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Case fatality rates after admission to hospital with stroke: linked database study

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7382.193 (Published 25 January 2003) Cite this as: BMJ 2003;326:193

Data supplement

  • Table A:  Case-fatality rates (CFRs) among patients aged under 75 years, ...

    Table B:  Case-fatality rates (CFRs) among patients aged under 65 years, ...

    Table C:  P values for differences in CFRs comparing all hospitals and all non-teaching hospitals ...
     

    Table A [posted as supplied by the authors] Case-fatality rates (CFRs) among patients aged under 75 years, standardised for age group and sex* for stroke by hospital of admission, using different definitions of a case fatality rate, 1978-87 and 1988-97
     

      In-hospital 

    deaths 

    		 Deaths anywhere

    < 30 days < 30 days < 90 days < 365 days

    No. of

    Hospital admissions CFR (95% CI) CFR (95% CI) CFR (95% CI) CFR (95% CI)

    1978-87
     

    I ‡
    1549
    		 
    24.5
    22.0-27.1 
    		 
    26.5
    23.8-29.1
    		 
    30.4
    27.6-33.2
    		 
    36.7
    33.6-39.8
    II
    421
    		 
    28.3
    23.2-33.4
    		  
    31.5
    26.2-36.9
    		 
    38.5
    32.5-44.5
    		 
    44.1
    37.8-50.5
    III
    677
    		 
    31.5
    27.0-36.1
    		 
    35.4
    30.6-40.2
    		 
    42.0
    36.7-47.2
    		 
    47.9
    42.2-53.5
    IV
    767
    		 
    36.7
    32.4-41.1
    		 
    41.0
    36.4-45.6
    		 
    46.1
    41.2-51.0
    		 
    51.0
    45.9-56.2
    V
    400
    		 
    33.6
    27.0-40.2
    		 
    35.6
    28.9-42.4
    		 
    42.5
    35.0-50.0
    		  
    49.3
    41.2-57.4
    VI
    450
    		 
    28.2
    23.3-33.1
    		 
    29.7
    24.6-34.8
    		 
    35.3
    29.8-40.8
    		 
    43.5
    37.4-49.5
    VII
    610
    		 
    33.0
    28.3-37.8
    		 
    37.1
    32.0-42.1
    		 
    41.6
    36.3-46.9
    		 
    46.6
    40.9-52.2
    VIII
    885
    		 
    26.8
    23.4-30.2
    		 
    28.6
    25.1-32.1
    		 
    33.8
    30.0-37.6
    		 
    42.6
    38.3-46.9
    IX
    532
    		 
    36.1
    30.9-41.4
    		 
    39.5
    34.0-45.0
    		 
    44.1
    38.3-49.9
    		 
    49.6
    43.5-55.8
    X
    246
    		 
    32.4
    25.2-39.6
    		 
    35.3
    27.8-42.8
    		 
    40.8
    32.8-48.8
    		 
    46.7
    38.1-55.3
    Sub total II-IX
    4988
    		 
    32.2
    30.6-33.7
    		 
    35.3
    33.3-37.0
    		 
    40.7
    38.9-42.5
    		 
    47.2
    45.3-49.1
    Total ‡ ‡
    6537
    		  
    30.3
    29.0-31.6
    		 
    33.2
    31.8-34.6
    		 
    38.2
    36.7-39.7
    		 
    44.7
    43.0-46.3
    Unadjusted CFR  
    30.0
    28.9-31.1
      
    		 

    32.9
    31.8-34.0
    		 
    37.8
    36.7-39.0
    		 
    44.2
    43.0-45.4
    Chi-square

    on 108 df †

    		  
    158.5
    		  
    167.4
    		  
    197.4
    		  
    178.5
    		 

     

