Abstract Body: Background: The COVID-19 pandemic disrupted healthcare systems and altered patient behaviors, potentially affecting stroke prevalence and outcomes. This study examines trends in stroke-related hospitalizations by age and sex in California from 2016 to 2022, focusing on the pandemic years (2020-2022).
Methods: A retrospective analysis of patient discharge data from the California Department of Health Care Access and Information was conducted, screening nearly 25 million inpatient events for stroke-related ICD-10-CM codes (I60-I63) among individuals aged 20 and older. Age-and-sex-standardized hospitalization rates per 100,000 population were calculated. Multivariate logistic regression (MLR) assessed the impact of pre- and post-COVID-19 periods on stroke-related admissions, adjusting for age, gender, race and ethnicity, geographic regions, and payer source. Results were interpreted using Adjusted Odds Ratios (AOR).
Results: The study identified 590,801 stroke-related hospitalizations and 66,096 in-hospital deaths (11.2%). From 2016 to 2019, stroke-related hospitalization rates were stable (257.7 to 259.2 per 100,000). A significant decrease to 242.6 occurred in 2020, followed by an increase to 253.7 in 2021, coinciding with peak COVID-19 cases. By 2022, the rate slightly declined to 251.0, indicating stabilization but not a return to pre-pandemic levels. While the overall trend from 2016 to 2022 was not statistically significant (p=0.400), fluctuations reflect the pandemic's impact, particularly in 2021.
Age and gender analyses showed distinct trends. The age-adjusted rate for males remained stable (p=0.774), while females faced a notable decrease (p=0.018). Among those aged 20-44, stroke-related hospitalizations increased by 19% (RR=1.19, p<0.001) and by 9% for those aged 45-54 (RR=1.09, p<0.001). Conversely, individuals aged 75 and older saw a 15.5% decrease (RR=0.85, p<0.001). MLR analysis indicated a 31% increase in hospitalizations (AOR=1.31, p<0.001) during the post-COVID period compared to pre-COVID levels. Stroke prevalence was 25.3% higher in males than females and 53.9% higher in Asians than Whites.
Conclusion: This seven-year analysis highlights the COVID-19 pandemic's significant impact on stroke-related hospitalizations, particularly in 2021, and the observed gender disparity. These findings emphasize the need for targeted interventions to address the increased stroke burden, especially among vulnerable populations, during and after the pandemic.