Dovepress stroke Age Male Midwest Northeast West Hypertension Diabetes TiA cOPD cHF Mi Table 6 cox proportional hazards analysis of time to death Outcome Cox proportional hazards model Hazard ratio 1.808 0.990 1.102 0.965 1.230 1.540 0.947 0.883 2.290 1.392 1.082 1.006 SE 0.310 0.006 0.166 0.156 0.316 0.458 0.145 0.154 0.643 0.278 0.220 0.322 P value 0.001 0.099 0.520 0.825 0.420 0.147 0.719 0.474 0.003 0.098 0.697 0.984 95% CI lower 95% CI upper 1.291 0.979 0.820 0.703 0.744 0.859 0.702 0.627 1.321 0.941 0.727 0.537 Abbreviations: CHF, congestive heart failure; CI, confidence interval; COPD, chronic obstructive pulmonary disease; Mi, myocardial infarction; sE, standard error; TiA, transient ischemic attack. As in other studies, clinical outcomes such as hospi- talization, additional stroke, and death were substantially higher among stroke patients compared with controls and among recurrent stroke patients compared with new stroke patients. Although our measurement period was different from that used by Samsa et al7 and by Vickery et al,19 trends in reported outcomes were similar. TIA and stroke were the most common clinical events occurring in the follow-up period. However, compared with Vickery et al,19 our rates of subsequent stroke were much lower. This study confirms previous reports that patients with ischemic stroke and TIA are more at risk for recurrent cere- brovascular events compared with cardiac events.20–22 In a Table 7 generalized linear modeling of per-patient-per-year total costs Generalized linear model Cost ratio (ExpB) P value 95% CI lower 95% CI upper stroke Age Male Midwest Northeast West Hypertension Diabetes TiA cOPD cHF Mi 3.821 1.008 1.011 0.939 0.945 1.006 1.348 1.247 1.064 1.445 1.560 1.327 SE 0.242 0.002 0.054 0.054 0.087 0.101 0.081 0.100 0.167 0.177 0.235 0.338 0.000 0.000 0.838 0.276 0.539 0.951 0.000 0.006 0.692 0.003 0.003 0.266 3.375 1.004 0.911 0.838 0.788 0.827 1.198 1.065 0.782 1.137 1.162 0.806 Abbreviations: CHF, congestive heart failure; CI, confidence interval; COPD, chronic obstructive pulmonary disease; ExpB, exponentiated coefficients; MI, myocardial infarction; sE, standard error; TiA, transient ischemic attack. Vascular Health and Risk Management 2010:6 2.531 1.002 1.479 1.324 2.034 2.759 1.277 1.242 3.969 2.060 1.611 1.885 4.325 1.013 1.122 1.052 1.133 1.224 1.516 1.460 1.447 1.836 2.094 2.186 costs and outcomes of ischemic stroke retrospective study of patients with ICD codes for ischemic stroke/TIA, Brown et al21 reported that cardiac events at 2 years had occurred in 7.7% of patients. Acute MI was the most common cardiac event reported. We found similar rates of MI (1.7%) compared with results reported by Vickery et al (1.5%).19 Similar to our study, Samsa et al7 found that in a Medicare population, recurrent stroke patients experienced a greater cost burden in 1 year following the index event compared with new stroke patients. All stroke patients had substantially higher costs than controls. Samsa et al7 reported that the cost burden for new and recurrent stroke the first year, including index hospitalization, was approximately $29,000 and $32,000, respectively. At the time of the Samsa7 study, Medicare did not cover outpatient pharmacy costs, which represented ∼11% of total cost in our study. In addition, other technological changes that have increased the cost of health care in general are likely contributing to the overall higher burden of illness observed in our study. Interestingly, according to the American Heart Asso- ciation, 36% of direct health care costs are allocated toward nursing home care. Because the commercial health plan covers only limited short-term nursing home care, our study probably underestimates the overall true burden of stroke.23 In addition to the limitations described above in the interpretation of our data, additional limitations may impact the results reported here. First, as with all studies relying on retrospective administrative claims data, there are limits to the degree to which claims data can accurately capture an indi- vidual’s medical history. Also, although comorbid conditions were considered controls in the modeling, the underlying health status of the stroke cohort may have been considerably worse than the control patients, resulting in the inappropriate attri- bution of rate and cost differentials to the presence of stroke. However, because stroke may occur in otherwise healthy adults and the major comorbidities contributing to excess costs were accounted for in the analysis, including hypertension and diabetes, we believe that the substantial burden of stroke is accurately reflected in this analysis. It is possible that the study underestimated the cost burden of stroke; the stroke popula- tion had a shorter length of follow-up than the control cohort, and it is not known how large the health care costs were for patients who disenrolled from the health plan and switched to another insurer or became uninsured. In addition, since the measure of mortality was based upon hospital discharge status in the claims, additional deaths may have occurred outside the inpatient setting that would not have been identi- fied for the study. Estimates of re-hospitalization were based upon the identification of claims for inpatient sites of service submit your manuscript | www.dovepress.com Dovepress 911