Socio-economic gradients in the occurrence of stroke and 30 days in- hospital mortality after a...
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Socio-economic gradients in the occurrence of stroke and 30 days in-hospital mortality after a stroke in Canada 2014 Canadian Population Health Association Conference Toronto, Canada Z. Chaudhary, K. Nguyen, L. Yin, C. Tosevski, Y. Gurevich Canadian Institute for Health Information
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Transcript of Socio-economic gradients in the occurrence of stroke and 30 days in- hospital mortality after a...
Socio-economic gradients in the occurrence of stroke and 30 days in-hospital mortality after a stroke in Canada
2014 Canadian Population Health Association Conference
Toronto, Canada
Z. Chaudhary, K. Nguyen, L. Yin, C. Tosevski, Y. Gurevich
Canadian Institute for Health Information
2
Overview
• Introduction
– Why Stroke?
– Indicators (Stroke Event and 30-Day Stroke In-hospital Mortality)
• SES lens
• Results
• Concluding remarks
• Resources
3
Why Stroke?
Stroke
Among top 10 causes
of in-hospital mortality
Common cause of hospitalization
Cost
4
Stroke Indicators
• Stroke Event Rate
Age-standardized rate of new stroke events admitted to an acute care hospital, per
100,000 population age 20 and older
• 30-Day Stroke In-Hospital Mortality
The risk-adjusted rate of all-cause in-hospital deaths occurring within 30 days of first
admission to an acute care hospital with a diagnosis of stroke
5
General Methodology
Data Source - Discharge Abstract Database (DAD)
• Acute care hospitalization data from all provinces/territories except Quebec
• Rates for Quebec are not available due to differences in data collection
Level of Reporting - based on patient postal code of residence
• Canada
• Provinces/territories
• Regions
6
SES Lens
Social stratification and income distribution have an impact on population health and safety
Measuring and reporting health disparities are important because some of them may be reduced or prevented
Understanding Stroke in the socio-economic context could help to focus on areas where interventions are more needed
7
SES Lens (cont’d)
• Neighbourhood Income Quintile - used as a proxy for SES (Quintile 1 – least affluent, Quintile 5 - most affluent)
• Disparity Rate Ratio
Ratio of the rate of a health indicator for the least affluent neighbourhood income quintile to the rate for the most affluent neighbourhood income quintile
• Potential Rate Reduction
Potential reduction in a health indicator rate that would occur in the hypothetical scenario that
each socio-economic group in the jurisdiction experienced the rate of the most affluent socio- economic group
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Hospitalized Stroke Events Rate - National Trend
2006 2007 2008 2009 2010 2011 2012 201395
100
105
110
115
120
125
130
135
140
145
150
155
160
111109
106105 103
99
152150
146 146
141 139
130
128
124 124
121
118
Combined
Male
Female
Year
Ag
e-S
tan
da
rdiz
ed
Ho
sp
ita
lize
d E
ve
nt
Str
ok
e R
ate
(p
er
10
0,0
00
)
*Age-Standardized Rates exclude Quebec
↓ 9%
↓ 9%
↓ 11%
9
Hospitalized Stroke Event Rate - Provincial Variation FY2007-2008 & FY2012-2013
NL PE NS NB ON MB SK AB BC0
20
40
60
80
100
120
140
160
180
FY07FY12
Province
Ag
e-S
tan
da
rdiz
ed
Ra
te p
er
10
0,0
00
Po
pu
lati
on
130118
10
Stroke Event Rate - by SES FY 2007-2008 & FY 2012-2013
Q1 Q2 Q3 Q4 Q50
20
40
60
80
100
120
140
160
180
154
137129
124116
138
125 123115
109
FY07
FY12
Neighbourhood Income Quintile
Ag
e-s
tan
da
rdiz
ed
ra
te (
pe
r 1
00
,00
0)
11
Stroke Event Rate - by SES and GenderFY 2012-2013
1-Least Affluent 2 3 4 5-Most Affluent0
20
40
60
80
100
120
140
160
180166
150 148
135129
116
103 10397
92
Male
Female
Neighbourhood Income Quintile
Ag
e-S
tan
da
rdiz
ed
Ra
te p
er
10
0,0
00
Po
pu
lati
on
12
Hospitalized Stroke Rates - by SES & ProvinceFY 2012-2013
CA NL PE NS NB ON MB SK AB BC0
20
40
60
80
100
120
140
160
180
200
1-Least Affluent 2 3 4
5-Most Affluent
Ag
e-S
tan
da
rdiz
ed
Ra
te p
er
10
0,0
00
Po
pu
lati
on
PRR-11% ↓
13
30-Day Stroke In-hospital Mortality National Trend
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
5
10
15
20
25
19.2 18.9 18.7 18.6 18.9 19.118.3 18.2 18.0 17.7
16.916.0
15.014.3
Year
Ris
k-A
dju
ste
d R
ate
(%
)
↓ 26%
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30-day In-hospital Stroke Mortality Provincial Variation, 2009 & 2011
NL PE NS NB ON MB SK AB BC0
5
10
15
20
25
FY09
Province
Ris
k-A
dju
ste
d R
ate
(p
er
10
0)
16.014.3
15
30-day In-hospital Stroke Mortality - by SES2009 & 2011
Q1 Q2 Q3 Q4 Q50
2
4
6
8
10
12
14
16
1816.9
16.015.4 15.6 15.8
14.1 13.9 13.813.1 13.1
FY09
FY11
Neighbourhood Income Quintile
Ris
k-A
dju
sted
Rat
er(%
)
PRR-4%↓
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Concluding Remarks
• Hospitalizations for stroke present a consistent association with socio-economic status.
• However once the patients are admitted to hospital difference in stroke mortality rates by socio-economic status are much less
• Examining trends and variations could help jurisdictions identify areas for improvement
• Could be used to target efforts needed to close sex and socio-economic gaps
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Resources
• OurHealthSystem.ca website– Indicator results at national, provincial/territorial and health
region level
www.OurHealthSystem.ca
• Health Indicators e-publication– Indicator results at national, provincial
/territorial and health region level
www.cihi.ca/hirpt
• Indicator Library
– http://indicatorlibrary.cihi.ca
Questions?
Zeerak ChaudharyProject Lead, Health Indicators & Client Support,Canadian Institute for Health Information (CIHI)
Email: [email protected]
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Thank You!
