VARIATIONS IN THE INCIDENCE, MANAGEMENT AND OUTCOME OF STROKE IN RESIDENTS UNDER THE AGE OF 75 IN 2 HEALTH DISTRICTS OF SOUTHERN ENGLAND

Background The aim of the study was to determine the incidence, outcom e and health service resources consumed by stroke care in defined popu lations. Methods Patients under the age of 75 experiencing their first stroke between August 1989 and July 1991 were assessed at the onset, and at three and 12 months after their stroke. The settings were West Lambeth (WL) and Tunbridge Wells (TW) health authorities in southern E ngland. The main outcome measures used were: age- and sex-specific inc idence rates, hospital admission rates, length of stay and use of reha bilitation services. Functional disability was assessed using the Bart hel scale. Results Four hundred and fifty-six strokes were registered. The annual incidence rates/1000 population aged under 75 years old [w ith 95% confidence interval (CI)] were 0.77 (0.67-0.87) in WL and 0.66 (0.58-0.75) in TW. The age and sex-standardized incidence ratios were significantly higher in WL (126; 95% CI 110-144) than in TW (84; 95% CI 74-95) (p<0.001). There were independent associations of incidence with age group (p<0.001), sex (p<0.001) and ethnic group (p<0.001). On e year case fatality was 36% (80/225). At one year, 11% (14) of surviv ing patients were moderately to severely disabled and 23% (28) mildly disabled. Seventy-one per cent (326) of patients were admitted to hosp ital and the average health service cost per case was 3800 pounds in W L and 2650 pounds in TW, 93% of the cost being for in-patient care. Co nclusions The study has demonstrated a significantly increased inciden ce of stroke in an inner-city district compared with a district in rur al southern England. It has also established ethnic group as a signifi cant independent risk factor for stroke in the United Kingdom. The cos t of care to the health services is considerable, and largely reflects nursing costs in hospital rather than effective treatment packages fo r stroke.