Abstract
Introduction: Though the incidence of acute ischemic stroke is decreasing overall in the US, improvement is not occurring uniformly. A high-yield strategy might be to identify and target micropopulations of very high-risk patients. Methods: All acute ischemic strokes among residents in the Greater Cincinnati/Northern Kentucky (GCNK) region (estimated population: 1.3 million) at least 20 years of age were identified using ICD-9 codes of 430-436 and verified by physician review in the calendar years 1999 and 2005. Each patient residing at home was geocoded according to listed home address; institutionalized patients were excluded. We calculated crude incidence rates for the 346 census tracts and used stroke events for numerators and 2000 Census data for denominators. We produced incidence maps for 1999 and 2005 and a rate change map for comparison. Results: We identified 2330 acute ischemic strokes in the GCNK region in 1999 and 2165 in 2005. After excluding recurrent events, events in institutionalized patients, and events in patients without geocodable addresses, we identified 1942 patients in 1999 and 1766 patients in 2005 for this analysis. Overall incidence was 189/100,000 in 1999 and 167/100,000 in 2005. The interquartile range of incidences in the census tracts was 124 - 270/100,000 in 1999 and 112 - 243/100,000 in 2005. Rates by year and rate difference are shown in the Figure. There were 23 census tracts with rates >300/100,000 in both study years and 21 census tracts with a rate increase >200/100,000 from 1999 to 2005. Discussion: Stroke incidence varies widely in census tracts in the GCNK region. We identified several micropopulations in which targeted efforts might result in reductions of stroke burden on the population. Further investigation of the impact of socioeconomic status and risk factors in these micropopulations will help tailor stroke reduction efforts. Microtargeting deserves further study in stroke education and prevention endeavors.
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