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February 17, 2006

Cost of strokes in Hispanics predicted to skyrocket

American Stroke Association meeting report:

KISSIMMEE, Fla. – Between now and the year 2050, ischemic strokes in Hispanic Americans will cost an estimated $357 billion, according to research presented today at the American Stroke Association’s International Stroke Conference 2006.

These costs include initial hospitalization, ongoing care and lost wages.

 “Armed with this information, public health officials and researchers need to give high priority to preventing and treating strokes in this large group,” said Devin L. Brown, M.D., M.S., lead author of the study and assistant professor of neurology at the University of Michigan in Ann Arbor.

Brown estimated the cost of treating ischemic stroke in Hispanics in 2005 alone was $3.2 billion.

Hispanics — who recently became the largest minority group in the United States — will make up an estimated one-fourth of the population by 2050.

Hispanics are twice as likely to develop ischemic stroke (caused by a blood clot in an artery feeding the brain) as non-Hispanic whites, Brown said.

“Three risk factors for stroke — inactivity, obesity and diabetes — tend to be more common in the Hispanic population,” she said.

Researchers sought to estimate the future economic burden of ischemic stroke in Hispanics in the United States from the years 2005 to 2050.  They projected costs using current Medicare reimbursement rates, either directly or as calculated in previous studies and presented in 2005 dollars.  Researchers used projections from 2000 census data to estimate the population of Hispanics 45 years or older.

Then researchers gauged the occurrence of stroke and the use of healthcare resources after stroke, with data from two ongoing surveillance projects.  The Brain Attack Surveillance in Corpus Christi (BASIC) project identifies strokes in a Texas community comprised mostly of Mexican Americans and non-Hispanic whites.  The Northern Manhattan Stroke Study (NOMASS) surveys stroke incidence in this multi-ethnic urban community that is more than half Hispanics.

 “The Hispanics in NOMASS are predominantly Dominicans, Puerto Ricans and Cuban Americans,” Brown said.  “We believe that estimates made with combined data from the two studies are more accurate and more reflective of the entire Hispanic community in the United States.”

Of the $357 billion stroke bill, 45 percent will be for treating new strokes, including ambulance services, initial hospitalization, rehabilitation services, medical equipment and visits to neurology clinics.  Fifty-five percent will be for the continuing care of patients who had strokes in a previous year, including medication, physician visits, nursing home costs and the value of informal caregiving.

“The value of informal caregiving — that care provided without charge by family and friends — was based on what a home health aide would receive for the same amount of time,” Brown said.

In the analysis, patients between 45–64 years old accounted for 42 percent of the costs; those 65–84 years old, 43 percent; and those 85 and older accounted for only 14 percent.

The three largest individual contributors to the estimated stroke bill for Hispanics were:

  • Initial hospitalization ($86 billion or 24 percent of the total),
  • Informal care ($60 billion or 17 percent of the total), and
  • Lost earnings ($79 billion or 23.71 percent of the total).

“A loss of earning ability hits Hispanics particularly hard because they tend to get strokes at younger ages and to need ongoing care,” Brown said.

“Future research needs to address how best to target the Hispanic community in terms of stroke prevention, recognition of stroke symptoms and access to prompt treatment,” Brown said.

Brown said the analysis focused solely on ischemic strokes.  The rate of hemorrhagic strokes (caused by blood vessel rupture) is also higher in Hispanics than in non-Hispanic whites and, if these were included, cost estimates would be substantially higher, she said.

Researchers did not assess costs for other ethnic groups.

Co-authors are Bernadette Boden-Albala, M.P.H., D.Ph.; Kenneth M. Langa, M.D., Ph.D.; Lynda D. Lisabeth, Ph.D.; Malika Fair, B.S.; Melinda A. Smith, M.P.H.; Ralph L. Sacco, M.D., M.S. and Lewis B. Morgenstern, M.D.

The research is funded in part by the National Institute of Neurological Disorders and Stroke.  NOMASS and BASIC are funded by the National Institutes of Health.

Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position.  The American Heart Association makes no representation or warranty as to their accuracy or reliability.

Note:  Abstract P465 will be presented at 5:30 p.m. EST on Friday, Feb. 17, 2006.


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