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Stroke and the 'Stroke Belt' in Dialysis: Contribution of Patient Characteristics to Ischemic Stroke Rate and Its Geographic Variation
- Publication Year :
- 2013
- Publisher :
- American Society of Nephrology, 2013.
-
Abstract
- Geographic variation in stroke rates is well established in the general population, with higher rates in the South than in other areas of the United States. ESRD is a potent risk factor for stroke, but whether regional variations in stroke risk exist among dialysis patients is unknown. Medicare claims from 2000 to 2005 were used to ascertain ischemic stroke events in a large cohort of 265,685 incident dialysis patients. A Poisson generalized linear mixed model was generated to determine factors associated with stroke and to ascertain state-by-state geographic variability in stroke rates by generating observed-to-expected (O/E) adjusted rate ratios for stroke. Older age, female sex, African American race and Hispanic ethnicity, unemployed status, diabetes, hypertension, history of stroke, and permanent atrial fibrillation were positively associated with ischemic stroke, whereas body mass index >30 kg/m2 was inversely associated with stroke (P1.0 were all in the South: North Carolina, Mississippi, and Oklahoma. Regional efforts to increase primary prevention in the “stroke belt” or to better educate dialysis patients on the signs of stroke so that they may promptly seek care may improve stroke care and outcomes in dialysis patients.
- Subjects :
- Male
medicine.medical_specialty
medicine.medical_treatment
Population
Medicare
Brain Ischemia
Brain ischemia
Renal Dialysis
Risk Factors
Atrial Fibrillation
medicine
Diabetes Mellitus
Ethnicity
Humans
Clinical Epidemiology
cardiovascular diseases
Risk factor
education
Stroke
Stroke Belt
Dialysis
Aged
Aged, 80 and over
education.field_of_study
business.industry
Incidence
Atrial fibrillation
General Medicine
Middle Aged
medicine.disease
Southeastern United States
United States
Nephrology
Emergency medicine
Hypertension
Multivariate Analysis
Physical therapy
Kidney Failure, Chronic
Female
business
Body mass index
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....35d3d42d1d9fe8bbd4f29f3344e65612