2019冠状病毒病时期缺血性脑卒中患者住院死亡率的趋势和差异：一项全国性研究（2016-2022）。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-06-09 DOI:10.1016/j.jstrokecerebrovasdis.2025.108367

Mian Urfy MD , Mariam Tariq Mir MD

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引用次数: 0

摘要

背景和目的：2019冠状病毒病大流行扰乱了卒中护理系统，但其对缺血性卒中患者住院死亡率和差异的影响尚不清楚。我们研究了COVID-19时代之前和期间的全国中风死亡率趋势，重点关注人口和社会经济差异。方法：我们使用全国住院患者样本（2016-2022）来识别初步诊断为缺血性脑卒中的成人住院患者。每年计算医院内粗死亡率，并按性别、年龄组、种族/民族和保险状况分层。在控制了年龄、年龄、性别、种族/民族、付款人和合并症的情况下，采用多变量logistic回归来估计住院死亡率的调整几率。结果：在入院的950,518例缺血性卒中患者中，住院死亡率从2019年的6.32%上升到2021年的8.24%，在COVID-19时代相对上升了30%。死亡率最高的是年龄≥85岁的患者（11.1%）、男性（7.2%）和自费患者（OR 2.33 vs. Medicare）。粗死亡率增加最多的是西班牙裔（+36.1%）、美洲印第安人/阿拉斯加原住民（+35.5%）和黑人患者（+26.7%）。调整后，与2016年相比，2020年（OR 1.05）、2021年（OR 1.17）和2022年（OR 1.09）的院内死亡几率仍显著升高。地区差异也被观察到，东北和西部调整后的死亡率增幅最大。结论：在COVID-19时代，住院卒中死亡率显著上升，其中种族和少数民族群体以及社会经济弱势群体的死亡率增幅更大。这些发现强调了在卒中护理系统中采取以公平为重点的干预措施的必要性。

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Trends and Disparities in In-Hospital Mortality Among Ischemic Stroke Patients During the COVID-19 Era: A Nationwide Study (2016–2022)

Background and Purpose

The COVID-19 pandemic disrupted stroke systems of care, but its impact on in-hospital mortality and disparities among ischemic stroke patients remains unclear. We examined nationwide trends in stroke mortality before and during the COVID-19 era, with a focus on demographic and socioeconomic disparities.

Methods

We used the National Inpatient Sample (2016–2022) to identify adult hospitalizations with a primary diagnosis of ischemic stroke. Crude in-hospital mortality rates were calculated annually and stratified by sex, age group, race/ethnicity, and insurance status. Multivariable logistic regression was used to estimate adjusted odds of in-hospital mortality, controlling for year, age, sex, race/ethnicity, payer, and comorbidities.

Results

Among 950,518 ischemic stroke admissions, in-hospital mortality rose from 6.32% in 2019 to 8.24% in 2021—a 30% relative increase during the COVID-19 era. Mortality was highest among patients aged ≥85 years (11.1%), males (7.2%), and those with self-pay status (OR 2.33 vs. Medicare). Crude mortality increased most among Hispanic (+36.1%), American Indian/Alaska Native (+35.5%), and Black patients (+26.7%). After adjustment, the odds of in-hospital death remained significantly elevated in 2020 (OR 1.05), 2021 (OR 1.17), and 2022 (OR 1.09) compared to 2016. Regional disparities were also observed, with the greatest adjusted mortality increases in the Northeast and West. Race-stratified models confirmed disproportionately higher pandemic-era mortality among minority groups

Conclusion

In-hospital stroke mortality rose significantly during the COVID-19 era, with disproportionately greater increases among racial and ethnic minority groups and socioeconomically vulnerable patients. These findings underscore the need for equity-focused interventions in stroke systems of care.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.