Winter excess in hospital admissions, in-patient mortality and length of acute hospital stay in stroke: a hospital database study over six seasonal years in Norfolk, UK

Phyo K Myint, Sarah L Vowler, Peter R Woodhouse, Oliver Redmayne, Robert A Fulcher

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

BACKGROUND: Several studies have examined the incidence and mortality of stroke in relation to season. However, the evidence is conflicting partly due to variation in the populations (community vs. hospital-based), and in climatic conditions between studies. Moreover, they may not have been able to take into account the age, sex and stroke type of the study population. We hypothesized that the age, sex and type of stroke are major determinants of the presence or absence of winter excess in morbidity and mortality associated with stroke.

METHODS: We analyzed a hospital-based stroke register from Norfolk, UK to examine our prior hypothesis. Using Curwen's method, we performed stratified sex-specific analyses by (1) seasonal year and (2) quartiles of patients' age and stroke subtype and calculated the winter excess for the number of admissions, in-patient deaths and length of acute hospital stay.

RESULTS: There were 5,481 patients (men=45%). Their ages ranged from 17 to 105 years (median=78 years). There appeared to be winter excess in hospital admissions, deaths and length of acute hospital stay overall accounting for 3/100,000 extra admissions (winter excess index of 3.4% in men and 7.6% in women) and 1/100,000 deaths (winter excess index of 4.7 and 8.6% in women) due to stroke in winter compared to non-winter periods. Older patients with non-haemorrhagic stroke mainly contribute to this excess. If our findings are replicated throughout England and Wales, it is estimated that there are 1,700 excess admissions, 600 excess in-patient deaths and 24,500 extra acute hospital bed days each winter, related to stroke within the current population of approximately 60 million.

CONCLUSIONS: Further research should be focused on the determinants of winter excess in morbidity and mortality associated with stroke. This may subsequently reduce the morbidity and mortality by providing effective preventive strategies in future.

Original languageEnglish
Pages (from-to)79-85
Number of pages7
JournalNeuroepidemiology
Volume28
Issue number2
DOIs
Publication statusPublished - Apr 2007

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Patient Admission
Length of Stay
Stroke
Databases
Mortality
Morbidity
Population
Wales
Community Hospital
England

Keywords

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Databases, Factual
  • Female
  • Great Britain
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Length of Stay
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Retrospective Studies
  • Seasons
  • Sex Factors
  • Stroke
  • Tomography, X-Ray Computed

Cite this

Winter excess in hospital admissions, in-patient mortality and length of acute hospital stay in stroke : a hospital database study over six seasonal years in Norfolk, UK. / Myint, Phyo K; Vowler, Sarah L; Woodhouse, Peter R; Redmayne, Oliver; Fulcher, Robert A.

In: Neuroepidemiology, Vol. 28, No. 2, 04.2007, p. 79-85.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Several studies have examined the incidence and mortality of stroke in relation to season. However, the evidence is conflicting partly due to variation in the populations (community vs. hospital-based), and in climatic conditions between studies. Moreover, they may not have been able to take into account the age, sex and stroke type of the study population. We hypothesized that the age, sex and type of stroke are major determinants of the presence or absence of winter excess in morbidity and mortality associated with stroke.METHODS: We analyzed a hospital-based stroke register from Norfolk, UK to examine our prior hypothesis. Using Curwen's method, we performed stratified sex-specific analyses by (1) seasonal year and (2) quartiles of patients' age and stroke subtype and calculated the winter excess for the number of admissions, in-patient deaths and length of acute hospital stay.RESULTS: There were 5,481 patients (men=45{\%}). Their ages ranged from 17 to 105 years (median=78 years). There appeared to be winter excess in hospital admissions, deaths and length of acute hospital stay overall accounting for 3/100,000 extra admissions (winter excess index of 3.4{\%} in men and 7.6{\%} in women) and 1/100,000 deaths (winter excess index of 4.7 and 8.6{\%} in women) due to stroke in winter compared to non-winter periods. Older patients with non-haemorrhagic stroke mainly contribute to this excess. If our findings are replicated throughout England and Wales, it is estimated that there are 1,700 excess admissions, 600 excess in-patient deaths and 24,500 extra acute hospital bed days each winter, related to stroke within the current population of approximately 60 million.CONCLUSIONS: Further research should be focused on the determinants of winter excess in morbidity and mortality associated with stroke. This may subsequently reduce the morbidity and mortality by providing effective preventive strategies in future.",
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T1 - Winter excess in hospital admissions, in-patient mortality and length of acute hospital stay in stroke

