of Neuroscience, Medical University of South Carolina (MUSC) Stroke Center, Charleston, SC (A.D.B., W.F., B.O., D.L.B., R.J.A., S.A.K., D.T.L.); Department of Health Science & Research, Medical University of South Carolina, Charleston (W.F., C.E., S.A.K.); and Ralph H. Johnson VA Medical Center, Charleston, SC (B.O., S.A.K.).
authors.forename: David L
authors.initials: DL
authors.lastname: Bachman
authors.affiliation: From the Department of Neuroscience, Medical University of South Carolina (MUSC) Stroke Center, Charleston, SC (A.D.B., W.F., B.O., D.L.B., R.J.A., S.A.K., D.T.L.); Department of Health Science & Research, Medical University of South Carolina, Charleston (W.F., C.E., S.A.K.); and Ralph H. Johnson VA Medical Center, Charleston, SC (B.O., S.A.K.).
authors.forename: Charles
authors.initials: C
authors.lastname: Ellis
authors.affiliation: From the Department of Neuroscience, Medical University of South Carolina (MUSC) Stroke Center, Charleston, SC (A.D.B., W.F., B.O., D.L.B., R.J.A., S.A.K., D.T.L.); Department of Health Science & Research, Medical University of South Carolina, Charleston (W.F., C.E., S.A.K.); and Ralph H. Johnson VA Medical Center, Charleston, SC (B.O., S.A.K.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
authors.affiliation: From the Department of Neuroscience, Medical University of South Carolina (MUSC) Stroke Center, Charleston, SC (A.D.B., W.F., B.O., D.L.B., R.J.A., S.A.K., D.T.L.); Department of Health Science & Research, Medical University of South Carolina, Charleston (W.F., C.E., S.A.K.); and Ralph H. Johnson VA Medical Center, Charleston, SC (B.O., S.A.K.).
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kautz
authors.affiliation: From the Department of Neuroscience, Medical University of South Carolina (MUSC) Stroke Center, Charleston, SC (A.D.B., W.F., B.O., D.L.B., R.J.A., S.A.K., D.T.L.); Department of Health Science & Research, Medical University of South Carolina, Charleston (W.F., C.E., S.A.K.); and Ralph H. Johnson VA Medical Center, Charleston, SC (B.O., S.A.K.).
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000208:ethnology; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D013022:South Carolina / Q000453:epidemiology / Q000208:ethnology; D020521:Stroke / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D013997:Time Factors; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data*; D001741:Black or African American
keywords: epidemiology; fees and charges; middle aged; minority health; stroke