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Recent evidence suggests that minority groups have prolonged hospital stays after ischemic stroke. However, disparities in the hospital stay after ischemic stroke among Native Hawaiians and other Pacific Islanders (NHPI) have not been studied. A retrospective study on consecutive patients hospitalized for ischemic stroke at a single tertiary center...
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Context 1
... 2008 and 2010, a total of 740 patients (whites 22%, Asians 53%, NHPI 21%, others 4%) hospitalized for ischemic stroke at QMC were identified. Unadjusted comparison be- tween NHPI and whites showed that NHPI were significantly younger (59 ± 14 years vs 72 ± 13 years) and had significantly higher prevalence of female sex (51% vs 38%), no health insurance (10% vs 4%), diabetes (53% vs 18%), hypertension (82% vs 62%), obesity (55% vs 20%) and prolonged hospital stay (20% vs 11%), and lower prevalence of residence outside of O'ahu (12% vs 23%) compared to whites (Table 1). ...
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Objective:
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Methods:
We queried the Nationwide Inpatient Sample (2002-2011) to identify all patients with a primary diagnosis of AIS and subset...
Objectives
The mean lifetime cost of ischemic stroke is approximately $140,048 in the United States, placing stroke among the top 10 most costly conditions among Medicare beneficiaries. The objective of this study was to describe the health-care resource utilization and costs in the year following hospitalization for acute ischemic stroke (AIS).
M...
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Citations
... Most studies 12,39,47 showed an association between diabetes and a longer in-hospital length of stay among stroke inpatients ( Table 2) 54 . In three studies 11,39,58 , diabetes was associated with increased hospital readmission and stroke recurrence at 3 months 58 , 6 months 11 and 1 year 11,39 after index stroke in people who had ischemic stroke, but not hemorrhagic stroke ( Table 2) 39,42 . ...
... Diabetes has been associated with a reduced amount of recovery after rehabilitation 12 , higher risk of mortality in some 7,8,71 but not all studies 45,51,93 and a risk factor for recurrent ischemic stroke 11,39,58 . The effect of diabetes on length of hospital stay has been inconsistent 12,39,47,54 . The relationship between diabetes and poorer stroke outcomes still remained after adjusting for stroke severity and subtypes. ...
Background
Diabetes Mellitus is an established risk factor for stroke and maybe associated with poorer outcomes following stroke.
Objective
The aims of this literature review were to determine (i) the prevalence of diabetes in acute stroke patients through a meta‐analysis, (ii) the association between diabetes and outcomes after ischemic and hemorrhagic stroke and (iii) to review the value of HbA1c and admission glucose based tests in predicting stroke outcomes.
Methods
Ovid MEDLINE and EMBASE searches were conducted to find studies relating diabetes and inpatient stroke populations published between January 2004 and April 2017. A meta‐analysis of the prevalence of diabetes from included studies was conducted. A narrative review on the associations of diabetes and different diagnostic methods on stroke outcomes was performed.
Results
Sixty‐six eligible articles met inclusion criteria. A meta‐analysis of 39 studies (n=359,783) estimated the prevalence of diabetes to be 28% (95%CI [26, 31]). The rate was higher in ischemic (33%, 95%CI [28, 38]) compared to hemorrhagic stroke (26%, 95%CI [19, 33]) inpatients. Most, but not all studies found that acute hyperglycemia and diabetes were associated with poorer outcomes after ischemic or hemorrhagic strokes: including higher mortality, poorer neurological and functional outcomes, longer hospital stay, higher readmission rates and stroke recurrence. Diagnostic methods for establishing diagnosis were heterogeneous between the reviewed studies.
Conclusion
Approximately one‐third of all stroke patients have diabetes. Uniform methods to screen for diabetes after stroke are required to identify individuals with diabetes to design interventions aimed at reducing poor outcomes in this high risk population.
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Background:
We evaluated disparities in in-hospital mortality rates among whites, Native Hawaiians and other Pacific Islanders (NHOPI), Filipinos, and other Asian groups in Hawaii who were hospitalized for acute ischemic stroke.
Materials and methods:
Using a statewide hospital claims database, we performed a retrospective study including sequential acute ischemic stroke patients between 2010 and 2015. We compared in-hospital mortality rates among whites, NHOPI, Filipinos, other Asian groups excluding Filipinos, and other races (Blacks, Hispanics, Native Americans, mixed race).
Results:
A total of 13,030 patient discharges were included in this study. The mean (±SD) age in years at the time of stroke was 63.5 ± 14.3 for NHOPI, 69.6 ± 14.4 for Filipinos, 67.8 ± 14.2 for other race, 71.4 ± 13.8 for whites, and 76.1 ± 13.5 for other Asians (P < .001). NHOPI patients had higher rates of diabetes (48.8%), obesity (18.4%), and tobacco use (31.3%) compared with patients in other racial-ethnic categories. Filipino patients had the highest rate of hemorrhagic transformation (9.7%). Age-adjusted stroke mortality rates were highest among Filipinos (15.9%; 95% confidence interval [CI] = 14.3%-17.6%), followed by other Asian groups (15.1%; 95% CI = 14.0%-16.2%), NHOPI (14.8%; 95% CI = 12.8%-16.8%), other race (14.4%; 95% CI = 11.3%-17.4%), and lowest among whites (12.8%; 11.5%-14.2%). After adjusting for other confounding variables, Filipinos had higher mortality (odds ratio = 1.22, 95% CI = 1.03-1.45), whereas other Asian groups, NHOPI, and other race patients had mortality rates that were similar to whites.
Conclusion:
In Hawaii, Filipino ethnicity is an independent risk factor for higher in-hospital stroke mortality compared with whites.
