Trends in 1-Year Recurrent Ischemic Stroke in the US Medicare Fee-for-Service Population

Erica C. Leifheit, Yun Wang, Larry B. Goldstein, Judith H. Lichtman

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: There have been important advances in secondary stroke prevention and a focus on healthcare delivery over the past decades. Yet, data on US trends in recurrent stroke are limited. We examined national and regional patterns in 1-year recurrence among Medicare beneficiaries hospitalized for ischemic stroke from 2001 to 2017. Methods: This cohort study included all fee-for-service Medicare beneficiaries aged ≥65 years who were discharged alive with a principal diagnosis of ischemic stroke from 2001 to 2017. Follow-up was up to 1 year through 2018. Cox models were used to assess temporal trends in 1-year recurrent ischemic stroke, adjusting for demographic and clinical characteristics. We mapped recurrence rates and identified persistently high-recurrence counties as those with rates in the highest sextile for stroke recurrence in ≥5 of the following periods: 2001-2003, 2004-2006, 2007-2009, 2010-2012, 2013-2015, and 2016-2017. Results: There were 3 638 346 unique beneficiaries discharged with stroke (mean age 79.0±8.1 years, 55.2% women, 85.3% White). The national 1-year recurrent stroke rate decreased from 11.3% in 2001-2003 to 7.6% in 2016-2017 (relative reduction, 33.5% [95% CI, 32.5%-34.5%]). There was a 2.3% (95% CI, 2.2%-2.4%) adjusted annual decrease in recurrence from 2001 to 2017 that included reductions in all age, sex, and race subgroups. County-level recurrence rates ranged from 5.5% to 14.0% in 2001-2003 and from 0.2% to 8.9% in 2016-2017. There were 76 counties, concentrated in the South-Central United States, that had the highest recurrence throughout the study. These counties had populations with a higher proportion of Black residents and uninsured adults, greater wealth inequity, poorer general health, and reduced preventive testing rates as compared with other counties. Conclusions: Recurrent ischemic strokes decreased over time overall and across demographic subgroups; however, there were geographic areas with persistently higher recurrence rates. These findings can inform secondary prevention intervention opportunities for high-risk populations and communities.

Original languageEnglish
Pages (from-to)3338-3347
Number of pages10
Issue number11
StatePublished - Nov 1 2022

Bibliographical note

Funding Information:
Supported by R01AG056628 (NIH National Institute on Aging) and 17GRNT33440121 (American Heart Association). This content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the American Heart Association.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.


  • Medicare
  • ischemic stroke
  • population
  • recurrence
  • secondary prevention

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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