What do you expect when our incompetent? hospitals aren't even measuring that!
“What's measured, improves.” So said management legend and author Peter F. Drucker ! If you don't measure it, you can't improve it and make it repeatable!
Ask any hospital president what their 30 day mortality rate is and they won't know it off the top of their head! THAT IS PURE INCOMPETENCE!
After years of decline, ischemic stroke mortality rate plateaus in US
Key takeaways:
- While the ischemic stroke incidence rate is sharply down since 1990, its prevalence has increased.
- Top factors contributing to disability-adjusted life years were metabolic, including high blood pressure.
SAN DIEGO — The age-standardized mortality rate following ischemic stroke in the U.S. has declined significantly since 1990, but the rate has plateaued since the mid-2010s while the number of people living with ischemic stroke has increased, according to a poster presentation.
The top risk factors contributing to disability-adjusted life years are largely related to vascular health, indicating the need to bolster vascular risk control and expand post-stroke rehabilitation, Ahar Bhatt, MBBS, a graduate of Smt. NHL Municipal Medical College in Ahmedabad, India, said at the American Neurological Association’s 151st annual conference.
“High systolic blood pressure was the leading attribute in the risk, followed by high LDL and then followed by high plasma glucose,” Bhatt told Healio. “Despite declining ischemic stroke incidence, the burden among people living with the condition remains substantial.”
Although stroke incidence has declined overall, it has nearly doubled among young adults, specifically, between 1990 and 2023, Healio previously reported.
Bhatt and colleagues analyzed 2023 Global Burden of Disease data from the Institute for Health Metrics and Evaluation.
They specifically examined aged-standardized incidence, prevalence and death rates as well as the age-standardized disability-adjusted life-year rate (ASDALYR) across each U.S. state and the District of Columbia.
Between 1990 and 2023, the age-standardized incidence rate (ASIR) for ischemic stroke declined by 27.2%, from 96.17 per 100,000 people to 70.4 per 100,000 people.
The age-standardized death rate (ASDR) fell by 40.4%, from 29.78 per 100,000 people in 1990 to around 17 per 100,000 people in the mid-2010s. However, the rate has since plateaued and has risen slightly to 17.75 per 100,000 people in 2023, Bhatt said.
Although the ASIR for ischemic stroke has been decreasing, the age-standardized prevalence rate (ASPR) increased by 10.9%, going from around 1,129 per 100,000 people in 1990 to 1,252.89 per 100,000 people in 2023. Although ischemic stroke incidence has declined, the increase in prevalence suggests that a substantial burden remains among people living with the condition, Bhatt said.
Bhatt and colleagues also evaluated risk-factor-attributable disability-adjusted life years to determine which risk factors were most prevalent among those who experienced ischemic stroke.
As of 2023, high systolic blood pressure was the top risk factor, with an ASDALYR of 205.4 per 100,000 people. The next top risk factors included high LDL cholesterol (128.71 per 100,000 people) and high-fasting plasma glucose (80.3 per 100,000 people).
“If we reduce the blood pressure problem, we can reduce most of the cases,” Bhatt said. “More follow-ups and better follow-ups with the ones who already have healthcare, because with blood pressure, the main problem is non-compliance.”
Between 1990 and 2023, ASDALYR decreased for all risk factors researchers examined except for two: high body mass index (rising from 41.8 per 100,000 people in 1990 to 49.4 per 100,000 people in 2023) and high alcohol use (rising from 11.7 per 100,000 people in 1990 to 16.6 per 100,000 people in 2023).
The risk factor to see the steepest decline in ASDALYR was air pollution, which fell from 70.1 per 100,000 people in 1990 to 15.3 per 100,000 people in 2023.
ASDALYR and ASDR were both higher for men aged younger than 75 years, but women had higher rates among those aged 75 years and older, Bhatt said.
States in the Southeastern U.S. saw the highest ASDALYR, including Alabama (648.72 per 100,000 people), Mississippi (581.21 per 100,000 people) and Louisiana (522.69 per 100,000 people).
“The main takeaway from our project is the geographic concentration,” Bhatt said. “How can we work towards strengthening community-based vascular risk control in these states and expanding post-stroke rehab so that the burden can be decreased?”
Bhatt said clinicians could focus on organizing health camps, especially in more rural areas, to spread awareness about the importance of tracking blood pressure.
Moving forward, Bhatt said the next steps in the research should more closely examine state-level data. The Global Burden of Disease, while useful, is only an estimate, he said.
“It uses statistical models and estimates to get the data that we have here,” Bhatt told Healio. “But an absolute number, that is something we don’t have. That is something we can get as well through a deeper dive into the research.”
For more information:
Ahar Bhatt, MBBS, can be reached at bhattahar7@gmail.com.
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