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Article ; Online: Risk Factors for Ischemic Stroke in Younger Adults: A Focused Update.

George, Mary G

2020 Volume 51, Issue 3, Page(s) 729–735

MeSH term(s)	Adult ; Age of Onset ; Brain Ischemia/epidemiology ; Brain Ischemia/prevention & control ; Female ; Humans ; Male ; Prevalence ; Risk Factors ; Sex Factors ; Stroke/epidemiology ; Stroke/prevention & control ; Young Adult
Language	English
Publishing date	2020-02-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.119.024156
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Article ; Online: Sex-specific racial and ethnic variations in short-term outcomes among patients with first or recurrent ischemic stroke: Paul Coverdell National Acute Stroke Program, 2016-2020.

Asaithambi, Ganesh / George, Mary G / Tong, Xin / Lakshminarayan, Kamakshi

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2024 Volume 33, Issue 4, Page(s) 107560

Abstract: Background and purpose: To understand the association of sex-specific race and ethnicity on the short-term outcomes of initial and recurrent ischemic stroke events.: Methods: Using the Paul Coverdell National Acute Stroke Program from 2016-2020, we ... ...

Abstract	Background and purpose: To understand the association of sex-specific race and ethnicity on the short-term outcomes of initial and recurrent ischemic stroke events. Methods: Using the Paul Coverdell National Acute Stroke Program from 2016-2020, we examined 426,062 ischemic stroke admissions from 629 hospitals limited to non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic patients. We performed multivariate logistic regression analyses to assess the combined effects of sex-specific race and ethnicity on short-term outcomes for acute ischemic stroke patients presenting with initial or recurrent stroke events. Outcomes assessed include rates of in-hospital death, discharge to home, and symptomatic intracranial hemorrhage (sICH) after reperfusion treatment. Results: Among studied patients, the likelihood of developing sICH after reperfusion treatment for initial ischemic stroke was not significantly different. The likelihood of experiencing in-hospital death among patients presenting with initial stroke was notably higher among NHW males (AOR 1.59 [95 % CI 1.46, 1.73]), NHW females (AOR 1.34 [95 % CI 1.23, 1.45]), and Hispanic males (AOR 1.57 [95 % CI 1.36, 1.81]) when compared to NHB females. Hispanic females were more likely to be discharged home when compared to NHB females after initial stroke event (AOR 1.32 [95 % CI 1.23, 1.41]). NHB males (AOR 0.90 [95 % CI 0.87, 0.94]) and NHW females (AOR 0.89 [95 % CI 0.86, 0.92]) were less likely to be discharged to home. All groups with recurrent ischemic strokes experienced higher likelihood of in-hospital death when compared to NHB females with the highest likelihood among NHW males (AOR 2.13 [95 % CI 1.87, 2.43]). Hispanic females had a higher likelihood of discharging home when compared to NHB females hospitalized for recurrent ischemic stroke, while NHB males and NHW females with recurrent ischemic stroke hospitalizations were less likely to discharge home. Conclusions: Sex-specific race and ethnic disparities remain for short-term outcomes in both initial and recurrent ischemic stroke hospitalizations. Further studies are needed to address disparities among recurrent ischemic stroke hospitalizations.
MeSH term(s)	Female ; Humans ; Male ; Black or African American ; Hospital Mortality ; Ischemic Stroke/diagnosis ; Ischemic Stroke/therapy ; Stroke/diagnosis ; Stroke/therapy ; White People ; White ; Hispanic or Latino
Language	English
Publishing date	2024-01-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2024.107560
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Article ; Online: Patient-reported outcomes after ischemic stroke as part of routine care.

George, Mary G / Zhao, Xingquan

Neurology

2018 Volume 90, Issue 16, Page(s) 717–718

MeSH term(s)	Brain Ischemia ; Humans ; Patient Reported Outcome Measures ; Recovery of Function ; Stroke ; Time Factors
Language	English
Publishing date	2018-03-28
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000005321
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Article ; Online: Contemporary Trends in the Treatment of Mild Ischemic Stroke with Intravenous Thrombolysis: Paul Coverdell National Acute Stroke Program.

Asaithambi, Ganesh / Tong, Xin / Coleman King, Sallyann M / George, Mary G

Cerebrovascular diseases (Basel, Switzerland)

2021 Volume 51, Issue 1, Page(s) 60–66

Abstract: Background: Presentation with mild symptoms is a common reason for intravenous thrombolysis (IVT) nonuse among acute ischemic stroke (AIS) patients. We examined the impact of IVT on the outcomes of mild AIS over time.: Methods: Using the Paul ... ...

