Short- and Long-term Survival after Stroke in Hospitalized Patients in Chile: A Nationwide 5-Year Study

• Published in: Journal of stroke and cerebrovascular diseases Vol. 22; no. 8; pp. e463 - e469
• Main Authors: Hoffmeister, Lorena, MPH, Lavados, Pablo M., MD, MPH, Murta-Nascimento, Cristiane, MD, PhD, Araujo, Miguel, MD, MSc, Olavarría, Verónica V., MD, MSc, Castells, Xavier, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2013
• Subjects: Age Factors; Aged; Aged, 80 and over; brain ischemia; Brain Ischemia - diagnosis; Brain Ischemia - mortality; Brain Ischemia - therapy; Cardiovascular; Chile; Chile - epidemiology; epidemiology; fatal outcome; Female; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - statistics & numerical data; Hospitalization - statistics & numerical data; Hospitals, Private - statistics & numerical data; Hospitals, Public - statistics & numerical data; Humans; Insurance, Health - statistics & numerical data; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Neurology; Patient Admission - statistics & numerical data; Patient Discharge - statistics & numerical data; Proportional Hazards Models; Registries; Residence Characteristics; Retrospective Studies; Risk Factors; Socioeconomic Factors; Stroke; Stroke - diagnosis; Stroke - mortality; Stroke - therapy; survival; Survival Rate; Survivors - statistics & numerical data; Time Factors; Chile; epidemiology; Stroke; brain ischemia; Chile; survival; fatal outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2013.05.005

Background Short- and long-term stroke survival is a key indicator of hospital performance in stroke care. Our aim was to estimate short- and long-term survival rates in discharged patients diagnosed with ischemic stroke in Chile in a 5-year period and identify associated variables. Materials and Methods We included all discharged patients from all hospitals in Chile with main diagnosis of ischemic stroke from 2003 to 2007, which were identified through the National Hospital Discharge Registry. To establish survival, discharges were linked to deaths in the Deaths Registry. Kaplan–Meier survival curves were used to estimate the cumulative 7-day, 30-day, 1-year, and 3-year survival rates. Independent predictors of death (sex, age, geographical regions, and status insurance) were assessed by Cox proportional hazard regression model. Results A total of 51,130 with first-ever ischemic stroke patients were identified. Overall survival rate decreased from 88.9% (95% confidence interval [CI] 88.6-89.2) 7 days after hospital admission to 81.9% (95% CI 81.6-82.3), 69.9% (95% CI 69.5-70.3), and 61.2% (95% CI 60.7-61.6) after 30-day, 1-year, and 3-year, respectively. The multivariable model showed that the elderly patients (>80 years; hazard ratio [HR] 4.07; 95% CI 3.89-4.26) and hospital admission in the North (HR 1.14; 95% CI 1.09-1.20) and South area (HR 1.06; 95% CI 1.03-1.110) were associated with lower survival after stroke. Patients with private health insurance have a higher probability of survival than patients with public insurance (private insurance, HR .53; 95% CI .49-.56). Conclusions Short- and long-term survival after ischemic stroke was heterogeneous by geographic regions and type of health insurance, regardless age and sex were the strongest predictors. This suggests an impact of socioeconomic factors and access to acute management of strokes on survival.