(Stroke. 1999;30:338-349.)
© 1999 American Heart Association, Inc.
Original Contributions |
Epidemiology of Recurrent Cerebral Infarction
A Medicare Claims–Based Comparison of First and Recurrent Strokes on 2-Year Survival and Cost
From the Center for Clinical Health Policy Research (G.P.S., J.B., J.L., D.B.M.) and the Departments of Community and Family Medicine (G.P.S.) and Medicine (G.P.S., D.B.M.), Duke University School of Medicine Durham, NC; the Sanford Institute for Public Policy (J.L.), Duke University, Durham, NC; Center for Health Services Research in Primary Care (D.B.M.), Department of Veterans Affairs Medical Center, Durham NC.
Correspondence to Gregory P. Samsa, PhD, Duke University Center for Clinical Health Policy Research; Suite 230; First Union Bldg; 2200 W Main St; Durham, NC 27705. E-mail samsa001{at}mc.duke.edu
Background and Purpose—Because recurrent strokes will tend to leave patients with greater disability than first strokes, patients with recurrent strokes should have poorer outcomes on average than those with first strokes. The extent of this difference has, however, not yet been estimated with precision.
Methods—Using a random 20% sample of Medicare patients aged 65 years and older admitted with a primary diagnosis of cerebral infarction during calendar year 1991, we used historical data from the previous 4 years to classify patients as having either first or recurrent stroke and followed survival and direct medical costs for 24 months after stroke. First and recurrent stroke groups were compared with the log-rank test (survival) and t test (cost) and also multivariate modeling.
Results—Survival from first stroke is consistently better than that for recurrent stroke: 24-month survival was 56.7% versus 48.3%, respectively. Costs were similar for the initial hospital stay and in months 1 to 3 after stroke. During months 4 to 24 after stroke, total costs were higher among those with recurrent stroke by approximately $375/mo across all patients, with this difference being greatest for younger patients and least for patients aged 80 years or older. Most of the difference in total monthly cost was attributable to nursing home utilization (averaging approximately $150/mo) and acute hospitalization (averaging approximately $120/mo).
Conclusions—Patients with recurrent stroke have, on average, poorer outcomes than those with first stroke. To be as accurate as possible, clinical policy analyses should use different estimates of health and cost outcomes for first and recurrent stroke.
Key Words: cerebral infarction • costs and cost analysis • epidemiology • mortality
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