Adverse outcome after incident stroke hospitalization for Indigenous and non-Indigenous Australians in the Northern Territory

Vincent He, John Condon, Jiqiong You, Yuejen Zhao, James Burrow

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Survival after a stroke is lower for Indigenous than other stroke patients in Australia. It is not known whether recurrence is more common for Indigenous patients, or whether their higher prevalence of comorbidity affects their lower survival.

Aims: 
This study aimed to investigate the stroke recurrence and role of comorbidities in adverse stroke outcomes (recurrence and death) for Indigenous compared with other Australians.

Methods: 
A retrospective cohort study of first hospitalization for stroke (n = 2105) recorded in Northern Territory hospital inpatient data between 1996 and 2011 was conducted. For the multivariable analyses of adverse outcomes, logistic regression was used for case fatality and competing risk analysis for recurrent stroke and long-term death. Comorbidities (identified from inpatient diagnosis data) were analyzed using the Charlson Comorbidity Index (modified for stroke outcomes).

Results: 
Prevalence of comorbidities, case fatality, incidence of re-hospitalization for recurrent stroke, and long-term death rate were higher for Indigenous than non-Indigenous stroke patients. Adjustment for comorbidity in multivariable analyses considerably reduced Indigenous patients' excess risk for case fatality (odds ratio: 1·25, 0·88–1·78) and long-term death (standard hazard ratio: 1·27, 1·01–1·61) (but not recurrence), implying that their excess risk of death was in part due to higher comorbidity prevalence.

Conclusion: 
Indigenous stroke patients have higher prevalence of comorbidities than non-Indigenous stroke patients, which explained part of the disparity in both case fatality and long-term survival but did not explain the disparity in stroke recurrence at all.
Original languageEnglish
Pages (from-to)89-95
Number of pages7
JournalInternational Journal of Stroke
Volume10
Issue numberA100
DOIs
Publication statusPublished - 2015

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Northern Territory
Hospitalization
Stroke
Comorbidity
Recurrence
Survival
Inpatients

Cite this

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title = "Adverse outcome after incident stroke hospitalization for Indigenous and non-Indigenous Australians in the Northern Territory",
abstract = "Background: Survival after a stroke is lower for Indigenous than other stroke patients in Australia. It is not known whether recurrence is more common for Indigenous patients, or whether their higher prevalence of comorbidity affects their lower survival.Aims: This study aimed to investigate the stroke recurrence and role of comorbidities in adverse stroke outcomes (recurrence and death) for Indigenous compared with other Australians.Methods: A retrospective cohort study of first hospitalization for stroke (n = 2105) recorded in Northern Territory hospital inpatient data between 1996 and 2011 was conducted. For the multivariable analyses of adverse outcomes, logistic regression was used for case fatality and competing risk analysis for recurrent stroke and long-term death. Comorbidities (identified from inpatient diagnosis data) were analyzed using the Charlson Comorbidity Index (modified for stroke outcomes).Results: Prevalence of comorbidities, case fatality, incidence of re-hospitalization for recurrent stroke, and long-term death rate were higher for Indigenous than non-Indigenous stroke patients. Adjustment for comorbidity in multivariable analyses considerably reduced Indigenous patients' excess risk for case fatality (odds ratio: 1·25, 0·88–1·78) and long-term death (standard hazard ratio: 1·27, 1·01–1·61) (but not recurrence), implying that their excess risk of death was in part due to higher comorbidity prevalence.Conclusion: Indigenous stroke patients have higher prevalence of comorbidities than non-Indigenous stroke patients, which explained part of the disparity in both case fatality and long-term survival but did not explain the disparity in stroke recurrence at all.",
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author = "Vincent He and John Condon and Jiqiong You and Yuejen Zhao and James Burrow",
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Adverse outcome after incident stroke hospitalization for Indigenous and non-Indigenous Australians in the Northern Territory. / He, Vincent; Condon, John; You, Jiqiong; Zhao, Yuejen; Burrow, James.