Abstract	Background: Presentation with mild symptoms is a common reason for intravenous thrombolysis (IVT) nonuse among acute ischemic stroke (AIS) patients. We examined the impact of IVT on the outcomes of mild AIS over time. Methods: Using the Paul Coverdell National Stroke Program data, we examined trends in IVT utilization from 2010 to 2019 among AIS patients presenting with National Institutes of Health Stroke Scale (NIHSS) scores ≤5. Outcomes adjudicated included rates of discharge to home and ability to ambulate independently at discharge. We used generalized estimating equation models to examine the effect of IVT on outcomes of AIS patients presenting with mild symptoms and calculated adjusted odds ratio (AOR) with 95% confidence intervals (CI). Results: During the study period, 346,762 patients presented with mild AIS symptoms. Approximately 6.2% were treated with IVT. IVT utilization trends increased from 3.7% in 2010 to 7.7% in 2019 (p < 0.001). Patients treated with IVT had higher median NIHSS scores upon presentation (IVT 3 [2, 4] vs. no IVT 2 [0, 3]). Rates of discharge to home (AOR 2.06, 95% CI: 1.99-2.13) and ability to ambulate at time of discharge (AOR 1.82, 95% CI: 1.76-1.89) were higher among those treated with IVT. Conclusion: There was an increased trend in IVT utilization among AIS patients presenting with mild symptoms. Utilization of IVT increased the odds of being discharged to home and the ability to ambulate at discharge independently in patients with mild stroke.
MeSH term(s)	Administration, Intravenous ; Brain Ischemia/diagnosis ; Brain Ischemia/drug therapy ; Fibrinolytic Agents ; Humans ; Ischemic Stroke/diagnosis ; Ischemic Stroke/drug therapy ; Stroke/diagnosis ; Stroke/drug therapy ; Thrombolytic Therapy/adverse effects ; Treatment Outcome
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2021-08-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1069462-6
ISSN	1421-9786 ; 1015-9770
ISSN (online)	1421-9786
ISSN	1015-9770
DOI	10.1159/000517969
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Article ; Online: COVID-19 and Risk of Acute Ischemic Stroke Among Medicare Beneficiaries Aged 65 Years or Older: Self-Controlled Case Series Study.

Yang, Quanhe / Tong, Xin / George, Mary G / Chang, Anping / Merritt, Robert K

Neurology

2022 Volume 98, Issue 8, Page(s) e778–e789

Abstract: Background and objectives: Findings of association between coronavirus disease 2019 (COVID-19) and stroke remain inconsistent, ranging from significant association to absence of association to less than expected ischemic stroke among hospitalized ... ...

Abstract	Background and objectives: Findings of association between coronavirus disease 2019 (COVID-19) and stroke remain inconsistent, ranging from significant association to absence of association to less than expected ischemic stroke among hospitalized patients with COVID-19. The current study examined the association between COVID-19 and risk of acute ischemic stroke (AIS). Methods: We included 37,379 Medicare fee-for-service (FFS) beneficiaries aged ≥65 years diagnosed with COVID-19 from April 1, 2020, through February 28, 2021, and AIS hospitalization from January 1, 2019, through February 28, 2021. We used a self-controlled case series design to examine the association between COVID-19 and AIS and estimated the incidence rate ratios (IRRs) by comparing incidence of AIS in risk periods (0-3, 4-7, 8-14, 15-28 days after diagnosis of COVID-19) vs control periods. Results: Among 37,379 Medicare FFS beneficiaries with COVID-19 and AIS, the median age at diagnosis of COVID-19 was 80.4 (interquartile range 73.5-87.1) years and 56.7% were women. When AIS at day of exposure (day = 0) was included in the risk periods, IRRs at 0-3, 4-7, 8-14, and 15-28 days following COVID-19 diagnosis were 10.3 (95% confidence interval 9.86-10.8), 1.61 (1.44-1.80), 1.44 (1.32-1.57), and 1.09 (1.02-1.18); when AIS at day 0 was excluded in the risk periods, the corresponding IRRs were 1.77 (1.57-2.01) (day 1-3), 1.60 (1.43-1.79), 1.43 (1.31-1.56), and 1.09 (1.01-1.17), respectively. The association appeared to be stronger among younger beneficiaries and among beneficiaries without prior history of stroke but largely consistent across sex and race/ethnicities. Discussion: Risk of AIS among Medicare FFS beneficiaries was 10 times (day 0 cases in the risk period) as high during the first 3 days after diagnosis of COVID-19 as during the control period and the risk associated with COVID-19 appeared to be stronger among those aged 65-74 years and those without prior history of stroke. Classification of evidence: This study provides Class IV evidence that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with increased risk of AIS in the first 3 days after diagnosis in Medicare FFS beneficiaries ≥65 years of age.
MeSH term(s)	Aged ; Aged, 80 and over ; COVID-19/complications ; COVID-19/epidemiology ; Female ; Humans ; Ischemic Stroke/epidemiology ; Ischemic Stroke/virology ; Male ; Medicare ; Risk Assessment ; United States/epidemiology
Language	English
Publishing date	2022-02-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000013184
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Article ; Online: Racial/Ethnic and Geographic Variations In Long-Term Survival Among Medicare Beneficiaries After Acute Ischemic Stroke.

