Ten-year trends in stroke admissions and outcomes in Canada

Background: We analyzed a 10-year stroke administrative dataset to examine trends in admissions, mortality, and discharge destination in Canada. Methods: We conducted an analysis of hospital administrative data from April 1(st) 2003 to March 31(st) 2013 from the Canadian Institute of Health Information's Discharge Abstract Database. Ten-year trends for population-based age-and sex-standardized admission rates were calculated. We reviewed 10-year trends in absolute stroke admissions for differences between provinces and age groups. Stroke 30-day in-hospital mortality rates were calculated and adjusted for sex, age, stroke type and comorbidities. We documented changes in discharge location for ischemic and hemorrhagic stroke patients discharged from acute care. Results: The rate of hospital admissions has declined from 140.2 to 117.5 (per 100,000 people). The number of absolute stroke admissions within provinces increased in Alberta and British Columbia (21.7% and 16.2% respectively). The proportion of stroke patients aged 40-69 years old increased by 4.8% (p < 0.0001) over the 10 years, whereas the proportion aged over 70 decreased by 4.9% (p< 0.0001). Risk-adjusted 30-day in-hospital mortality decreased from: 18.5% to 14.9% for all strokes; 15.2% to 12.1% for ischemic strokes; 35.6% to 29.7% for intracerebral hemorrhage; and 25.1% to 18.0% for subarachnoid hemorrhage. The absolute increase in patients requiring inpatient and outpatient support increased by 4% (p< 0.0001). Conclusion: The rate of admissions for stroke is decreasing but there is an increase in stroke admissions for younger patients. In-hospital mortality is decreasing; fewer patients are going directly home without services and more are requiring support services.