Data_Sheet_1_Comorbidity and outcomes among hospitalized patients with stroke: a nationwide inpatient analysis.DOCX

ObjectiveWe aimed to characterize healthcare utilization and comorbidity outcomes among hospitalized elderly stroke patients using a nationally representative dataset in the United States.MethodsUsing the 2019 National Inpatient Sample, patients aged 65 years or older with and without comorbidities who were hospitalized for acute stroke were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Patient comorbidities were identified with the use of the Elixhauser Comorbidity Index. The prevalence of comorbidities, in-hospital mortality, length of stay, and total hospital costs were analyzed for these patients.ResultsWithin 451,945 patients (mean age 78 years, 54.1% women, 73.7% white), we observed that more than 90% of patients had a minimum of two comorbidities. The median number of comorbidities was 4.0 (IQR 3.0–6.0). There was significant variation in the prevalence rate of comorbidities. The five most common comorbidities were uncomplicated hypertension (55.4%), paralysis (40.1%), congestive heart failure (39.8%), various neurological illnesses (38.3%), and complex hypertension (32.5%). After adjusting for patient- and hospital-level characteristics, a statistically significant association was observed between comorbidities and various adverse outcomes. Specifically, comorbidities were found to be significantly associated with an increased risk of inpatient mortality (odds ratio: 1.09; 95% CI: 1.08–1.11; P < 0.001), a longer duration of hospitalization (0.68 days; 95% CI: 0.66–0.71; P < 0.001), and higher total cost ($1,874.9; 95% CI: 1,774.6–1,975.2; P < 0.001).ConclusionThis national data suggests that comorbidity is common among hospitalized older stroke patients and substantially increases the healthcare burden and inpatient mortality in the United States. These findings underscore the integration of comorbidity management into the care of older stroke patients.

本研究旨在利用美国国家代表性数据集，对住院老年卒中患者的医疗利用率和合并症结局进行描述。研究方法上，通过2019年国家住院样本数据，利用国际疾病分类第十版临床修正版代码识别了65岁及以上患有和未患有合并症的急性卒中住院患者。患者的合并症通过Elixhauser合并症指数进行识别。对患者的合并症患病率、院内死亡率、住院时长和总住院费用进行了分析。研究结果显示，在451,945名患者（平均年龄78岁，女性占54.1%，白人占73.7%）中，超过90%的患者至少有两种合并症。合并症的中位数为4.0（四分位距3.0-6.0）。合并症的患病率存在显著差异。最常见的五种合并症分别为非复杂性高血压（55.4%）、瘫痪（40.1%）、充血性心力衰竭（39.8%）、各种神经系统疾病（38.3%）和复杂性高血压（32.5%）。在调整患者和医院层面的特征后，合并症与各种不良结局之间存在统计学意义的关联。具体而言，合并症与住院死亡率增加（比值比：1.09；95%置信区间：1.08-1.11；P<0.001）、住院时间延长（0.68天；95%置信区间：0.66-0.71；P<0.001）和总成本增加（1,874.9美元；95%置信区间：1,774.6-1,975.2美元；P<0.001）显著相关。结论部分指出，这一国家数据表明，合并症在住院老年卒中患者中较为普遍，并且显著增加了美国的医疗负担和住院死亡率。这些发现强调了将合并症管理纳入老年卒中患者护理的重要性。