Tong, Xin / Schieb, Linda / George, Mary G / Gillespie, Cathleen / Merritt, Robert K / Yang, Quanhe

Preventing chronic disease

2021 Volume 18, Page(s) E15

Abstract: Introduction: Little information is available about racial/ethnic and geographic variations in long-term survival among older patients (≥65) after acute ischemic stroke (AIS).: Methods: We examined data on 1,019,267 Medicare fee-for-service (FFS) ... ...

Abstract	Introduction: Little information is available about racial/ethnic and geographic variations in long-term survival among older patients (≥65) after acute ischemic stroke (AIS). Methods: We examined data on 1,019,267 Medicare fee-for-service (FFS) beneficiaries aged 66 or older, hospitalized with a primary diagnosis of AIS from 2008 through 2012. Survival was defined as the time from the date of AIS to date of death, or an end of follow-up date of December 31, 2017. We used Cox proportional hazard models to estimate 5-year survival after AIS, adjusted for age, sex, race and Hispanic ethnicity, poverty level, Charlson Comorbidity Index, and state. Results: Among 1,019,267 Medicare FFS beneficiaries hospitalized with AIS from 2008 through 2012, we documented 701,718 deaths (68.8%) during a median of 4 years of follow-up with 4.08 million person-years. The overall adjusted 5-year survival was 44%. Non-Hispanic Black men had the lowest 5-year survival, and 5-year survival varied significantly by state, from the highest at 49.1% (North Dakota) to the lowest at 40.5% (Hawaii). The ranges between the highest and lowest 5-year survival rates across states also varied significantly by racial/ethnic groups, with percentage point differences of 9.6 among non-Hispanic White, 11.3 among non-Hispanic Black, 17.7 among Hispanic, and 28.5 among other racial/ethnic beneficiaries. Conclusion: We identified significant racial/ethnic and geographic variations in 5-year survival rates after AIS among 2008-2012 Medicare FFS beneficiaries. Further study is needed to understand the reasons for these variations and develop prevention strategies to improve survival and racial disparities in survival after AIS.
MeSH term(s)	Aged ; Brain Ischemia ; Ethnic Groups ; Female ; Hispanic Americans ; Humans ; Ischemic Stroke ; Male ; Medicare ; Stroke ; United States/epidemiology
Language	English
Publishing date	2021-02-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2135684-1
ISSN	1545-1151 ; 1545-1151
ISSN (online)	1545-1151
ISSN	1545-1151
DOI	10.5888/pcd18.200242
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Article ; Online: Changing Spatiotemporal Trends in County-Level Heart Failure Death Rates in the United States, 1999 to 2018.

Vaughan, Adam S / George, Mary G / Jackson, Sandra L / Schieb, Linda / Casper, Michele

Journal of the American Heart Association

2021 Volume 10, Issue 4, Page(s) e018125

Abstract: Background Amid recently rising heart failure (HF) death rates in the United States, we describe county-level trends in HF mortality from 1999 to 2018 by racial/ethnic group and sex for ages 35 to 64 years and 65 years and older. Methods and Results ... ...

