Trends in In-Hospital Mortality among Patients with Stroke in China

Qian He,Zhi-Yong Wang,Cheng Wu,Jian Lu,Ying-Yi Qin,Hong Luo,Jia He,Xiu-Qiang Ma,Shun-Quan Wu,Fei-Fei Yu,Chun Xiang,Yan-Fang Zhao,Alice Y W Chang

doi:10.1371/journal.pone.0092763

Qian He, Zhi-Yong Wang + Show 11 more

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https://doi.org/10.1371/journal.pone.0092763

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Journal: PLoS ONE	Publication Date: Mar 20, 2014
Citations: 42	License type: CC BY 4.0

Affiliation: Second Military Medical University, Changhai Hospital

Abstract

BackgroundThe incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China.Methods109 grade III class A hospitals were sampled by multistage stratified cluster sampling. All patients admitted to hospitals between 2007 and 2010 with a discharge diagnosis of stroke were included. Trends in in-hospital mortality among patients with stroke were assessed. Influence factors of in-hospital death after stroke were explored using multivariable logistic regression.ResultsOverall stroke hospitalizations increased from 79,894 in 2007 to 85,475 in 2010, and in-hospital mortality of stroke decreased from 3.16% to 2.30% (P<0.0001). The percentage of severe patients increased while odds of mortality (2010 versus 2007) decreased regardless of stroke type: subarachnoid hemorrhage (OR 0.792, 95% CI = 0.636 to 0.987), intracerebral hemorrhage (OR 0.647, 95% CI = 0.591 to 0.708), and ischemic stroke (OR 0.588, 95% CI = 0.532 to 0.649). In multivariable analyses, older age, male, basic health insurance, multiple comorbidities and severity of disease were linked to higher odds of in-hospital mortality.ConclusionsThe mortality of stroke hospitalizations decreased likely reflecting advancements in stroke care and prevention. Decreasing of mortality with increasing of severe stroke patients indicated that we should pay more attention to rehabilitation and life quality of stroke patients. Specific individual and hospital-level characteristics may be targets for facilitating further declines.

Highlights

Stroke is one of the leading causes of death and disability throughout the world [1], responsible for 4.4 million (9%) of the total 50.5 million deaths each year [2]
Analyzing of influence factors of trend of stroke outcomes may lead to strategies for enhancing quality improvement at several levels of policymaking [7].The objectives of this study were to assess trends of the proportion of stroke hospitalizations that resulted in death in China in recent years and find some potential influence factors of in-hospital mortality after stroke hospitalization
The number of inpatient increased in north for subarachnoid hemorrhage (SAH) (P,0.0001), west for intracerebral hemorrhage (ICH) (P,0.0001), south and west for ischemic stroke (IS) (P,0.0001)

Summary

Introduction

Stroke is one of the leading causes of death and disability throughout the world [1], responsible for 4.4 million (9%) of the total 50.5 million deaths each year [2]. About 2 million people of all ages suffer a new stroke, and 15 million stroke-related deaths occur in each year [3]. It is becoming the first leading cause of death in China [1]. Mortality of stroke at discharge significantly increased with age, with 1.15%, 1.46%, 3.31%, and 7.63% in-hospital mortality according to age group (#45,46–65,66–79, $80 years old) respectively, and the very old patients had the worst outcomes even after adjusted by prognostic factors[4].

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