Epidemiology of recurrent cerebral infarction : A Medicare claims-based comparison of first and recurrent strokes on 2-year survival and cost.
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.
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). (...)
Mots-clés Pascal : Accident cérébrovasculaire, Récidive, Survie, Analyse coût, Coût, Etats Unis, Amérique du Nord, Amérique, Economie santé, Epidémiologie, Etude comparative, Pronostic, Personne âgée, Homme, Système nerveux pathologie, Système nerveux central pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Medicare
Mots-clés Pascal anglais : Stroke, Relapse, Survival, Cost analysis, Costs, United States, North America, America, Health economy, Epidemiology, Comparative study, Prognosis, Elderly, Human, Nervous system diseases, Central nervous system disease, Cerebral disorder, Cerebrovascular disease, Cardiovascular disease, Vascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0128950
Code Inist : 002B17C. Création : 16/11/1999.