    1988-97
     

    I ‡
    1833
    		  
    18.9
    16.9-20.9
    		  
    20.6
    18.5-22.7
    		 
    25.0
    22.7-27.4
    		 
    30.7
    28.1-33.3
    II
    450
    		  
    28.6
    23.6-33.5
    		  
    29.8
    24.7-34.8
    		  
    33.9
    28.5-39.3
    		 
    39.5
    33.7-45.3
    III
    830
    		  
    19.0
    15.9-22.0
    		  
    26.5
    22.8-30.1
    		 
    30.9
    27.0-34.8
    		 
    38.5
    34.1-42.9
    IV
    1161
    		  
    23.7
    20.9-26.6
    		  
    25.5
    22.5-28.4
    		 
    30.5
    27.3-33.7
    		 
    37.9
    34.3-41.5
    V & VI
    954
    		  
    22.0
    18.9-25.0
    		  
    24.0
    20.8-27.1
    		 
    27.2
    23.8-30.6
    		 
    32.3
    28.7-36.0
    VII & VIII
    1425
    		  
    24.5
    22.0-27.1
    		   
    26.4
    23.7-29.1
    		 
    31.8
    28.9-34.7
    		 
    36.9
    33.8-40.1
    IX & X
    1045
    		  
    23.9
    20.9-26.9
    		  
    26.3
    23.2-29.4
    		 
    32.0
    28.6-35.5
    		 
    37.1
    33.4-40.8
    XI
    556
    		  
    21.5
    17.6-25.3
    		  
    24.1
    20.0-28.1
    		 
    27.4
    23.1-31.8
    		 
    33.6
    28.8-38.4
    XII
    601
    		  
    22.2
    18.4-26.0
    		  
    23.6 
    19.7-27.5
    		 
    29.0
    24.7-33.4
    		 
    37.1
    32.2-42.0
    Sub total II-XII
    7022
    		  
    23.3
    22.1-24.4
    		   
    25.8
    24.6-27.0
    		 
    30.5
    29.2-31.8
    		 
    36.6
    35.2-38.1
    Total ‡ ‡
    8855
    		  
    22.4
    21.4-23.4
    		  
    24.7
    23.7-25.8
    		 
    29.4
    28.2-30.5
    		 
    35.4
    34.2-36.7
    Unadjusted CFR
       
    		   

    22.2
    21.3-23.1
    		  
    24.6
    23.7-25.5
    		 
    29.2
    28.2-30.1
    		 
    35.1
    34.1-36.1
    Chi-square

    on 96 df †

    		     
    131.5
    		    
    129.1
    		    
    139.4
    		    
    138.0
    		 

    * Standardised by the direct method, using all patients admitted for stroke in the region in 1978-97 as the standard, for making comparisons over time and between hospitals.

    ‡ Differences between the teaching hospital (hospital I) and all others combined at 30 days in period 1 = 8.8% (95% confidence interval = 6.2, 11.4; p<0.001) and in period 2 = 5.2% (3.1, 7.3; p<0.001). Differences between the teaching hospital and others at 30-365 days (i.e. excluding deaths in the first 30 days) in period 1 = 1.7% (-0.1, 3.5; p=0.067) and in period 2 = 0.7% (-0.9, 2.3; p=0.39).

    ‡ ‡ The total CFR at 30 days declined by 8.5% from period 1 to 2 (95% confidence interval = 7.0, 10.1; p<0.001) and the total CFR for deaths from 30-365 days declined by 0.8% (-0.2, 1.8; p=0.12).

    † The chi-square statistic and its degrees of freedom, were obtained through logistic regression analysis. This provides an overall test of the variation in CFRs between all individual hospitals: comparisons between hospitals in the eight sets of CFRs were all significant (p<0.01 in seven cases and (p<0.05 in one). Corresponding chi-square statistics, comparing the non-teaching hospitals only, were 117.5, 124.7, 132.9 and on 96 df for the four successive periods after admission during 1978-87 and 108.5, 100.5, 109.5 and on 84 df for 1988-97. These were significant (p<0.05) in five cases and marginally non-significant (0.10<p<0.05) in two. Chi-square statistics for variation in CFRs from 30 to 365 days (i.e. excluding deaths in the first 30 days), comparing all hospitals, were non-significant in both 1978-87 (116.4 on 108 df; p=0.27) and 1988-97 (102.5 on 96 df; p=0.31).
     

