Reemergence of Acute ischemic Stroke hospitalizations in the United States from 2010 to 2020

Abstract

AbstractBackground and ObjectivesStroke hospitalization rates in the United States are unequally distributed across the population. Factors such as age, race, socioeconomic status, and sex are associated with different hospitalization rates for acute ischemic stroke (AIS). This study aimed to review the patterns in these rates from 2010 to 2020.MethodsThe National Inpatient Sample (NIS) was used to analyze patterns in AIS hospitalizations in the United States between 2010 and 2020. The hospitalization rates were examined based on age, sex, race, region, stroke comorbidities, and income.ResultsThe overall rate of AIS hospitalization increased from 230 to 254 per 100,000 individuals (+10.4%) between 2010 and 2020. Initially, the rates declined from 2010 to 2015 (230 to 227 per 100,000); however, from 2016 to 2020, the AIS hospitalization rates (AIS-HR) increased (242 to 254 per 100,000). The rate of AIS hospitalization increased significantly for individuals aged 25–44 years (25–37 per 100,000, +48.0%) and 45–65 years (171–235 per 100,000, +37.4%). AIS hospitalization rates remained relatively stable for individuals aged 65– 84 years (669–688 per 100,000, +3.7%) and declined for those over 85 years (2005–1756 per 100,000, -12.4%). Among sex comparisons, AIS hospitalization rates were stable in women (241–250 per 100,000, +3.7%) and increased in men (270–308 per 100,000, +14.1%). In terms of race, Blacks had the highest age-adjusted yearly hospitalization rate (437), followed by Whites (215) and Hispanics (207) per 100,000 in 2020. There was a stepwise increase in AIS hospitalization rates based on the Charlson Comorbidity Index (CCI), with White, Black, and Hispanic populations having AIS hospitalization rates of CCI 0 and 1 (533, 434, and 233), CCI 2 (2197, 2555, and 2125), and CCI ≥ 3 (5283, 5724, and 4767) per 100,000, respectively.DiscussionAlthough the overall AIS hospitalization rate increased between 2010 and 2020, there was an initial decline until 2015, followed by a resurgence. This resurgence in AIS hospitalization rates was driven by greater underlying comorbidities, with disproportionate increases observed in Black and Hispanic populations. Further population analyses and cohort studies are required to confirm our findings.