title: The use of national administrative data to describe the spatial distribution of in-hospital mortality following stroke in France, 2008-2011.
abstract: BACKGROUND
  In the context of implementing the National Stroke Plan in France, a spatial approach was used to measure inequalities in this disease. Using the national PMSI-MCO databases, we analyzed the in-hospital prevalence of stroke and established a map of in-hospital mortality rates with regard to the socio-demographic structure of the country.
  
  
  METHODS
  The principal characteristics of patients identified according to ICD10 codes relative to stroke (in accordance with earlier validation work) were studied. A map of standardized mortality rates at the level of PMSI geographic codes was established. An exploratory analysis (principal component analysis followed by ascending hierarchical classification) using INSEE socio-economic data and mortality rates was also carried out to identify different area profiles.
  
  
  RESULTS
  Between 2008 and 2011, the number of stroke patients increased by 3.85%, notably for ischemic stroke in the 36-55 years age group (60% of men). Over the same period, in-hospital mortality fell, and the map of standardized rates illustrated the diagonal of high mortality extending from the north-east to the south-west of the country. The most severely affected areas were also those with the least favorable socio-professional indicators.
  
  
  CONCLUSIONS
  The PMSI-MCO database is a major source of data on the health status of the population. It can be used for the area-by-area observation of the performance of certain healthcare indicators, such as in-hospital mortality, or to follow the implementation of the National Stroke Plan. Our study showed the interplay between social and demographic factors and stroke-related in-hospital mortality. The map derived from the results of the exploratory analysis illustrated a variety of areas where social difficulties, aging and high mortality seemed to meet. The study raises questions about access to neuro-vascular care in isolated areas and in those in demographic decline. Telemedicine appears to be the solution favored by decision makers. The aging of the population managed for stroke must not mask the growing incidence in younger people, which raises questions about the development of classical (smoking, hypertension) or new (drug abuse) risk factors.
authors.affiliation: Service de Biostatistique et d'Informatique Médicale (DIM), CHRU Dijon, Dijon, 21000, France. adrien.roussot@chu-dijon.fr.|Université de Bourgogne, Dijon, 21000, France. adrien.roussot@chu-dijon.fr.
authors.forename: Adrien
authors.initials: A
authors.lastname: Roussot
authors.affiliation: Service de Biostatistique et d'Informatique Médicale (DIM), CHRU Dijon, Dijon, 21000, France. jonathan.cottenet@chu-dijon.fr.|Université de Bourgogne, Dijon, 21000, France. jonathan.cottenet@chu-dijon.fr.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cottenet
authors.affiliation: Laboratoire d'Economie de Dijon, Université de Bourgogne, UMR 6307 CNRS, INSERM U1200, Dijon, France. maryse.gadreau@u-bourgogne.fr.
authors.forename: Maryse
authors.initials: M
authors.lastname: Gadreau
authors.affiliation: Registre des AVC dijonnais, EA4184, CHRU, Univ de Bourgogne, Dijon, France. maurice.giroud@chu-dijon.fr.
authors.forename: Maurice
authors.initials: M
authors.lastname: Giroud
authors.affiliation: Registre des AVC dijonnais, EA4184, CHRU, Univ de Bourgogne, Dijon, France. yannick.bejot@chu-dijon.fr.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Béjot
authors.affiliation: Service de Biostatistique et d'Informatique Médicale (DIM), CHRU Dijon, Dijon, 21000, France. catherine.quantin@chu-dijon.fr.|Université de Bourgogne, Dijon, 21000, France. catherine.quantin@chu-dijon.fr.|INSERM, CIC 1432, Dijon, France. catherine.quantin@chu-dijon.fr.|Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon University Hospital, Dijon, France. catherine.quantin@chu-dijon.fr.|Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Univ. Bourgogne Franche-Comté, Inserm UMR 1181, Dijon, 21000, France. catherine.quantin@chu-dijon.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Quantin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000706:statistics & numerical data* / Q000639:trends*; D003710:Demography / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis / Q000401:mortality*