    Table B [posted as supplied by the authors] Case-fatality rates (CFRs) among patients aged under 65 years, standardised for age group and sex*, for stroke by hospital of admission, using different definitions of a case fatality rate, 1978-87 and 1988-97
     

     In-hospital 

    deaths 

    		 Deaths anywhere

    < 30 days < 30 days < 90 days < 365 days

    No. of

    Hospital admissions CFR (95% CI) CFR (95% CI) CFR (95% CI) CFR (95% CI)

    1978-87
     

    I ‡
    670
    		 
    19.7
    16.1-23.2 
    		 
    21.4
    17.7-25.1
    		 
    23.4
    19.6-27.2
    		 
    27.1
    23.0-31.2
    II
    133
    		 
    23.7
    15.6-31.8
    		 
    25.0
    16.7-33.3
    		 
    31.2
    21.8-40.6
    		 
    34.6
    24.8-44.5
    III
    381
    		 
    28.7
    23.3-34.0
    		 
    31.5
    25.9-37.1
    		 
    35.6
    29.7-41.6
    		 
    39.4
    33.1-45.6
    IV
    330
    		 
    27.0
    21.4-32.7
    		 
    31.6
    25.5-37.7
    		 
    33.9
    27.5-40.2
    		 
    38.0
    31.3-44.7
    V
    243
    		 
    26.0
    19.3-32.7
    		 
    28.8
    21.8-35.8
    		 
    31.1
    23.9-38.3
    		 
    34.3
    26.7-41.8
    VI
    117
    		 
    18.2
    10.5-25.9
    		 
    20.4
    12.3-28.6
    		 
    22.4
    14.0-30.9
    		 
    27.9
    18.6-37.2
    VII
    260
    		 
    27.6
    20.5-34.7
    		 
    31.6
    24.1-39.1
    		 
    33.7
    26.1-41.4
    		 
    35.7
    27.8-43.5
    VIII
    324
    		 
    19.2
    14.4-23.9
    		 
    21.0
    16.1-26.0
    		 
    24.5
    19.2-29.9
    		 
    28.5
    22.7-34.3
    IX
    244
    		 
    29.9
    22.9-36.9
    		 
    33.7
    26.3-41.1
    		 
    35.0
    27.5-42.5
    		 
    40.2
    32.1-48.2
    X
    86
    		 
    26.4
    15.4-37.3
    		 
    30.2
    18.6-41.8
    		 
    33.5
    21.3-45.7
    		 
    35.6
    23.0-48.1
    Sub total II-IX
    2118
    		 
    26.1
    24.0-28.3
    		 
    29.6
    27.3-32.0
    		 
    32.6
    30.1-35.0
    		 
    36.5
    33.9-39.0
    Total ‡ ‡
    2788
    		 
    24.5
    22.6-26.3
    		 
    27.5
    25.6-29.5
    		 
    30.2
    28.2-32.3
    		  
    34.1
    31.9-36.3
    Unadjusted CFR  
    24.4
    22.8-26.0
      
    		 

    27.5
    25.8-29.1
    		 
    30.2
    28.5-31.9
    		 
    34.1
    32.4-35.9
    Chi-square

    on 72 df †

    		  
    90.1
    		  
    100.0
    		   
    107.7
    		   
    101.5
    		 

     

    1988-97
     

    I ‡
    775
    		 
     14.9
    12.2-17.7
    		 
    16.7
    13.7-19.6
    		  
    18.9
    15.8-22.0
    		 
    22.2
    18.8-25.6
    II
    142
    		 
    19.1
    11.8-26.4
    		 
    21.2
    13.5-28.8
    		 
    26.2
    17.6-34.8
    		 
    29.0
    20.0-38.1
    III
    375
    		 
    14.4
    10.5-18.4
    		 
    20.5
    15.6-25.5
    		 
    22.3
    17.1-27.5
    		 
    27.9
    22.2-33.6
    IV
    494
    		 
    18.6
    14.8-22.5
    		 
    19.6
    15.6-23.5
    		 
    22.6
    18.4-26.8
    		 
    27.0
    22.4-31.7
    V & VI
    401
    		 
    13.4
    9.8-17.0
    		 
    15.1
    11.4-18.9
    		 
    16.8
    12.7-20.8
    		 
    19.7
    15.3-24.0
    VII & VIII
    559
    		 
    20.2
    16.5-23.9
    		 
    23.2
    19.2-27.1
    		 
    26.7
    22.4-31.0
    		 
    29.9
    25.4-34.4
    IX & X
    405
    		 
    19.1
    14.8-23.4
    		 
    21.9
    17.4-26.5
    		 
    24.7
    19.9-29.6
    		 
    27.6
    22.5-32.7
    XI
    215
    		 
    20.5
    14.5-26.5
    		 
    22.2
    16.0-28.5
    		 
    23.7
    17.2-30.2
    		 
    26.8
    19.9-33.6
    XII
    252
    		 
    16.6
    11.5-21.6
    		 
    19.2 
    13.8-24.7
    		 
    23.2
    17.2-29.2
    		 
    29.0
    22.3-35.8
    Sub total II-XII
    2843
    		 
    18.0
    16.5-19.6
    		 
    20.7
    19.0-22.3
    		 
    23.4
    21.6-25.2
    		 
    27.3
    25.4-29.2
    Total ‡ ‡
    3618
    		 
    17.4
    16.1-18.8
    		 
    19.8
    18.4-21.3
    		 
    22.5
    20.9-24.0
    		 
    26.2
    24.5-27.9
    Unadjusted CFR 
       
    		  

