Abstract 214: Stroke Epidemiology in the State of Maine 2010-2014

Abstract

Purpose: Maine’s stroke prevalence/mortality is highest of New England states, yet US mortality rates are in decline overall. We hypothesized that the epidemiology of stroke in Maine has unique characteristics to explain the disparity; that a high mortality rate is due to geography, aging and non-traditional factors such as polysubstance abuse or cancer. Objective: This study aims to identify local determinants for in hospital mortality stroke in Maine, comparing demographics, clinical factors and access to certified stroke centers. Design/ Methods: As a descriptive study using all Maine inpatient stroke related discharge data: demographics, diagnosis, procedure codes and disposition from Maine Health Data Organization (MHDO), stroke was classified as ischemic, hemorrhagic, and Transient Cerebral Ischemia. Traditional risk factors include: age, sex, hypertension, diabetes mellitus, tobacco use, atrial fibrillation, left ventricular hypertrophy and dyslipidemia. Clinical nontraditional risk factors: sleep apnea, neoplasm, mental disorders and polysubstance and alcohol abuse. Zip codes were used to determine driving distance of one hour or more from certified stroke centers; Maine has only three. Statistical Analysis: Cases with complete data were included. Excluded were diagnostic codes for pregnancy, childbirth, puerperium, preeclampsia, eclampsia or traumatic brain injury; cases of ICD-9-CM codes for epidural and subdural hematoma; and ill-defined cerebrovascular disease or late effects of cerebrovascular disease. Descriptive statistics identified stroke characteristic. Multiple linear regression analyses identified associations between in hospital mortality due to stroke and age, gender, clinical factors, and driving distances to identify the independent predictors. Analyses were done using SPSS software version 21. Results: From 2010-2014, 13,857 hospital stroke diagnoses represented 2% of all Maine discharges. Mean age for all stroke events was 73 (± 14 years), and 52% were female. Overall, ischemic strokes accounted for 66% of all stroke discharges followed by TIA (19%) and hemorrhagic (15%). There were no statistically significant changes in mortality rate during the five year period. A Multiple logistic regression model showed associations with older age, atrial fibrillation, neoplasm, and more than one hour to a certified stroke center; and a negative trend for traditional factors. Maine had lower prevalence of Hypertension, Diabetes mellitus and tobacco use when compared with national rates (50% vs. 74%; 24.6% vs. 30%; 13.6% vs. 17% respectively). Conclusion: Maine local determinants for in hospital stroke mortality include: limited access to a certified stroke center and an older population. Other concomitants conditions for risk include atrial fibrillation and neoplasm.