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Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay, Costs and Mortality among Older Adults Hospitalised for Acute Stroke

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  • Richard Ofori-Asenso

    (Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
    Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
    Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia)

  • Ella Zomer

    (Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia)

  • Ken Lee Chin

    (Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia)

  • Si Si

    (Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia)

  • Peter Markey

    (Alfred Hospital, Melbourne, VIC 3004, Australia)

  • Mark Tacey

    (Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia)

  • Andrea J. Curtis

    (Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia)

  • Sophia Zoungas

    (Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia)

  • Danny Liew

    (Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia)

Abstract

The burden of comorbidity among stroke patients is high. The aim of this study was to examine the effect of comorbidity on the length of stay (LOS), costs, and mortality among older adults hospitalised for acute stroke. Among 776 older adults (mean age 80.1 ± 8.3 years; 46.7% female) hospitalised for acute stroke during July 2013 to December 2015 at a tertiary hospital in Melbourne, Australia, we collected data on LOS, costs, and discharge outcomes. Comorbidity was assessed via the Charlson Comorbidity Index (CCI), where a CCI score of 0–1 was considered low and a CCI ≥ 2 was high. Negative binomial regression and quantile regression were applied to examine the association between CCI and LOS and cost, respectively. Survival was evaluated with the Kaplan–Meier and Cox regression analyses. The median LOS was 1.1 days longer for patients with high CCI than for those with low CCI. In-hospital mortality rate was 18.2% (22.1% for high CCI versus 11.8% for low CCI, p < 0.0001). After controlling for confounders, high CCI was associated with longer LOS (incidence rate ratio [IRR]; 1.35, p < 0.0001) and increased likelihood of in-hospital death (hazard ratio [HR]; 1.91, p = 0.003). The adjusted median, 25th, and 75th percentile costs were AUD$2483 (26.1%), AUD$1446 (28.1%), and AUD$3140 (27.9%) higher for patients with high CCI than for those with low CCI. Among older adults hospitalised for acute stroke, higher global comorbidity (CCI ≥ 2) was associated adverse clinical outcomes. Measures to better manage comorbidities should be considered as part of wider strategies towards mitigating the social and economic impacts of stroke.

Suggested Citation

  • Richard Ofori-Asenso & Ella Zomer & Ken Lee Chin & Si Si & Peter Markey & Mark Tacey & Andrea J. Curtis & Sophia Zoungas & Danny Liew, 2018. "Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay, Costs and Mortality among Older Adults Hospitalised for Acute Stroke," IJERPH, MDPI, vol. 15(11), pages 1-11, November.
    • Handle: RePEc:gam:jijerp:v:15:y:2018:i:11:p:2532-:d:182195
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    References listed on IDEAS

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    1. Adel A. Alhazzani & Ahmed A. Mahfouz & Ahmed Y. Abolyazid & Nabil J. Awadalla & Khaled Katramiz & Aesha Faraheen & Shamsun Nahar Khalil & Razia Aftab, 2018. "In Hospital Stroke Mortality: Rates and Determinants in Southwestern Saudi Arabia," IJERPH, MDPI, vol. 15(5), pages 1-10, May.
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    Cited by:

    1. Fidel López-Espuela & Raúl Roncero-Martín & Maria de la Luz Canal-Macías & Jose M. Moran & Vicente Vera & Adela Gomez-Luque & Alejandro Lendinez-Mesa & Juan Diego Pedrera-Zamorano & Ignacio Casado-Nar, 2020. "Depressed Mood after Stroke: Predictive Factors at Six Months Follow-Up," IJERPH, MDPI, vol. 17(24), pages 1-11, December.

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