NCHS Data Brief ■ No. 95 ■ May 2012

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Hospitalization for Stroke in U.S. Hospitals, 1989–2009

Margaret Jean Hall, Ph.D.; Shaleah Levant, M.P.H.; and Carol J. DeFrances, Ph.D.

Key findings

•	 The rate of hospitalization 

for stroke (cerebrovascular 

disease) per 10,000 population 

increased from 32.4 in 1989 

to 34.9 in 1999, and then 

decreased to 31.8 in 2009. 

•	 About 800,000 

hospitalizations for stroke 

occurred in 1989 and almost 

1 million in 1999 and 2009. 

More than two-thirds of these 

hospitalizations were for 

patients aged 65 and over. 

•	 The stroke hospitalization 

rate from 1999 to 2009 

decreased 20% for those aged 

65–74 and 85 and over, and 

24% for those aged 75–84. 

•	 The rate of hospitalization 

for older stroke patients 

increased with advancing age in 

1989, 1999, and 2009. 

•	 The average length of stay 

for stroke patients was similar 

in 1999 (5.4 days) and 2009 

(5.3 days). These stays were 

significantly shorter than the

10.2-day average stay in 1989. 

•	 A smaller proportion of 

stroke patients died in the 

hospital in 2009 (5%) than in 

1989 (9%). 

An estimated 7 million Americans have had a stroke (cerebrovascular disease) 

(1). In 2008, direct medical costs of stroke were about $18.8 billion, with 

almost half of this amount being for hospitalization (1). Stroke was the fourth 

leading U.S. cause of death in 2009 and 2010 (2,3). 

Numerous public health campaigns have sought to educate the public on how 

to lower stroke risk: for example, by increasing physical activity, controlling 

weight, stopping smoking, and taking medication to lower high blood pressure 

and high cholesterol (4,5). This report examines nationally representative data 

from 1989 to 2009 to see how inpatient hospital care for stroke has changed.

Keywords: inpatient care • health care utilization • cerebrovascular disease • 

National Hospital Discharge Survey

Has the rate of hospitalization for stroke changed from 1989 

to 2009?

•	 The rate of hospitalization for stroke increased from 32.4 to 34.9 per 10,000 

population from 1989 to 1999, but by 2009 the rate had decreased to 31.8 per 

10,000 (Figure 1). Rate per 10,000 population

0

50

100

150

200

250

300

350

400

450

Total

85 years and over

75–84 years

65–74 years

Under 65 years

1989 1991 1993 1997 1995 1999 2001 2003 2005 2007 2009

Figure 1. Hospitalization rates for stroke, by age: United States, 1989–2009

NOTE: Significant linear trend in rates for stroke was observed from 1999 through 2009 for age groups 65–74, 75–84, and 85 

years and over, and total hospitalizations.

SOURCE: CDC/NCHS, National Hospital Discharge Survey, 1989–2009.
NCHS Data Brief ■ No. 95 ■ May 2012

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•	 The stroke hospitalization rate increased 5% for those aged 65–74 from 1989 to 1999, and 

then decreased 20% from 1999 to 2009. For those aged 75 and over, the rates did not change 

significantly from 1989 to 1999, but from 1999 to 2009 the rate decreased 24% for those aged

75–84 and 20% for those 85 and over.

Have the characteristics of persons hospitalized for stroke changed 

between 1989 and 2009?

•	 There were close to 800,000 hospitalizations for stroke in 1989 and almost 1 million in both 

1999 and 2009 (see Table). 

•	 In 1989, the proportion of those hospitalized for stroke who were male was 43%, but by 2009 

the share of males and females was similar.

•	 The average age of stroke patients (70–71 years) was similar in 1989, 1999, and 2009.

Table. Number and characteristics of hospitalizations for stroke: United States, 1989, 1999, and 2009 

Characteristic 1989 1999 2009

Total stroke hospitalizations 795,000 961,000 971,000

Average age of hospital inpatients (years) 71 71 70

Percent

Proportion by sex

Male 43 45 48

Female 57 55 52

Proportion by age group

Under 65 years 24 27 34

65 years and over 76 73 66

Proportion with comorbidities

Diabetes 18 23 23

Hypertension 37 55 58

Atrial fibrillation 10 12 12

At least one of the above comorbidities1 65 91 94

1

Percentage of stroke inpatients with one or more of the above comorbidities in diagnostic fields 2 through 7 on the National Hospital Discharge Survey patient

medical abstract form.

SOURCE: CDC/NCHS, National Hospital Discharge Survey, 1989, 1999, and 2009.
NCHS Data Brief ■ No. 95 ■ May 2012

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•	 The percentage of stroke hospitalizations with a comorbidity (secondary diagnosis) of diabetes 

rose from 18% in 1989 to 23% in 1999, but remained the same from 1999 to 2009. Stroke 

hospitalizations with a comorbidity of hypertension increased from 37% in 1989 to 55% in 1999. 

In 2009 the percentage with hypertension was 58%, but this was not a significant change from

1999. These conditions, as well as atrial fibrillation (which did not change over this time period),

have been shown to increase the risk of stroke (1). 

