D Chyatte1, K Easley, L M Brass. 1. Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, OH, USA.
Abstract
BACKGROUND: The incidence and mortality of all types of strokes, including intracerebral hemorrhages, declined during the 1970s. However, some evidence exists that these trends stabilized or reversed during the 1980s. In the present study, a large North American population was observed from 1981 to 1989 to assess changes in the annual hospital admission rates of intracerebral hemorrhage. METHOD: Data provided by the Connecticut Health Information Management and Exchange (CHIME, Wallingford, Connecticut), a state-wide clinical database of records submitted voluntarily by all of Connecticut's 36 acute care, nongovernment hospitals, was analyzed for all patients with primary diagnosis of intracerebral hemorrhage (ICD-9-CM=431) for the fiscal years 1981, 1983, 1985, 1987, 1988, and 1989. RESULTS: During the time periods studied, there were 3,277 hospitalizations with a primary diagnosis of intracerebral hemorrhage. There was an initial annual hospital admission rate of 12 per 100,000 in 1981. Rates steadily increased to nearly 20 per 10,000 in 1988 and 1989. This increase in hospital admission rates from intracerebral hemorrhage was statistically significant when the data were adjusted for gender, race, and age (P<.001). When admission rates for intracerebral hemorrhage were stratified by age, admission rates increased dramatically only in those 65 years and older (P<.001). The in-hospital death rate decreased during the study decade (P=.004); however, age-adjusted analysis indicated that in-hospital deaths increased significantly (P<.001) in patients 65 years and older. CONCLUSIONS: Hospital admission rates for intracerebral hemorrhage nearly doubled from 1981 to 1989. This change may be due to an actual increase in the annual incidence of intracerebral hemorrhage caused by mechanisms that are not yet fully understood.
BACKGROUND: The incidence and mortality of all types of strokes, including intracerebral hemorrhages, declined during the 1970s. However, some evidence exists that these trends stabilized or reversed during the 1980s. In the present study, a large North American population was observed from 1981 to 1989 to assess changes in the annual hospital admission rates of intracerebral hemorrhage. METHOD: Data provided by the Connecticut Health Information Management and Exchange (CHIME, Wallingford, Connecticut), a state-wide clinical database of records submitted voluntarily by all of Connecticut's 36 acute care, nongovernment hospitals, was analyzed for all patients with primary diagnosis of intracerebral hemorrhage (ICD-9-CM=431) for the fiscal years 1981, 1983, 1985, 1987, 1988, and 1989. RESULTS: During the time periods studied, there were 3,277 hospitalizations with a primary diagnosis of intracerebral hemorrhage. There was an initial annual hospital admission rate of 12 per 100,000 in 1981. Rates steadily increased to nearly 20 per 10,000 in 1988 and 1989. This increase in hospital admission rates from intracerebral hemorrhage was statistically significant when the data were adjusted for gender, race, and age (P<.001). When admission rates for intracerebral hemorrhage were stratified by age, admission rates increased dramatically only in those 65 years and older (P<.001). The in-hospital death rate decreased during the study decade (P=.004); however, age-adjusted analysis indicated that in-hospital deaths increased significantly (P<.001) in patients 65 years and older. CONCLUSIONS: Hospital admission rates for intracerebral hemorrhage nearly doubled from 1981 to 1989. This change may be due to an actual increase in the annual incidence of intracerebral hemorrhage caused by mechanisms that are not yet fully understood.