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Projected costs of ischemic stroke in the United States

From the Stroke Program (D.L.B., L.D.L., M.F., M.A.S., L.B.M.), University of Michigan Medical School, Division of General Medicine (K.M.L.), Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Practice Management and Outcomes Research (K.M.L.), Institute for Social Research (K.M.L.), University of Michigan, and Department of Epidemiology (L.D.L., L.B.M.), University of Michigan School of Public Health, Ann Arbor, and Department of Neurology (B.B.-A., R.L.S.), Columbia University College of Physicians and Surgeons, Departments of Sociomedical Science (B.B.-A.) and Epidemiology (R.L.S.), Mailman School of Public Health, Columbia University, New York, NY.

Address correspondence and reprint requests to Dr. D. Brown, TC 1920/0316, 1500 E. Medical Center Dr., University of Michigan, Ann Arbor, MI 48109; e-mail: devinb{at}med.umich.edu

Background: There are barriers to acute stroke care in minority groups as well as a higher incidence of ischemic stroke when compared with non-Hispanic whites.

Objective: To estimate the future economic burden of stroke in non-Hispanic whites, Hispanics, and African Americans in the United States from 2005 to 2050.

Methods: We used U.S. Census estimates of the race–ethnic group populations age 45 years and older. We obtained stroke epidemiology and service utilization data from the Northern Manhattan Stroke Study and the Brain Attack Surveillance in Corpus Christi project and other published data. We estimated costs directly from Medicare reimbursement or from studies that used Medicare reimbursement. Direct and indirect costs considered included ambulance services, initial hospitalization, rehabilitation, nursing home costs, outpatient clinic visits, drugs, informal caregiving, and potential lost earnings.

Results: The total cost of stroke from 2005 to 2050, in 2005 dollars, is projected to be $1.52 trillion for non-Hispanic whites, $313 billion for Hispanics, and $379 billion for African Americans. The per capita cost of stroke estimates are highest in African Americans ($25,782), followed by Hispanics ($17,201), and non-Hispanic whites ($15,597). Loss of earnings is expected to be the highest cost contributor in each race–ethnic group.

Conclusions: The economic burden of stroke in African Americans and Hispanics will be enormous over the next several decades. Further efforts to improve stroke prevention and treatment in these high stroke risk groups are necessary.

Editorial, see page 1328

This article was previously published in electronic format as an Expedited E-Pub on August 16, 2006, at www.neurology.com.

Disclosures: NOMASS is supported by NIH R01 NS029993. BASIC is supported by NIH R01NS038916. Dr. Brown is supported by an NINDS career development award (K23 NS051202). Dr. Lisabeth is supported by an NINDS career development award (K23 NS050161). Dr. Langa was supported by an NIA career development award (K08 AG19180) and a Paul Beeson Physician Faculty Scholars in Aging Research award.

Received December 6, 2005. Accepted in final form June 22, 2006.

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