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January 04, 2021Article

Prevalence of Cervical Artery Dissection among Hospitalized Patients with Stroke by Age in a Nationally Representative Sample from the United States

Yahya B. Atalay, Pirouz Piran, Abhinaba Chatterjee, Santosh Murthy, Babak B. Navi, Ava L. Liberman, Joseph Dardick, Cenai Zhang, Hooman Kamel, Alexander E. Merkler
First published January 4, 2021, DOI: https://doi.org/10.1212/WNL.0000000000011420
Yahya B. Atalay
1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY
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Pirouz Piran
1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY
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Abhinaba Chatterjee
1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY
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Santosh Murthy
1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY
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Babak B. Navi
1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY
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Ava L. Liberman
2Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Joseph Dardick
2Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Cenai Zhang
1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY
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Hooman Kamel
1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY
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Alexander E. Merkler
1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medical College, New York, NY
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Citation
Prevalence of Cervical Artery Dissection among Hospitalized Patients with Stroke by Age in a Nationally Representative Sample from the United States
Yahya B. Atalay, Pirouz Piran, Abhinaba Chatterjee, Santosh Murthy, Babak B. Navi, Ava L. Liberman, Joseph Dardick, Cenai Zhang, Hooman Kamel, Alexander E. Merkler
Neurology Jan 2021, 10.1212/WNL.0000000000011420; DOI: 10.1212/WNL.0000000000011420

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Abstract

Objective: To test the hypothesis that the prevalence of cervical artery dissection remains constant across age groups, we evaluated the relationship between age and cervical artery dissection in patients with stroke using a Nationally Representative Sample from the United States.

Methods: We used inpatient claims data included in the 2012-2015 releases of the National Inpatient Sample (NIS). We used validated ICD-9-CM codes to identify adults hospitalized with ischemic stroke and a concomitant diagnosis of carotid- or vertebral-artery dissection. Survey weights provided by the NIS and population estimates from the U.S. census were used to calculate nationally representative estimates. The chi-square test for trend was used to compare the prevalence of concomitant dissection among stroke hospitalizations across patient subgroups defined by age. Poisson regression and the Wald test for trend were used to evaluate whether the prevalence of hospitalizations for stroke and concomitant dissection per million person-years varied by age groups.

Results: There were 17,320 (95% confidence interval [CI], 15,614-19,026) hospitalizations involving ischemic stroke and a concomitant dissection. The prevalence of dissection among stroke hospitalizations decreased across 10-year age groups from 7.2% (95% CI, 6.2%-8.1%) among persons younger than age 30 years to 0.2% (95% CI, 0.1%-0.2%) among persons older than age 80 years (P value for trend <0.001). However, the prevalence of hospitalizations for stroke and concomitant dissection increased from 5.4 (95% CI, 4.6-6.2) hospitalizations per million person-years among adults younger than age 30 to 24.4 (95% CI, 21.0-27.9) hospitalizations per million person-years among adults older than age 80 (P value for trend <0.01).

Conclusions: In a nationally representative sample, the prevalence of hospitalizations for dissection-related stroke increased with age.

  • Received June 22, 2020.
  • Accepted in final form October 14, 2020.
  • © 2021 American Academy of Neurology

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