Cardiovascular Health Indicator
Measure: Stroke Hospitalization Rate

Analysis

As shown in Table 1, the total number of hospitalizations of Minnesotans due to stroke and transient ischemic attacks (TIA) has remained fairly stable from 2007 through 2015, followed by an increase of more than 1,700 annual hospitalizations through 2019. TIAs are temporary blockages in the blood supply to the brain. Sometimes these are called “mini-strokes.” The rate of hospitalization for all stroke and TIA declined in a steady fashion, until leveling out in recent years, as shown in Chart 1. The average hospitalization rate was relatively stable from 2015 through 2019, before dropping significantly in 2020, the first year of the COVID-19 pandemic.

Table 1: Total Hospitalizations and Hospitalization Rate due to Stroke and TIA for all Minnesotans, 2007-2021

Chart 1: Age-adjusted Hospitalization Rate due to Stroke and TIA for all Minnesotans, 2007-2021

Table 2 shows the number of hospitalizations and hospitalization rate by year for younger (ages 18-44), middle-aged (ages 45-64), and older (ages 65+) adults. In each year, the vast majority of hospitalizations is occurring in older adults 65 years and older. The overall decline in the rate of stroke and TIA hospitalization rates appears to be driven exclusively by declines in the rate of stroke among older adults aged 65 or older.

Table 2: Total Hospitalizations and Hospitalization Rate due to Stroke and TIA for adult Minnesotans by age group, 2007-2021

Chart 2A shows the rate of hospitalizations for stroke for 18-44 year olds. Between 2007 and 2016, the overall rate remained essentially unchanged, hovering between 26 and 30 hospitalizations per 100,000 per year. Since 2017, the hospitalization rate has exceeded 30 per 100,000 per year, higher than in any year going back to 2007. Despite large drops in overall stroke hospitalizations in the first year of the COVID-19 pandemic, the number of stroke hospitalizations in younger adults increased again in 2020, and was almost 25% higher than in 2009.

Chart 2A: Hospitalization Rate due to Stroke and TIA for Minnesotans ages 18-44, 2007-2021

Chart 2B shows the hospitalization rate for stroke for 45-64 year olds. Like for younger adults, the overall hospitalization rate has remained essentially unchanged over the 2007 to 2015 time period, hovering between 201 and 215 hospitalizations per 100,000 per year. Between 2015 and 2019, the rate increased by 34 hospitalizations per 100,000 per year, or about 17%. In 2020, the hospitalization rate dropped by more than 8%, with only a small increase in 2021. It is unclear if these recent changes are a trend or are temporary impacts of the COVID-19 pandemic.

Chart 2B: Hospitalization Rate due to Stroke and TIA for Minnesotans ages 45-64, 2007-2021

Chart 2C shows the rate of hospitalizations for stroke for individuals 65 years and older. Between 2007 and 2016, the overall rate dropped by 343 hospitalizations per 100,000 per year, or about 25%. Unlike in the younger and middle-aged adults, this long-term decline was consistent through 2016, followed by very little change in the hospitalization rate from 2016 through 2019. In 2020, the hospitalization rate dropped by 14%, with an increase of 3% in 2021. It is unclear if these recent changes are a trend or are temporary impacts of the COVID-19 pandemic.

Chart 2C: Hospitalization Rate due to Stroke and TIA for Minnesotans ages 65+, 2007-2021

Other Resources

• Interactive Atlas of Heart Disease & Stroke
  Online mapping tool from CDC with health indicators (including mortality and hospitalizations), risk factors, social and economic data, health care delivery, insurance, and health care costs data for states and counties. Some census tract data is also available.


• AHRQ HCUPNet
  Online data tool from the Agency for Healthcare Research and Quality (AHRQ) for the Healthcare Cost and Utilization Project (HCUP). Users can download quick tables or create custom queries of national and state-level data on inpatient hospitalization, emergency department, and ambulatory surgery care.





























 
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Data Source

The data were obtained through the Minnesota Hospital Discharge Dataset, also known as the Minnesota Hospital Uniform Billing (UB) Claims Data, provided to the Health Economics Program at the Minnesota Department of Health by the Minnesota Hospital Association. The dataset captures hospitalizations for Minnesota residents and comes from Minnesota hospitals (except for Federal Hospitals owned by the Veterans Administration or the Indian Health Service) or other states that share data with the state of Minnesota (including the bordering states of Iowa, North Dakota, and South Dakota; hospitalizations that occur in Wisconsin for Minnesota residents are not included/shared). Annual population estimates were obtained through the U.S. Census Bureau in collaboration with the National Center for Health Statistics.

Measure Definition

Cerebrovascular Disease (Stroke) hospitalizations through September 30, 2015 are identified as the primary discharge diagnosis of ICD-9: 430-438, including Hemorrhagic Stoke as ICD-9: 430-431, Ischemic Stroke as ICD-9: 434 and 436, and Transient Ischemic Attack (TIA) as ICD-9: 435. Starting on October 1, 2015, hospitalizations for cerebrovascular disease (stroke) were identified as the primary discharge diagnosis as ICD-10: I60-I69, including Hemorrhagic Stroke as ICD-10: I60-I62, Ischemic Stroke as ICD-10: I63, and Transient Ischemic Attack (TIA) as ICD-10: G45.9. Patients who are discharged to another hospital are excluded so as to prevent double-counting single events resulting in hospitalizations at multiple facilities.

The change from ICD-9 to ICD-10 introduces some uncertainty in the trend from 2014 through 2016, , because changes in coding may lead to differences in classification of conditions before and after the transition.