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AU - Myint, Phyo K

AU - Vowler, Sarah L

AU - Woodhouse, Peter R

AU - Redmayne, Oliver

AU - Fulcher, Robert A

N1 - (c) 2007 S. Karger AG, Basel.

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N2 - BACKGROUND: Several studies have examined the incidence and mortality of stroke in relation to season. However, the evidence is conflicting partly due to variation in the populations (community vs. hospital-based), and in climatic conditions between studies. Moreover, they may not have been able to take into account the age, sex and stroke type of the study population. We hypothesized that the age, sex and type of stroke are major determinants of the presence or absence of winter excess in morbidity and mortality associated with stroke.METHODS: We analyzed a hospital-based stroke register from Norfolk, UK to examine our prior hypothesis. Using Curwen's method, we performed stratified sex-specific analyses by (1) seasonal year and (2) quartiles of patients' age and stroke subtype and calculated the winter excess for the number of admissions, in-patient deaths and length of acute hospital stay.RESULTS: There were 5,481 patients (men=45%). Their ages ranged from 17 to 105 years (median=78 years). There appeared to be winter excess in hospital admissions, deaths and length of acute hospital stay overall accounting for 3/100,000 extra admissions (winter excess index of 3.4% in men and 7.6% in women) and 1/100,000 deaths (winter excess index of 4.7 and 8.6% in women) due to stroke in winter compared to non-winter periods. Older patients with non-haemorrhagic stroke mainly contribute to this excess. If our findings are replicated throughout England and Wales, it is estimated that there are 1,700 excess admissions, 600 excess in-patient deaths and 24,500 extra acute hospital bed days each winter, related to stroke within the current population of approximately 60 million.CONCLUSIONS: Further research should be focused on the determinants of winter excess in morbidity and mortality associated with stroke. This may subsequently reduce the morbidity and mortality by providing effective preventive strategies in future.

AB - BACKGROUND: Several studies have examined the incidence and mortality of stroke in relation to season. However, the evidence is conflicting partly due to variation in the populations (community vs. hospital-based), and in climatic conditions between studies. Moreover, they may not have been able to take into account the age, sex and stroke type of the study population. We hypothesized that the age, sex and type of stroke are major determinants of the presence or absence of winter excess in morbidity and mortality associated with stroke.METHODS: We analyzed a hospital-based stroke register from Norfolk, UK to examine our prior hypothesis. Using Curwen's method, we performed stratified sex-specific analyses by (1) seasonal year and (2) quartiles of patients' age and stroke subtype and calculated the winter excess for the number of admissions, in-patient deaths and length of acute hospital stay.RESULTS: There were 5,481 patients (men=45%). Their ages ranged from 17 to 105 years (median=78 years). There appeared to be winter excess in hospital admissions, deaths and length of acute hospital stay overall accounting for 3/100,000 extra admissions (winter excess index of 3.4% in men and 7.6% in women) and 1/100,000 deaths (winter excess index of 4.7 and 8.6% in women) due to stroke in winter compared to non-winter periods. Older patients with non-haemorrhagic stroke mainly contribute to this excess. If our findings are replicated throughout England and Wales, it is estimated that there are 1,700 excess admissions, 600 excess in-patient deaths and 24,500 extra acute hospital bed days each winter, related to stroke within the current population of approximately 60 million.CONCLUSIONS: Further research should be focused on the determinants of winter excess in morbidity and mortality associated with stroke. This may subsequently reduce the morbidity and mortality by providing effective preventive strategies in future.

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KW - Hospitalization

KW - Humans

KW - Length of Stay

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Seasons

KW - Sex Factors

KW - Stroke

KW - Tomography, X-Ray Computed

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