Age Differences in Incidence Rates and In-hospital Outcomes among adults with Stroke or transient ischemic attack: a 10-year time-series analysis
 
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1
Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China Rm 503, JC School of Public Health Building, Prince of Wales, Chinese University of Hong Kong Hong Kong
 
2
Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
 
3
Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China Hong Kong
 
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Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China Hong Kong
 
 
Publication date: 2023-04-26
 
 
Popul. Med. 2023;5(Supplement):A39
 
ABSTRACT
Background:
An emerging trend of increasing strokes has been noted among the younger population. However, studies on the age differences in incidence and in-hospital outcomes are lacking, particularly for the Asian population.

Objective:
To compare incidence and in-hospital outcomes and to evaluate their 10-year trends according to age and stroke subtype.

Method:
A total of 137,927 patients with a primary diagnosis of stroke or transient ischemic attack (TIA) in Hong Kong between 2011-2020 were included. Outcomes were incidence, in-hospital deaths, length of stay (LOS), and 30-day unplanned readmission rates by age and subtype. Time-series analysis using cumulative annual percentage changes (CAPC) and statistical process control (SPC) was conducted to examine time trends.

Results:
Decreasing incidence was observed in all subtypes among old adults (aged≥65), who yielded the most dramatic incidence reduction in ischemic stroke (IS) and intracerebral hemorrhage (ICH) (per 100,000 person-years 2011-2020, CAPC; IS: 931 to 424, -54%; ICH: 180 to 101, -44%), compared to young (aged≤44) and midlife adults (aged 45-64). TIA incidence increased in young by 19% but declined by 40% in old adults, whereas subarachnoid hemorrhage (SAH) incidence remained steady for young and midlife. In-hospital deaths (10%) and 30-day unplanned readmission rates (9.8%) were highest for old adults with any subtype, while acute LOS was longest in the young (mean [SD] days; IS: 6.1 [13.3]; ICH: 14.6 [47.4]; SAH: 21.9 [60.2]) except TIA. SPC analysis demonstrated a significant rise in in-hospital deaths for all IS. There were longer LOS and more 30-day stroke-cause unplanned readmissions for all subtypes in young adults over ten years, but outcomes did not change in old adults apart from IS and TIA.

Conclusion:
Age-specific trends in incidence and in-hospital outcomes varied in stroke subtypes. The temporal increase in LOS and readmissions in young strokes highlight the need for age-targeted care improvements.

ISSN:2654-1459
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