Stroke incidence, mortality declines in senior patients
Stroke incidence declines for senior Medicare patients
HealthDay News -- Incident stroke and in mortality from strokes decreased from 1988 to 2008 in Medicare patients aged 65 years and older, according to a study published in The American Journal of Medicine.
“With the aging population, the absolute number of strokes in the United States is likely to increase. However, stroke is a preventable disease,” wrote Margaret C. Fang, MD, MPH, of the University of California in San Francisco, and colleagues.
“Several prevention strategies have been shown to be efficacious in clinical trial settings, in particular, modification of stroke risk factors such as hypertension and hyperlipidemia.”
In order to describe trends in the incidence, outcomes, and risk factors for stroke in the Medicare population, the investigators analyzed data from a 20% sample of hospitalized Medicare beneficiaries with a principal diagnosis of ischemic stroke (n=918,124 patients) or hemorrhagic stroke (n=133,218 patients).
National Health and Nutrition Examination Survey data were used to determine stroke risk factors, and medication uptake was obtained from the Medicare Current Beneficiary Survey.
There was a decrease in the incidence of ischemic stroke (927 to 545 per 100,000) and hemorrhagic stroke (112 to 94 per 100,000) from 1988 to 2008, reported the researchers. From 1988 to 2008, the risk-adjusted 30-day mortality decreased from 15.9% to 12.7% for ischemic stroke and from 44.7% to 39.3% for hemorrhagic stroke.
The Framingham stroke model predicted increased stroke risk, despite the observed decrease in stroke rates (mean stroke score: 8.3% in 1988 to 1994 and 8.8% in 2005 to 2008). In the general population there was an increase in statin use (4% to 41.4% from 1992 to 2008) and antihypertensive use (53% to 73.5% in from 1992 to 2008).
"Incident strokes in the Medicare population aged ≥65 years decreased by approximately 40% over the last two decades, a decline greater than expected on the basis of the population's stroke risk factors," wrote the inspectors.
"Although causality cannot be proven, declining stroke rates paralleled increased use of statins and antihypertensive medications."