Evidence map›Paper›PMID 30583824›Full record

ArticleJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2019

Geographic Disparities in the Incidence of Stroke among Patients with Atrial Fibrillation in the United States.

J'Neka S Claxton, Pamela L Lutsey, Richard F MacLehose, Lin Y Chen, Tené T Lewis, Alvaro Alonso

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

J'Neka S ClaxtonDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. Electronic address: j'neka.claxton@emory.edu.
Pamela L LutseyDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
Richard F MacLehoseDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
Lin Y ChenCardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Tené T LewisDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Alvaro AlonsoDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Comparative Effectiveness of Oral Anticoagulants in Atrial FibrillationR01HL122200 · NHLBI · UNIVERSITY OF MINNESOTA · PI ALONSO, ALVARO · 2015 to 2017
$1.2M
American Heart Association-American Stroke Association 16EIA26410001NCATS NIH HHS UL1 TR001863NHLBI NIH HHS R01 HL122200
6 · The paper itself

Abstract

aimTo determine whether regional variation in stroke incidence exists among individuals with AF.

methodsUsing healthcare utilization claims from 2 large US databases, MarketScan (2007-2014) and Optum Clinformatics (2009-2015), and the 2010 US population as the standard, we estimated age-, sex-, race- (only in Optum) standardized stroke incidence rates by the 9 US census divisions. We also used Poisson regression to examine incidence rate ratios (IRR) of stroke and the probability of anticoagulation prescription fills across divisions.

resultsBoth databases combined included 970,683 patients with AF who experienced 15,543 strokes, with a mean follow-up of 23 months. In MarketScan, the age- and sex-standardized stroke incidence rate was highest in the Middle Atlantic and East South Central divisions at 3.8/1000 person-years (PY) and lowest in the West North Central at 3.2/1000 PY. The IRR of stroke and the probability of anticoagulation fills were similar across divisions. In Optum Clinformatics, the age-, sex-, and race-standardized stroke incidence rate was highest in the East North Central division at 5.0/1000 PY and lowest in the New England division at 3.3/1000 PY. IRR of stroke and the probability of anticoagulation fills differed across divisions when compared to New England.

conclusionsThese findings suggest regional differences in stroke incidence among AF patients follow a pattern that differs from the hypothesized trend found in the general population and that other factors may be responsible for this new pattern. Cross-database differences provide a cautionary tale for the identification of regional variation using health claims data.

Indexed as

Health Status DisparitiesAgedAged, 80 and overAge DistributionAnticoagulantsAtrial FibrillationComorbidityDatabases, FactualFemaleHealthcare DisparitiesHealth Services ResearchHumansIncidenceMaleRisk FactorsSex DistributionAnticoagulantsAtrial fibrillationepidemiologygeographic disparitieshealth services researchstrokestroke incidence

Identifiers

PMID30583824
PMCPMC6475902

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.