(Stroke. 1999;30:2523.)
© 1999 American Heart Association, Inc.
Original Contributions |
Incidence and Occurrence of Total (First-Ever and Recurrent) Stroke
From the Department of Health Outcomes Management and Research (G.R.W., J.G.J.), Knoll Pharmaceutical Co, Mount Olive, NJ; the Department of Epidemiology and Biostatistics (G.R.W.), School of Public Health, Boston University, Boston, Mass; and the Center for Clinical Health Policy Research (D.B.M., G.P.S.) and the Departments of Medicine (D.B.M., G.P.S.) and Community and Family Medicine (G.P.S.), Duke University, Durham, NC.
Background and Purpose—It has recently been hypothesized that the figure of approximately half a million strokes substantially underestimates the actual annual stroke burden for the United States. The majority of previously reported studies on the epidemiology of stroke used relatively small and homogeneous population-based stroke registries. This study was designed to estimate the occurrence, incidence, and characteristics of total (first-ever and recurrent) stroke by using a large administrative claims database representative of all 1995 US inpatient discharges.
Methods—We used the Nationwide Inpatient Sample of the Healthcare
Cost and Utilization Project, release 4, which contains 
20% of
all 1995 US inpatient discharges. Because the accuracy of
International Classification of Diseases, 9th Revision, Clinical
Modification (ICD-9-CM) coding is suboptimal, we performed a
literature review of ICD-9-CM 430 to 438 validation studies. The pooled
results from the literature review were used to make appropriate
adjustments in the analysis to correct for some of the
inaccuracies of the diagnostic codes.
Results—There were 682 000 occurrences of stroke with hospitalization (95% CI 660 000 to 704 000) and an estimated 68 000 occurrences of stroke without hospitalization. The overall incidence rate for occurrence of total stroke (first-ever and recurrent) was 259 per 100 000 population (age- and sex-adjusted to 1995 US population). Incidence rates increased exponentially with age and were consistently higher for males than for females.
Conclusions—We conservatively estimate that there were 750 000 first-ever or recurrent strokes in the United States during 1995. This new figure emphasizes the importance of preventive measures for a disease that has identifiable and modifiable risk factors and for the development of new and improved treatment strategies and infrastructures that can reduce the consequences of stroke.
Key Words: diagnosis • epidemiology • hospitalization • incidence • stroke, acute
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