Dovepress events versus 9 incident TIA events per 1000 patient-years). Similarly, the rates of MI and fatal MI were higher among stroke patients compared with general-population controls (11 incident MIs versus 6 incident MIs per 1000 patient- years; 2 fatal MIs versus ,1 fatal MI per 1000 patient-years); however, this did not reach statistical significance. Recurrent stroke patients had the highest risk of all-cause mortality (86 deaths per 1000 patient-years), followed by new stroke patients and controls (37 deaths and 4 deaths per 1000 patient- years, respectively) (Table 2). The average cost of index hospitalization was $15,634 (SD $27,536) for new stroke patients and $17,121 (SD $53,693) for recurrent stroke patients (Table 3). Among the 168 (2.6%) patients in the control cohort with a hospitalization on the index date, the average cost of hospitalization was $11,281 (SD $29,052). Patients in the stroke cohort had significantly greater costs in the first year following the index event com- pared with controls. Medical costs averaged $23,725 (SD $58,227) per stroke patient compared with an average of $5142 (SD $16,619) per control. Similarly, pharmacy costs averaged $2950 (SD $3549) per stroke patient compared with an average of $1388 ($2302) per control. Total combined costs were $26,675 (SD $58,605) per stroke patient per year. Recurrent stroke patients had 38% higher costs compared with new stroke patients, averaging $34,639 per patient in the first year following discharge from the index hospitalization compared with $25,036 per new stroke patient. Adjusted analysis After adjusting for covariates, results from the Cox pro- portional hazards model suggested that stroke patients were 2.4 times more likely to be hospitalized in follow-up compared with control subjects (HR 2.4; 95% CI: 2.2–2.6) (Table 4). Older age was associated with a greater risk of hospitalization, with a 2% increase in hazard of being hospitalized for each additional year of age (P , 0.001). costs and outcomes of ischemic stroke Patients who were male and who lived in the Northeast had a lower hazard of being hospitalized by 8% (95% CI: 0.8, 1.0) and 13% (95% CI: 0.7, 1.0), respectively. In addition, patients with pre-index comorbid conditions had higher hazards of being hospitalized over the follow-up compared to patients without these conditions. Specifically, the haz- ard of hospitalization was higher by 26% for hypertension (95% CI: 1.1, 1.4), 28% for diabetes (95% CI: 1.1, 1.4), and 29% for TIA (95% CI: 1.1, 1.4). Patients with COPD faced even higher increases in the risk of hospitalization, with a 57% increased hazard compared to patients without COPD (95% CI: 1.3, 1.8). CHF and MI also conferred additional risk of hospitalization by 79% and 50%, respectively (CHF 95% CI: 1.5, 2.1; MI 95% CI: 1.1, 2.1). Cox proportional hazards model results indicated that occurrence of stroke following discharge was 21 times more likely among stroke patients compared with control subjects (95% CI: 16.1–27.3) (Table 5). No other covariates were significant predictors of subsequent stroke in this model. Being in the stroke cohort was predictive of death in follow-up after adjusting for covariate (Table 6); stroke patients were 1.8 times more likely to die in follow-up compared with control patients (95% CI: 1.3–2.5). Diagnosis of TIA in the pre-index period was the only other covariate that was statistically significant in the model; patients with pre-index TIA had a hazard of dying that was 2.3 times that of patients without prior TIA (95% CI: 1.3, 4.0). Stroke patients had significantly higher costs compared with control patients in the year following the index event controlling for age, gender, region, and comorbid conditions (Table 7). Total costs were 3.8 times higher among stroke patients compared with control patients, ranging from 3.4 times to 4.3 times higher (P , 0.001). Compared to patients without these comorbid condition, hypertension, diabetes, COPD, and CHF, all were associated with higher costs in follow-up, with cost ratios ranging from 1.2 higher Table 2 Unadjusted rates of clinical events during follow-up period Patients with an event (%) Total ischemic stroke [rate per 1000 patient-years] cohort (N = 2180) Hospitalization 752 (34.5) [307] Any stroke 340 (15.6) [115] Fatal stroke 19 (0.9) [6] Hemorrhagic stroke 45 (2.1) [13] Fatal hemorrhagic stroke 5 (0.2) [1] TiA 483 (22.1) [186] Mi 38 (1.7) [11] Fatal Mi 7 (0.3) [2] All-cause mortality 151 (6.9) [44] Abbreviations: Mi, myocardial infarction; TiA, transient ischemic attack. New stroke (N = 1808) 619 (34.2) [294] 272 (15.0) [107] 15 (0.8) [5] 33 (1.8) [12] 4 (0.2) [1] 388 (21.5) [173] 32 (1.8) [11] 5 (0.3) [2] 108 (6.0) [37] Vascular Health and Risk Management 2010:6 Recurrent stroke (N = 372) 133 (35.8) [382] 68 (18.3) [165] 4 (1.1) [8] 12 (3.2) [25] 1 (0.3) [2] 95 (25.5) [266] 6 (1.6) [12] 2 (0.5) [4] 43 (11.6) [86] Control cohort (N = 6540) 1387 (21.2) [100] 73 (1.1) [5] 3 (0.1) [0] 14 (0.2) [1] 1 (0.0) [0] 138 (10.0) [9] 101 (1.5) [6] 5 (0.1) [0] 69 (1.1) [4] submit your manuscript | www.dovepress.com Dovepress 909