Skip to main content Accessibility help
×
Home

Ten-year trends in stroke admissions and outcomes in Canada

  • Noreen Kamal (a1), M. Patrice Lindsay (a2), Robert Côté (a3), Jiming Fang (a4), Moira K. Kapral (a5) and Michael D. Hill (a1) (a6)...

Abstract

Background

We analyzed a 10-year stroke administrative dataset to examine trends in admissions, mortality, and discharge destination in Canada.

Methods

We conducted an analysis of hospital administrative data from April 1st 2003 to March 31st 2013 from the Canadian Institute of Health Information’s Discharge Abstract Database. Ten-year trends for population-based age- and sex-standardized admission rates were calculated. We reviewed 10-year trends in absolute stroke admissions for differences between provinces and age groups. Stroke 30-day in-hospital mortality rates were calculated and adjusted for sex, age, stroke type and comorbidities. We documented changes in discharge location for ischemic and hemorrhagic stroke patients discharged from acute care.

Results

The rate of hospital admissions has declined from 140.2 to 117.5 (per 100,000 people). The number of absolute stroke admissions within provinces increased in Alberta and British Columbia (21.7% and 16.2% respectively). The proportion of stroke patients aged 40-69 years old increased by 4.8% (p<0.0001) over the 10 years, whereas the proportion aged over 70 decreased by 4.9% (p<0.0001). Risk-adjusted 30-day in-hospital mortality decreased from: 18.5% to 14.9% for all strokes; 15.2% to 12.1% for ischemic strokes; 35.6% to 29.7% for intracerebral hemorrhage; and 25.1% to 18.0% for subarachnoid hemorrhage. The absolute increase in patients requiring inpatient and outpatient support increased by 4% (p<0.0001).

Conclusion

The rate of admissions for stroke is decreasing but there is an increase in stroke admissions for younger patients. In-hospital mortality is decreasing; fewer patients are going directly home without services and more are requiring support services.

Tendances décennales des hospitalisations et des résultats concernant les accidents vasculaires cérébraux au Canada. Contexte: Nous avons analysé les données administratives décennales des hospitalisations, de la mortalité et de la destination au moment du congé hospitalier des patients atteints d’accidents vasculaires cérébraux (AVC) au Canada. Méthode: Nous avons analysé les données administratives hospitalières du 1er avril 2003 au 31 mars 2013 contenues dans la base de données de l’Institut canadien d’information sur la santé. Nous avons calculé les tendances décennales pour les taux d’admission selon la population, standardisés pour l’âge et le sexe. Nous avons revu les tendances des taux d’hospitalisation pour AVC pour détecter des différences entre les provinces et les groupes d’âges. Les taux de mortalité hospitalière due à l’AVC dans les 30 premiers jours ont été calculés et ajustés pour le sexe, l’âge, le type d’AVC et les comorbidités. Nous avons documenté les changements dans la destination au congé hospitalier pour les patients atteints d’un AVC ischémique et d’un AVC hémorragique. Résultats: Le taux d’hospitalisation a diminué, passant de 140,2 à 117,5 (par 100,000 habitants). Le nombre absolu d’hospitalisations pour AVC dans chaque province a augmenté en Alberta et en Colombie Britannique (21,7% et 16,2% respectivement). La proportion de patients de 40 à 69 ans atteints d’un AVC a augmenté de 4,8% (p<0,0001) au cours de ces 10 ans alors que la proportion de ceux de plus de 70 ans a diminué de 4,9% (p<0,0001). La mortalité hospitalière dans les 30 jours de l’admission, ajustée pour le risque, a diminuée de 18,5% à 14,9% pour tous les AVC ; de 15,2% à 12,1% pour les AVC ischémiques; de 35,6% à 29,7% pour les hémorragies intracérébrales et de 25,1% à 18,0% pour les hémorragies sous-arachnoïdiennes. L’augmentation absolue du nombre de patients nécessitant un soutien hospitalier et extrahospitalier a augmenté de 4% (p<0,0001). Conclusion: Le taux d’hospitalisation pour AVC est en décroissance, mais il y a une augmentation des admissions pour un AVC de patients plus jeunes. La mortalité hospitalière diminue; moins de patients retournent directement à leur domicile sans services d’appoint et un plus grand nombre de patients a besoin de tels services.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Ten-year trends in stroke admissions and outcomes in Canada
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Ten-year trends in stroke admissions and outcomes in Canada
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Ten-year trends in stroke admissions and outcomes in Canada
      Available formats
      ×

Copyright

Corresponding author

Correspondence to: Noreen Kamal, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Foothills Hospital, Room 1242 A,1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada. Email: nrkamal@ucalgary.ca

