Geographic Disparities in the Incidence of Stroke among Patients with Atrial Fibrillation in the United States

J'Neka S. Claxton; Pamela L. Lutsey; Richard F. MacLehose; Lin Y. Chen; Tené T. Lewis; Alvaro Alonso

doi:10.1016/j.jstrokecerebrovasdis.2018.12.005

Geographic Disparities in the Incidence of Stroke among Patients with Atrial Fibrillation in the United States

J'Neka S. Claxton, Pamela L. Lutsey, Richard F. MacLehose, Lin Y. Chen, Tené T. Lewis, Alvaro Alonso

Research output: Contribution to journal › Article › peer-review

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Abstract

Aim: To determine whether regional variation in stroke incidence exists among individuals with AF. Methods: Using healthcare utilization claims from 2 large US databases, MarketScan (2007-2014) and Optum Clinformatics (2009-2015), and the 2010 US population as the standard, we estimated age-, sex-, race- (only in Optum) standardized stroke incidence rates by the 9 US census divisions. We also used Poisson regression to examine incidence rate ratios (IRR) of stroke and the probability of anticoagulation prescription fills across divisions. Results: Both databases combined included 970,683 patients with AF who experienced 15,543 strokes, with a mean follow-up of 23 months. In MarketScan, the age- and sex-standardized stroke incidence rate was highest in the Middle Atlantic and East South Central divisions at 3.8/1000 person-years (PY) and lowest in the West North Central at 3.2/1000 PY. The IRR of stroke and the probability of anticoagulation fills were similar across divisions. In Optum Clinformatics, the age-, sex-, and race-standardized stroke incidence rate was highest in the East North Central division at 5.0/1000 PY and lowest in the New England division at 3.3/1000 PY. IRR of stroke and the probability of anticoagulation fills differed across divisions when compared to New England. Conclusions: These findings suggest regional differences in stroke incidence among AF patients follow a pattern that differs from the hypothesized trend found in the general population and that other factors may be responsible for this new pattern. Cross-database differences provide a cautionary tale for the identification of regional variation using health claims data.

Original language	English (US)
Pages (from-to)	890-899
Number of pages	10
Journal	Journal of Stroke and Cerebrovascular Diseases
Volume	28
Issue number	4
DOIs	https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.12.005
State	Published - Apr 2019

Bibliographical note

Funding Information:
Funding: Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health [award number R01HL122200]; and the American Heart Association [grant number 16EIA26410001]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the American Heart Association. Funding: Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health [award number R01HL122200]; and the American Heart Association [grant number 16EIA26410001]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the American Heart Association.

Publisher Copyright:
© 2018 National Stroke Association

Keywords

Atrial fibrillation
epidemiology
geographic disparities
health services research
stroke
stroke incidence

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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title = "Geographic Disparities in the Incidence of Stroke among Patients with Atrial Fibrillation in the United States",

abstract = "Aim: To determine whether regional variation in stroke incidence exists among individuals with AF. Methods: Using healthcare utilization claims from 2 large US databases, MarketScan (2007-2014) and Optum Clinformatics (2009-2015), and the 2010 US population as the standard, we estimated age-, sex-, race- (only in Optum) standardized stroke incidence rates by the 9 US census divisions. We also used Poisson regression to examine incidence rate ratios (IRR) of stroke and the probability of anticoagulation prescription fills across divisions. Results: Both databases combined included 970,683 patients with AF who experienced 15,543 strokes, with a mean follow-up of 23 months. In MarketScan, the age- and sex-standardized stroke incidence rate was highest in the Middle Atlantic and East South Central divisions at 3.8/1000 person-years (PY) and lowest in the West North Central at 3.2/1000 PY. The IRR of stroke and the probability of anticoagulation fills were similar across divisions. In Optum Clinformatics, the age-, sex-, and race-standardized stroke incidence rate was highest in the East North Central division at 5.0/1000 PY and lowest in the New England division at 3.3/1000 PY. IRR of stroke and the probability of anticoagulation fills differed across divisions when compared to New England. Conclusions: These findings suggest regional differences in stroke incidence among AF patients follow a pattern that differs from the hypothesized trend found in the general population and that other factors may be responsible for this new pattern. Cross-database differences provide a cautionary tale for the identification of regional variation using health claims data.",

keywords = "Atrial fibrillation, epidemiology, geographic disparities, health services research, stroke, stroke incidence",

author = "Claxton, {J'Neka S.} and Lutsey, {Pamela L.} and MacLehose, {Richard F.} and Chen, {Lin Y.} and Lewis, {Ten{\'e} T.} and Alvaro Alonso",

note = "Funding Information: Funding: Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health [award number R01HL122200]; and the American Heart Association [grant number 16EIA26410001]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the American Heart Association. Funding: Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health [award number R01HL122200]; and the American Heart Association [grant number 16EIA26410001]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the American Heart Association. Publisher Copyright: {\textcopyright} 2018 National Stroke Association",

year = "2019",

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doi = "10.1016/j.jstrokecerebrovasdis.2018.12.005",

language = "English (US)",

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AU - Claxton, J'Neka S.

AU - Lutsey, Pamela L.

AU - MacLehose, Richard F.

AU - Chen, Lin Y.

AU - Lewis, Tené T.

AU - Alonso, Alvaro

N1 - Funding Information: Funding: Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health [award number R01HL122200]; and the American Heart Association [grant number 16EIA26410001]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the American Heart Association. Funding: Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health [award number R01HL122200]; and the American Heart Association [grant number 16EIA26410001]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the American Heart Association. Publisher Copyright: © 2018 National Stroke Association

PY - 2019/4

Y1 - 2019/4

N2 - Aim: To determine whether regional variation in stroke incidence exists among individuals with AF. Methods: Using healthcare utilization claims from 2 large US databases, MarketScan (2007-2014) and Optum Clinformatics (2009-2015), and the 2010 US population as the standard, we estimated age-, sex-, race- (only in Optum) standardized stroke incidence rates by the 9 US census divisions. We also used Poisson regression to examine incidence rate ratios (IRR) of stroke and the probability of anticoagulation prescription fills across divisions. Results: Both databases combined included 970,683 patients with AF who experienced 15,543 strokes, with a mean follow-up of 23 months. In MarketScan, the age- and sex-standardized stroke incidence rate was highest in the Middle Atlantic and East South Central divisions at 3.8/1000 person-years (PY) and lowest in the West North Central at 3.2/1000 PY. The IRR of stroke and the probability of anticoagulation fills were similar across divisions. In Optum Clinformatics, the age-, sex-, and race-standardized stroke incidence rate was highest in the East North Central division at 5.0/1000 PY and lowest in the New England division at 3.3/1000 PY. IRR of stroke and the probability of anticoagulation fills differed across divisions when compared to New England. Conclusions: These findings suggest regional differences in stroke incidence among AF patients follow a pattern that differs from the hypothesized trend found in the general population and that other factors may be responsible for this new pattern. Cross-database differences provide a cautionary tale for the identification of regional variation using health claims data.

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Geographic Disparities in the Incidence of Stroke among Patients with Atrial Fibrillation in the United States

Abstract

Bibliographical note

Keywords

UN SDGs

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