What is the relationship between age and hospitalization for stroke? 

•	 The rate of hospitalization for stroke for the population aged 65 and over increased with age in 

1989, 1999, and 2009 (Figure 2). 

•	 The rate of hospitalization for stroke for those aged 85 and over was three times the rate for 

those aged 65–74 in 1989, and in 1999 and 2009 it was more than two and one-half times greater 

for the group aged 85 and over compared with those aged 65–74. Rate per 10,000 population

0

50

100

150

200

250

300

350

400

1989 1999 2009

65–74 years 75–84 years 85 years and over

Figure 2. Hospitalization rates for stroke for those aged 65 and over: United States, 1989, 1999, and 2009

NOTE: Rates are significantly higher for each successive age group in every year.

SOURCE: CDC/NCHS, National Hospital Discharge Survey, 1989, 1999, and 2009.

129.3 135.6

108.1

265.3 257.3

196.5

385.8

359.3

288.3
NCHS Data Brief ■ No. 95 ■ May 2012

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Did the length of hospital stay for stroke inpatients change from 1989 to 

2009?

•	 The average length of stay for stroke patients was 10.2 days in 1989, 5.4 days in 1999, and 5.3 

days in 2009 (Figure 3).

•	 From 1989 to 1999, the average length of stay for stroke patients decreased 47%. During this 

same period, the length of stay for all hospitalizations decreased 23%.

•	 From 2000 to 2009, the average length of stay for all patients, as well as for stroke patients, did 

not change significantly. Days

1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009

0

2

4

6

8

10

12

All patients

Stroke patients

Figure 3. Average length of stay for hospitalizations for stroke: United States, 1989–2009

NOTE: A significant linear trend was observed from 1989 to 1999 for all and for stroke inpatients.

SOURCE: CDC/NCHS, National Hospital Discharge Survey, 1989–2009.
NCHS Data Brief ■ No. 95 ■ May 2012

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Was there a change in the discharge status of stroke patients from 1989 to 

2009?

•	 In 1989, 1999, and 2009, similar proportions of patients hospitalized for stroke were routinely 

discharged (generally to home), discharged to other short-term hospitals, or discharged to longterm care institutions (Figure 4). 

•	 In 1989 and 1999, similar proportions of stroke patients died in the hospital, but in 2009 the 

percentage who died in the hospital was significantly lower than in 1989.

•	 Although stroke inpatients made up only about 3% of total hospitalizations, they died at more 

than twice the rate of other patients in 1989, 1999, and 2009 (data not shown). Percent

0

10

20

30

40

50

60

70

Long-term care Died Other

institution

Short-term

hospital

Routine

Figure 4. Discharge disposition of stroke patients: United States, 1989, 1999, and 2009

62

5

16

8 9

57

7

18

7

11

59

5

18

5

12

1989 1999 2009

SOURCE: CDC/NCHS, National Hospital Discharge Survey, 1989, 1999, and 2009.

Discharge disposition
NCHS Data Brief ■ No. 95 ■ May 2012

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Summary

Stroke remains one of the most significant U.S. health problems (6). Although the stroke 

hospitalization rate has declined, in 2009 there were still almost 1 million hospitalizations for 

stroke. Many stroke patients, upon discharge, went to another short-stay hospital or a long-term 

care institution. In addition, outpatient or in-home services (including rehabilitation) are often 

provided to those who have had a stroke, to prevent future strokes and to restore functioning 

(6,7). 

In 2011, the U.S. Department of Health and Human Services announced its “Million Hearts” 

campaign, which aims to prevent 1 million heart attacks and strokes over the next 5 years (8). 

Efforts like this are especially important because the baby boomer population is aging into the 

years when strokes are more common. It is important to continue to track the number and rate 

of stroke hospitalizations, in order to gauge the effects of campaigns like Million Hearts as well 

as the effectiveness of provisions in health care legislation (including the Patient Protection and 

Affordable Care Act) that promote preventive care and coordination of care. 

Definitions

Stroke (cerebrovascular disease): An interruption in the blood supply to any part of the brain (9).

Hospitalization for stroke: A hospitalization with stroke as the principal or first-listed diagnosis.

The definition includes hospitalizations for acute stroke, transient ischemic attack, and for late

effects of stroke. That is, stroke is the main cause or reason for the hospitalization and is recorded 

using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–

CM) codes 430–438 (10).

Comorbidities (secondary diagnoses): Conditions that are recorded in diagnostic fields 2

through 7 on the National Hospital Discharge Survey (NHDS) patient medical abstract form. 

The comorbidities included in this report are those discussed as being risk factors for stroke (1): 

hypertension (high blood pressure), ICD–9–CM codes 401–405; diabetes, code 250; and atrial 

fibrillation, code 427.31. Inpatients having any of these secondary diagnoses are counted, but not

the number of times they have these diagnoses. In other words, if an inpatient had one or more 

diabetes codes in fields 2 through 7 the patient would still be counted only once.

Rate: The number of hospitalizations per unit of population (i.e., per 10,000 population in this 

study).

