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Sunday 23rd October 2016

US cost of stroke care rises

31st August 2006

04092006_hispanic_women1.jpgA study published online in Neurology has found that in the next half century, the United States will face an “enormous� burden of stroke, estimated at a total $2.2 trillion.

The cost will disproportionately affect its Hispanic and African-American populations. It finds that stroke is the third leading cause of death in the United States and the leading cause of adult disability.

The study looked at the projected costs of ischaemic stroke from 2005 to 2050 in non-Hispanic white, Hispanic, and African-American people. The authors conclude that the greatest economic effect will be lost earnings, followed by the cost of rehabilitation.

African-American and Hispanic US citizens have higher incidences of ischaemic stroke than their non-Hispanic counterparts.  Hispanic and African-American will lose more earnings because their median age is 10 to 13 years younger than white people, and they tend to have strokes at younger ages, before retirement.

About half of the total predicted costs were accounted for by patients with stroke aged 45 to 64 years. People aged 85 years and older accounted for only 10% of the costs, although strokes were more common in this age group. The study says that intervention should be directed at younger groups.

Hispanic and African-American people have a higher prevalence of risk factors such as high blood pressure, diabetes, smoking and obesity. They are also less likely to have received education about the warning signs for stroke or stroke prevention; to have health insurance;  and to have access to quality health care. Non-Hispanic white people have a higher prevalence of atrial fibrillation and coronary artery disease. 

Prophylactic warfarin in atrial fibrillation, use of tissue plasminogen activator to treat acute ischaemic stroke, smoking cessation programmes, and treatment of hypertension could be used to limit cost said lead author, Devin Brown.  Increased use tissue plasminogen activator would improve outcomes and 'hopefully decrease lost earnings as treatment with tissue plasminogen activator leads to a 30-50% increased chance of being normal or near normal at three months after a stroke. Twenty to twenty fiver per cent of patients arrive in the emergency department within three hours of symptoms starting—the window for using tissue plasminogen activator, howwever only 3-8.5% of eligible patients receive the drug.

The direct costs of stroke were admission to hospital; ambulance services; inpatient and outpatient rehabilitation; nursing homes; visits to outpatient neurology clinics; drugs; doctors’ visits; and informal care giving. Only about half of stroke patients return to work therefore indirect costs included lost earnings for people younger than 65.

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