Abstract	Background Amid recently rising heart failure (HF) death rates in the United States, we describe county-level trends in HF mortality from 1999 to 2018 by racial/ethnic group and sex for ages 35 to 64 years and 65 years and older. Methods and Results Applying a hierarchical Bayesian model to National Vital Statistics data representing all US deaths, ages 35 years and older, we estimated annual age-standardized county-level HF death rates and percent change by age group, racial/ethnic group, and sex from 1999 through 2018. During 1999 to 2011, ~30% of counties experienced increasing HF death rates among adults ages 35 to 64 years. However, during 2011 to 2018, 86.9% (95% CI, 85.2-88.2) of counties experienced increasing mortality. Likewise, for ages 65 years and older, during 1999 to 2005 and 2005 to 2011, 27.8% (95% CI, 25.8-29.8) and 12.6% (95% CI, 11.2-13.9) of counties, respectively, experienced increasing mortality. However, during 2011 to 2018, most counties (67.4% [95% CI, 65.4-69.5]) experienced increasing mortality. These temporal patterns by age group held across racial/ethnic group and sex. Conclusions These results provide local context to previously documented recent national increases in HF death rates. Although county-level declines were most common before 2011, some counties and demographic groups experienced increasing HF death rates during this period of national declines. However, recent county-level increases were pervasive, occurring across counties, racial/ethnic group, and sex, particularly among ages 35 to 64 years. These spatiotemporal patterns highlight the need to identify and address underlying clinical risk factors and social determinants of health contributing to these increasing trends.
MeSH term(s)	Adult ; Age Distribution ; Aged ; Ethnic Groups ; Female ; Follow-Up Studies ; Forecasting ; Heart Failure/ethnology ; Heart Failure/mortality ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment/methods ; Risk Factors ; Sex Distribution ; Survival Rate/trends ; United States/epidemiology
Language	English
Publishing date	2021-02-04
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.120.018125
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Article ; Online: Effect of Insurance Status on Outcomes of Acute Ischemic Stroke Patients Receiving Intra-Arterial Treatment: Results from the Paul Coverdell National Acute Stroke Program.

Asaithambi, Ganesh / Tong, Xin / Lakshminarayan, Kamakshi / Coleman King, Sallyann M / George, Mary G

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2021 Volume 30, Issue 5, Page(s) 105692

Abstract: Background: Stroke continues to be a leading cause of death and disability in the United States. Rates of intra-arterial reperfusion treatments (IAT) for acute ischemic stroke (AIS) are increasing, and these treatments are associated with more favorable ...

Abstract	Background: Stroke continues to be a leading cause of death and disability in the United States. Rates of intra-arterial reperfusion treatments (IAT) for acute ischemic stroke (AIS) are increasing, and these treatments are associated with more favorable outcomes. We sought to examine the effect of insurance status on outcomes for AIS patients receiving IAT within a multistate stroke registry. Methods: We used data from the Paul Coverdell National Acute Stroke Program (PCNASP) from 2014 to 2019 to quantify rates of IAT (with or without intravenous thrombolysis) after AIS. We modeled outcomes based on insurance status: private, Medicare, Medicaid, or no insurance. Outcomes were defined as rates of discharge to home, in-hospital death, symptomatic intracranial hemorrhage (sICH), or life-threatening hemorrhage during hospitalization. Results: During the study period, there were 486,180 patients with a clinical diagnosis of AIS (mean age 70.6 years, 50.3% male) from 674 participating hospitals in PCNASP. Only 4.3% of patients received any IAT. As compared to private insurance, uninsured patients receiving any IAT were more likely to experience in-hospital death (AOR 1.36 [95% CI 1.07-1.73]). Medicare (AOR 0.78 [95% CI 0.71-0.85]) and Medicaid (AOR 0.85 [95% CI 0.75-0.96]) beneficiaries were less likely but uninsured patients were more likely (AOR 1.90 [95% CI 1.61-2.24]) to be discharged home. Insurance status was not found to be independently associated with rates of sICH. Conclusions: Insurance status was independently associated with in-hospital death and discharge to home among AIS patients undergoing IAT.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Endovascular Procedures/adverse effects ; Endovascular Procedures/mortality ; Female ; Fibrinolytic Agents/administration & dosage ; Fibrinolytic Agents/adverse effects ; Healthcare Disparities ; Hospital Mortality ; Humans ; Insurance, Health ; Intracranial Hemorrhages/etiology ; Intracranial Hemorrhages/mortality ; Ischemic Stroke/diagnosis ; Ischemic Stroke/drug therapy ; Ischemic Stroke/mortality ; Male ; Medicaid ; Medically Uninsured ; Medicare ; Middle Aged ; Patient Discharge ; Registries ; Risk Assessment ; Risk Factors ; Thrombolytic Therapy/adverse effects ; Time Factors ; Treatment Outcome ; United States/epidemiology ; Young Adult
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2021-03-04
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2021.105692
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Article ; Online: US trends in premature heart disease mortality over the past 50 years: Where do we go from here?

Ritchey, Matthew D / Wall, Hilary K / George, Mary G / Wright, Janet S

Trends in cardiovascular medicine

2019 Volume 30, Issue 6, Page(s) 364–374

Abstract: Despite the premature heart disease mortality rate among adults aged 25-64 decreasing by 70% since 1968, the rate has remained stagnant from 2011 on and, in 2017, still accounted for almost 1-in-5 of all deaths among this age group. Moreover, these ... ...

