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Cerebrovascular Diseases as Primary Hospital Discharge Diagnoses: National Trend (1970–2000) Among Older Adults

¹ Division of Gerontology and Geriatric Medicine, Department of Medicine, Schools of Medicine, and Department of Epidemiology and International Health, School of Public Health, Center for Aging, and Geriatric Heart Failure Clinic, University of Alabama at Birmingham, Section of Geriatrics and Geriatric Heart Failure Clinic, Birmingham VA Medical Center, and Heart Failure Project, Alabama Quality Assurance Foundation, Birmingham, Alabama.
² Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Health Care, Iowa City.
³ Department of Biostatistics, School of Public Health, University of Alabama at Birmingham.
⁴ Sections of Cardiology and Geriatrics, Department of Medicine, New York Medical College, Valhalla, New York, and Mount Sinai School of Medicine, New York, New York.

Address correspondence to Jose Ness, MD, University of Iowa Hospitals and Clinics, Division of General Internal Medicine, Department of Internal Medicine, SE624, GH, 200 Hawkins Drive, Iowa City, IA 52242. E-mail: jose-ness{at}uiowa.edu

Background. Cerebrovascular diseases are a common cause of mortality, morbidity, and hospitalization among older adults. However, the long-term national trends in cerebrovascular disease-related hospitalizations in this age group are not well known.

Methods. We used the National Center for Health Statistics trend data from the National Hospital Discharge Surveys (1970–2000) to determine incidence of cerebrovascular disease-related hospitalizations among persons 65 years and older in the United States. Only patients discharged with a primary discharge diagnosis of cerebrovascular disease were included. We estimated rates of hospitalization per 1000 civilian residents 65 years and older, for all patients and stratified by age, sex, and race.

Results. Among persons 65 years of age and older, the total number of cerebrovascular disease-related hospitalizations increased from 372,000 in 1970 to 711,000 in 2000. However, the rates of hospitalization due to cerebrovascular disease remained unchanged at 20.7/1000 in 1970 and 20.4/1000 in 2000. The rates for persons 75–84 years and >85 years were, respectively, 2 and 3 times higher than that for persons 65–74 years throughout the study period. Rates for men and women were comparable and stable during the study period. Rates for African Americans, in contrast, increased from 14/1000 in 1970 to 20.6/1000 in 2000, peaking in 1985 (27.4/1000).

Conclusions. The overall rates of hospitalization due to cerebrovascular disease remained high yet stable. However, the absolute number of hospitalizations due to cerebrovascular disease increased considerably, with potential for serious social, financial, and public health implications for the coming decades.

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