    17.3
    16.1-18.6
    		 
    19.8
    18.5-21.1
    		 
    22.4
    21.0-23.7
    		 
    26.0
    24.6-27.5 
    Chi-square

    on 64 df †

    		  
    80.4
    		  
    83.1
    		  
    89.7
    		  
    83.5
    		 

    * Standardised by the direct method, using all patients admitted for stroke in the region in 1978-1997 as the standard, for making comparisons over time and between hospitals.

    ‡ Differences between the teaching hospital (hospital I) and all others combined at 30 days in period 1 = 8.2% (95% confidence interval = 4.5, 11.9; p<0.001) and in period 2 = 4.0% (1.0, 7.0; p<0.05). Differences between the teaching hospital and others at 30-365 days (i.e. excluding deaths in the first 30 days) in period 1 = 1.2% (-0.9, 3.3; p=0.28) and in period 2 = 1.1% (-0.7, 2.9; p=0.27).

    ‡ ‡ The total CFR at 30 days declined by 7.7% from period 1 to 2 (95% confidence interval = 5.6, 9.8; p<0.001) and the total CFR for deaths from 30-365 days declined by 0.2% (-1.0, 1.4; p=0.75).

    † The chi-square statistic and its degrees of freedom, were obtained through logistic regression analysis. This provides an overall test of the variation in CFRs between all individual hospitals: comparisons between hospitals in all eight sets of CFRs were significant (p<0.05) in four cases and marginally non significant in four cases (0.10<p<0.05). Corresponding chi-square statistics, comparing the non-teaching hospitals only, were 73.8, 75.5, and 77.3 on 64 df for the four successive periods after admission during 1978-87 and 74.5, 75.0, and 71.4 on 56 df for 1988-97. These were significant (p<0.05) in three cases and marginally non-significant (0.10<p<0.05) in two. Chi-square statistics for variation in CFRs from 30 to 365 days (i.e. excluding deaths in the first 30 days), comparing all hospitals, were non-significant in both 1978-87 (70.5 on 72 df; p=0.53) and 1988-97 (57.8 on 64 df; p=0.69).
     

    Table C [posted as supplied by the authors] P values for differences in CFRs comparing all hospitals and all non-teaching hospitals (i.e. excluding the teaching hospital), testing for heterogeneity between them, for people admitted in 1978-87 and 1988-97

    All hospitals
     

      In-hospital 

    deaths

    		  Deaths anywhere

    Time period < 30 days < 30 days < 90 days < 365 days
     

    1978-87:        
             
    All patientsp<0.001 p<0.001 p<0.001 p<0.001
            
    Aged under 75p<0.01  p<0.001 p<0.001 p<0.001
            
    Aged under 65p=0.073 p<0.05 p<0.01 p<0.05
             
            
    1988-97:       
             
    All patientsp<0.001 p<0.001 p<0.001 p<0.001
            
    Aged under 75p<0.01 p<0.05 p<0.01 p<0.01
             
    Aged under 65p=0.081 p=0.055 p<0.05  p=0.051

    Non-teaching hospitals
     

      In-hospital 

    deaths

    		  Deaths anywhere
            

    Time period < 30 days < 30 days < 90 days < 365 days
     

             
    1978-87:       
            
    All patientsp<0.01 p<0.01 p<0.001 p<0.05
            
    Aged under 75p=0.067 p<0.05 p<0.01 p=0.053
                                                       
    Aged under 65p=0.19 p=0.15 p=0.093 p=0.12
             
            
     1988-97:       
            
    All patientsp<0.001 p<0.01 p<0.01 p<0.001
            
    Aged under 75p<0.05 p=0.11 p<0.05 p<0.05
             
    Aged under 65p<0.05 p<0.05 p<0.05 p=0.081

     

     

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  • Case fatality rates after hospital admission for stroke: Covariates were not measured
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