References

Hide All
1. Kunst, AE, Amiri, M, Janssen, F. The Decline in Stroke Mortality Exploration of Future Trends in 7 Western European Countries. Stroke. 2011;42:2126-2130.
2. Schmidt, M, Jacobsen, JB, Johnsen, SP, Bøtker, HE, Sørensen, HT. Eighteen-year trends in stroke mortality and the prognostic influence of comorbidity. Neurology. 2014;82:340-350.
3. Sivenius, J, Tuomilehto, J, Immonen-Räihä, P, et al. Continuous 15-Year Decrease in Incidence and Mortality of Stroke in Finland The FINSTROKE Study. Stroke. 2004;35:420-425.
4. Benatru, I, Rouaud, O, Durier, J, et al. Stable stroke incidence rates but improved case-fatality in Dijon, France, from 1985 to 2004. Stroke. 2006;37:1674-1679.
5. Carandang, R, Seshadri, S, Beiser, A, et al. Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA. 2006;296:2939-2946.
6. Broderick, JP. Stroke trends in Rochester, Minnesota, during 1945 to 1984. Annals of Epidemiol. 1993;3:476-479.
7. Broderick, JP, Phillips, SJ, Whisnant, JP, O'Fallon, WM, Bergstralh, EJ. Incidence rates of stroke in the eighties: the end of the decline in stroke? Stroke. 1989;20:577-582.
8. Cheng, XM, Ziegler, DK, Lai, YHC, et al. Stroke in China, 1986 through 1990. Stroke. 1995;26:1990-1994.
9. Kubo, M, Kiyohara, Y, Ninomiya, T, et al. Decreasing incidence of lacunar vs other types of cerebral infarction in a Japanese population. Neurology. 2006;66:1539-1544.
10. Morikawa, Y, Nakagawa, H, Naruse, Y, et al. Trends in Stroke Incidence and Acute Case Fatality in a Japanese Rural Area The Oyabe Study. Stroke. 2000;31:1583-1587.
11. Thorvaldsen, P, Davidsen, M, Brønnum-Hansen, H, Schroll, M. Stable stroke occurrence despite incidence reduction in an aging population stroke trends in the Danish monitoring trends and determinants in cardiovascular disease (MONICA) population. Stroke. 1999;30:2529-2534.
12. Rothwell, PM, Coull, AJ, Giles, MF, et al. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet. 2004;363:1925-1933.
13. Anderson, CS, Carter, KN, Hackett, ML, et al. Trends in stroke incidence in Auckland, New Zealand, during 1981 to 2003. Stroke. 2005;36:2087-2093.
14. Redon, J, Olsen, MH, Cooper, RS, et al. Stroke mortality and trends from 1990 to 2006 in 39 countries from Europe and Central Asia: implications for control of high blood pressure. Eur Heart J. 2011;32:1424-1431.
15. Niessen, LW, Barendregt, JJ, Bonneux, L, Koudstaal, PJ. Stroke trends in an aging population. The Technology Assessment Methods Project Team. Stroke. 1993;24:931-939.
16. Börsch-Supan, A, Chiappori, PA. Aging population: Problems and policy options in the US and Germany. Econ Policy. 1991;104-39.
17. Lozano, R, Naghavi, M, Foreman, K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380:2095-2128.
18. Mayo, NE, Hendlisz, J, Goldberg, MS, Korner-Bitensky, N, Becker, R, Coopersmith, H. Destinations of stroke patients from the Montreal area acute-care hospitals. Stroke. 1989;20:351-356.
19. Fonarow, GC, Reeves, MJ, Smith, EE, et al. Characteristics, Performance Measures, and In-Hospital Outcomes of the First One Million Stroke and Transient Ischemic Attack Admissions in Get With The Guidelines-Stroke. Circ Cardiovasc Qual Outcomes. 2010;3:291-302.
20. Statistics Canada. Table 051-0001 - Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (persons unless otherwise noted), CANSIM (database). (accessed: 2014-04-10).
21. Canadian Institute for Health Information. DAD Metadata. http://www.cihi.ca/CIHI-ext-portal/internet/en/document/types+of+care/hospital+care/acute+care/dad_metadata (accessed: 2014-04-30).
22. Kokotailo, RA, Hill, MD. Coding of stroke and stroke risk factors using international classification of diseases, revisions 9 and 10. Stroke. 2005;36:1776-1781.
23. Canadian Institute for Health Information. Health Indicators 2011: Definitions, Data Sources and Rationale, June 2011 http://www.cihi.ca/CIHI-ext-portal/pdf/internet/DEFINITIONS_062011_EN.
24. Mayo, NE, Nadeau, L, Daskalapoulou, SS, Côté, R. The evolution of stroke in Quebec: a 15-year perspective. Neurology. 2007;68:1122-1127.
25. Campbell, NR, McKay, DW. Accurate blood pressure measurement: Why does it matter? Can Med Assoc J. 1999;161:277-278.
26. Bogiatzi, C, Hackam, DG, McLeod, AI, Spence, JD. Secular trends in ischemic stroke subtypes and stroke risk factors. Stroke. 2014;45:3208-3213.
27. Morgenstern, LB, Smith, MA, Lisabeth, LD, et al. Excess stroke in Mexican Americans compared with non-Hispanic whites. The Brain Attack Surveillance in Corpus Christi Project. Am J Epidemiol. 2004;160:376-383.

Keywords

Related content

Powered by UNSILO

Ten-year trends in stroke admissions and outcomes in Canada

  • Noreen Kamal (a1), M. Patrice Lindsay (a2), Robert Côté (a3), Jiming Fang (a4), Moira K. Kapral (a5) and Michael D. Hill (a1) (a6)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.