In: International Journal of Stroke, Vol. 10, No. A100, 2015, p. 89-95.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Adverse outcome after incident stroke hospitalization for Indigenous and non-Indigenous Australians in the Northern Territory

AU - He, Vincent

AU - Condon, John

AU - You, Jiqiong

AU - Zhao, Yuejen

AU - Burrow, James

PY - 2015

Y1 - 2015

N2 - Background: Survival after a stroke is lower for Indigenous than other stroke patients in Australia. It is not known whether recurrence is more common for Indigenous patients, or whether their higher prevalence of comorbidity affects their lower survival.Aims: This study aimed to investigate the stroke recurrence and role of comorbidities in adverse stroke outcomes (recurrence and death) for Indigenous compared with other Australians.Methods: A retrospective cohort study of first hospitalization for stroke (n = 2105) recorded in Northern Territory hospital inpatient data between 1996 and 2011 was conducted. For the multivariable analyses of adverse outcomes, logistic regression was used for case fatality and competing risk analysis for recurrent stroke and long-term death. Comorbidities (identified from inpatient diagnosis data) were analyzed using the Charlson Comorbidity Index (modified for stroke outcomes).Results: Prevalence of comorbidities, case fatality, incidence of re-hospitalization for recurrent stroke, and long-term death rate were higher for Indigenous than non-Indigenous stroke patients. Adjustment for comorbidity in multivariable analyses considerably reduced Indigenous patients' excess risk for case fatality (odds ratio: 1·25, 0·88–1·78) and long-term death (standard hazard ratio: 1·27, 1·01–1·61) (but not recurrence), implying that their excess risk of death was in part due to higher comorbidity prevalence.Conclusion: Indigenous stroke patients have higher prevalence of comorbidities than non-Indigenous stroke patients, which explained part of the disparity in both case fatality and long-term survival but did not explain the disparity in stroke recurrence at all.

AB - Background: Survival after a stroke is lower for Indigenous than other stroke patients in Australia. It is not known whether recurrence is more common for Indigenous patients, or whether their higher prevalence of comorbidity affects their lower survival.Aims: This study aimed to investigate the stroke recurrence and role of comorbidities in adverse stroke outcomes (recurrence and death) for Indigenous compared with other Australians.Methods: A retrospective cohort study of first hospitalization for stroke (n = 2105) recorded in Northern Territory hospital inpatient data between 1996 and 2011 was conducted. For the multivariable analyses of adverse outcomes, logistic regression was used for case fatality and competing risk analysis for recurrent stroke and long-term death. Comorbidities (identified from inpatient diagnosis data) were analyzed using the Charlson Comorbidity Index (modified for stroke outcomes).Results: Prevalence of comorbidities, case fatality, incidence of re-hospitalization for recurrent stroke, and long-term death rate were higher for Indigenous than non-Indigenous stroke patients. Adjustment for comorbidity in multivariable analyses considerably reduced Indigenous patients' excess risk for case fatality (odds ratio: 1·25, 0·88–1·78) and long-term death (standard hazard ratio: 1·27, 1·01–1·61) (but not recurrence), implying that their excess risk of death was in part due to higher comorbidity prevalence.Conclusion: Indigenous stroke patients have higher prevalence of comorbidities than non-Indigenous stroke patients, which explained part of the disparity in both case fatality and long-term survival but did not explain the disparity in stroke recurrence at all.

KW - adult

KW - adverse outcome

KW - age

KW - Article

KW - Australia

KW - brain hemorrhage

KW - brain ischemia

KW - cerebrovascular accident

KW - Charlson Comorbidity Index

KW - cohort analysis

KW - comorbidity

KW - congestive heart failure

KW - controlled study

KW - death

KW - diabetes mellitus

KW - fatality

KW - female

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KW - hospital readmission

KW - hospitalization

KW - human

KW - hypertension

KW - incidence

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KW - kidney failure

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KW - non indigenous people

KW - outcome assessment

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KW - risk assessment

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U2 - 10.1111/ijs.12600

DO - 10.1111/ijs.12600

M3 - Article

VL - 10

SP - 89

EP - 95

JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

IS - A100

ER -