Data source and methods

Data for this report are from NHDS—a national probability sample survey of discharges from 

nonfederal, short-stay hospitals or general hospitals in the United States, conducted annually by 

the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics, 

Division of Health Care Statistics. NHDS uses a modified three-stage design. Units selected at the

first stage consist of either hospitals or geographic areas such as counties, groups of counties, or

metropolitan statistical areas. Next, within a sampled geographic area, hospitals are selected. At 

the last stage, systematic random sampling is used to select discharges within sampled hospitals. 

Survey data on hospital discharges were obtained from the hospitals’ administrative data. 
NCHS Data Brief ■ No. 95 ■ May 2012

■  7  ■

Note that if an individual is admitted to the hospital multiple times during the survey year, that 

individual will be counted more than once in NHDS. 

Because of the complex multistage design of NHDS, the survey data must be inflated or weighted

in order to produce national estimates. Estimates of inpatient care presented in this report exclude 

newborns. More details about the design of NHDS have been published elsewhere (11). 

Trend data from the 2000–2009 NHDS were used in creating Figures 1 and 3. A weighted least 

squares regression method (12) was used to test the significance of the time trends shown. Figures

2 and 4, and the table, contain data from 1989, 1999, and 2009. 

Differences among subgroups were evaluated with two-tailed t tests using p < 0.05 as the level 

of significance. Terms that express differences, such as “higher,” “lower,” “largest,” “smallest,”

“leading,” “increased,” or “decreased,” were used only when the differences were statistically 

significant. When a comparison is described as “similar,” it means that no statistically significant

difference was found. All comparisons reported in the text were statistically significant unless

otherwise indicated. Data analyses were performed using the statistical packages SAS version 

9.2 (SAS Institute, Cary, N.C.) and SUDAAN version 10.0 (RTI International, Research Triangle 

Park, N.C.). 

About the authors

Margaret Jean Hall, Shaleah Levant, and Carol J. DeFrances are with CDC’s National Center for 

Health Statistics, Division of Health Care Statistics. 

References 

1. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease

and stroke statistics—2012 update: A report from the American Heart Association. Circulation 

125(1):188–97. 2012.

2. Kochanek KD, Xu JQ, Murphy SL, et al. Deaths: Preliminary data for 2009. National vital 

statistics reports; vol 59 no 4. Hyattsville, MD: National Center for Health Statistics. 2011. 

Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_04.pdf.

3. Murphy SL, Xu JQ, Kochanek KD. Deaths: Preliminary data for 2010. National vital statistics 

reports; vol 60 no 4. Hyattsville, MD: National Center for Health Statistics. 2012. Available from: 

http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf.

4. Goldstein LB, Bushnell RJ, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al. Guidelines 

for the primary prevention of stroke: A guideline for healthcare professionals from the American 

Heart Association/American Stroke Association. Stroke 42(2):517–84. 2011.

5. Brownstein JN. Addressing heart disease and stroke prevention through comprehensive 

population-level approaches. Prev Chronic Dis 5(2):A31. 2008. Available from: http://www.cdc.

gov/pcd/issues/2008/apr/07_0251.htm. Accessed November 2011.

6. Demaerschalk BM, Hwang HM, Leung G. U.S. cost burden of ischemic stroke: A systematic 

literature review. Am J Manag Care. 16(7):525–33. 2010.
NCHS Data Brief ■ No. 95 ■ May 2012

7. Lee WC, Christensen MC, Joshi AV, Pashos CL. Long-term cost of stroke

subtypes among Medicare beneficiaries. Cerebrovasc Dis 23(1):57–65. 2007.

8. New public-private sector initiative aims to prevent 1 million heart 

attacks and strokes in five years [press release]. HHS News, 13 Sep 2011.

U.S. Department of Health and Human Services. Available from: http://www.

hhs.gov/news/press/2011pres/09/20110913a.html.

9. Stroke. PubMed Health, ADAM Medical Encyclopedia. Bethesda, MD: 

U.S. National Library of Medicine, National Institutes of Health. Available 

from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001740/. Accessed 

October 2011.

10.U.S. Department of Health and Human Services. Centers for Disease 

Control and Prevention, Centers for Medicare & Medicaid Services. 

International classification of diseases, ninth revision, clinical modification,

6th ed. DHHS Pub No. (PHS) 06–1260. 2006. Available from: http://www.

cdc.gov/nchs/icd/icd9cm.htm.

11. Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A. National Hospital

Discharge Survey: 2007 summary. National health statistics reports; no 29. 

Hyattsville, MD: National Center for Health Statistics. 2010. Available from: 

http://www.cdc.gov/nchs/data/nhsr/nhsr029.pdf.

12.Gillum BS, Graves EJ, Kozak LJ. Trends in hospital utilization: United 

States, 1988–92. National Center for Health Statistics. Vital Health Stat 

13(124). 1996. Available from: http://www.cdc.gov/nchs/data/series/sr_13/

sr13_124.pdf.

Suggested citation

Hall MJ, Levant S, DeFrances CJ. 

Hospitalization for stroke in U.S. hospitals, 

1989–2009. NCHS data brief, no 95. 

Hyattsville, MD: National Center for Health 

Statistics. 2012.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

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