Hospital Cost And Functional Outcomes In Patients With Acute Stroke

PART Ⅰ:Constitutions and Determinants of Hospital Cost for Acute Stroke in ChinaBackground and Purpose:The burden of stroke is high and increasing worldwide. Hospital cost is the main part of the economic burden caused by stroke. We aimed to analysis the constitutions and determinants of hospital cost for acute stroke in China.Methods:Participants of this study were registered in the Nanjing Stroke Registry Program during 2009 and 2014. We collected baseline characteristics, medical information and hospital cost of the patients. The hospital costs were classified as high and low hospital costs. Multivariate logistic regression analysis was performed to assess the determinants of hospital costs.Results:A total of 1910 patients were enrolled in the study. There were 666 (34.9%) patients with low and 1244 (65.1%) patients with high hospital costs. Mean hospital cost was 33,214 Chinese Yuan (1 CNY≈US$ 6.3) per patient. In univariant analysis, patients with low hospital costs were older (62 vs 61,P=0.045). And the percentage of female, patients with medical insurance and urban residents in low hospital costs were higher. In multivariant analysis adjusted for age, sex, stroke subtype, high baseline NIHSS (OR=2.22,95% CI=1.79-2.75) and longer length of stay (OR=10.74, 95% CI=7.39-15.62) were associated with high hospital costs.Conclusions:Mean hospital cost was 33,214 Chinese Yuan (1 CNY≈US$ 6.3) per patient. Age, sex, stroke type, the history of TIA, baseline NIHSS and the length of stay are the independent predictors of hospital costs.PART Ⅱ:The Relationship between Hospital Cost and Functional Outcomes of Acute Stroke in ChinaBackground and Purpose:Socioeconomic status and functional outcomes of stroke interact with each other. We aimed to analysis the association between functional outcomes and hospital cost in China.Methods:Participants of this study were registered in the Nanjing Stroke Registry Program during 2009 and 2014. The functional outcomes were followed at 6 months, and classified according to modified Rankin Scale (mRS) score as good (mRS=0 to 2) and poor outcomes (mRS=3 to 6). Multivariate logistic regression analysis was performed to assess the relationship between hospital cost and functional outcomes.Results:A total of 1061 patients were enrolled in the study. There were 830 (78.2%) patients with good and 231 (21.8%) patients with poor outcomes. Mean hospital cost was 37,200 Chinese Yuan (1 CNY≈US$ 6.3) per patient. Patients with poor outcomes had higher hospital cost than patients with good outcomes (34,300 vs 22,600 CNY, P=4.03×10-13). In univariant analysis, more urban patients had good outcomes than rural patients (89.2% vs 84.4%, P=0.049), and more patients with medical insurance had good outcomes than patients without (52.5% vs 42.0%, P=0.005). In multivariant analysis adjusted for baseline NIHSS, age and stroke subtype, without medical insurance was associated with less chance for favorable outcomes (OR=0.585,95% CI=0.409-0.838).Conclusions:Hospital cost was correlated with functional outcomes. Patients lived in rural area and patients without medical insurance had poorer functional outcomes.