Outcomes for younger adults with stroke in the australian stroke clinical registry (AUSCR)

Abstract

Background and purpose: Stroke has devastating consequences at all ages but particularly so among younger adults, with impacts on health-related quality-of-life (HRQoL), roles and usual activities including work. We aimed to compare patient characteristics, quality of hospital care indicators, and outcomes for younger (age <65 years) compared with older (65+ years) adults with stroke. Methods: Data were from the prospective Australian Stroke Clinical Registry (AuSCR) obtained January 2010 to December 2013 (40 hospitals). Multilevel regression models were used in group comparisons HRQoL was assessed with the EQ-5D visual analogue scale (VAS) at 90-180 days; median VAS scores of AuSCR participants were compared to population norm scores (VAS of 100 = perfect health). Results: Among 16,780 registrants, 4,149 (33%) were aged <65 years. Compared to older patients, younger patients were more likely male (63% vs. 51%) and could walk on admission (49% vs. 35%; p < 0.001). Fewer younger patients were discharged on an antihypertensive agent(s) (57% vs. 71%; p < 0.001). After accounting for patient and hospital characteristics, younger patients were more likely to be discharged home (adjusted odds ratio [aOR] 1.88, 95% CI 1.72-2.06) and less often received inpatient rehabilitation (aOR 0.09, 95% CI 0.07-0.15). The net difference in median VAS score was greater in younger patients (Δ10 points AuSCR 76 vs. norms 86) compared to older patients (Δ5 points AuSCR: 70 vs. norms 75). Conclusions: Compared to older patients, younger patients have different characteristics and in-hospital management, and experience greater HRQoL declines after stroke compared to the age-matched normal population.<br />