Abstract	Despite the premature heart disease mortality rate among adults aged 25-64 decreasing by 70% since 1968, the rate has remained stagnant from 2011 on and, in 2017, still accounted for almost 1-in-5 of all deaths among this age group. Moreover, these overall findings mask important differences and continued disparities observed by demographic characteristics and geography. For example, in 2017, rates were 134% higher among men compared to women and 87% higher among blacks compared to whites, and, while the greatest burden remained in the southeastern US, almost two-thirds of all US counties experienced increasing rates among adults aged 35-64 during 2010-2017. Continued high rates of uncontrolled blood pressure and increasing prevalence of diabetes and obesity pose obstacles for re-establishing a downward trajectory for premature heart disease mortality; however, proven public health and clinical interventions exist that can be used to address these conditions.
MeSH term(s)	Adult ; Age Distribution ; Age of Onset ; Female ; Heart Diseases/diagnosis ; Heart Diseases/ethnology ; Heart Diseases/mortality ; Heart Diseases/prevention & control ; Humans ; Male ; Middle Aged ; Mortality/trends ; Preventive Health Services/trends ; Race Factors ; Risk Assessment ; Risk Factors ; Risk Reduction Behavior ; Sex Distribution ; Sex Factors ; Time Factors ; United States/epidemiology
Language	English
Publishing date	2019-09-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1097434-9
ISSN	1873-2615 ; 1050-1738
ISSN (online)	1873-2615
ISSN	1050-1738
DOI	10.1016/j.tcm.2019.09.005
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Article ; Online: Effect of herpes zoster vaccine and antiviral treatment on risk of ischemic stroke.

Yang, Quanhe / George, Mary G / Chang, Anping / Tong, Xin / Merritt, Robert / Hong, Yuling

Neurology

2020 Volume 95, Issue 6, Page(s) e708–e717

Abstract: Objective: To determine whether increased risk of acute ischemic stroke (AIS) following herpes zoster (HZ) might be modified by the status of zoster vaccine live (ZVL) vaccination and antiviral treatment following HZ.: Methods: We included 87,405 ... ...

Abstract	Objective: To determine whether increased risk of acute ischemic stroke (AIS) following herpes zoster (HZ) might be modified by the status of zoster vaccine live (ZVL) vaccination and antiviral treatment following HZ. Methods: We included 87,405 Medicare fee-for-service beneficiaries aged ≥66 years diagnosed with HZ and AIS from 2008 to 2017. We used a self-controlled case series design to examine the association between HZ and AIS, and estimated incidence rate ratios (IRRs) by comparing incidence of AIS in risk periods vs control periods. To examine effect modification by ZVL and antiviral treatment, beneficiaries were classified into 4 mutually exclusive groups: (1) no vaccination and no antiviral treatment; (2) vaccination only; (3) antiviral treatment only; and (4) both vaccination and antiviral treatment. We tested for interaction to examine changes in IRRs across 4 groups. Results: Among 87,405 beneficiaries with HZ and AIS, 22.0%, 2.0%, 70.1%, and 5.8% were in groups 1 to 4, respectively. IRRs in 0-14, 15-30, 31-90, and 91-180 days following HZ were 1.89 (95% confidence interval [CI], 1.77-2.02), 1.58 (95% CI, 1.47-1.69), 1.36 (95% CI, 1.31-1.42), and 1.19 (95% CI, 1.15-1.23), respectively. There was no evidence of effect modification by ZVL and antiviral treatment on AIS ( Conclusions: Risk of AIS increased significantly following HZ, and this increased risk was not modified by ZVL and antiviral treatment. Our findings suggest the importance of following recommended HZ vaccination in prevention of HZ and HZ-associated AIS.
MeSH term(s)	Age Distribution ; Aged ; Aged, 80 and over ; Antiviral Agents/therapeutic use ; Brain Ischemia/epidemiology ; Brain Ischemia/etiology ; Brain Ischemia/prevention & control ; Ethnicity/statistics & numerical data ; Herpes Zoster/complications ; Herpes Zoster/drug therapy ; Herpes Zoster/prevention & control ; Herpes Zoster Vaccine ; Humans ; Male ; Medicare/statistics & numerical data ; Sex Distribution ; Stroke/etiology ; United States/epidemiology
Chemical Substances	Antiviral Agents ; Herpes Zoster Vaccine
Language	English
Publishing date	2020-07-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	207147-2
ISSN	1526-632X ; 0028-3878
ISSN (online)	1526-632X
ISSN	0028-3878
DOI	10.1212/WNL.0000000000010028
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