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Assessing improvements in survival for stroke patients in the Northern Territory 1992-2013: a marginal structural analysis

Zhao, Yuejen, Condon, John R., You, Jiqiong, Guthridge, Steven L. and He, Vincent Y. F. (2015). Assessing improvements in survival for stroke patients in the Northern Territory 1992-2013: a marginal structural analysis. Australian Health Review,39(4):437-443.

Document type: Journal Article
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IRMA ID 10444xPUB20
Title Assessing improvements in survival for stroke patients in the Northern Territory 1992-2013: a marginal structural analysis
Author Zhao, Yuejen
Condon, John R.
You, Jiqiong
Guthridge, Steven L.
He, Vincent Y. F.
Journal Name Australian Health Review
Publication Date 2015
Volume Number 39
Issue Number 4
ISSN 0156-5788   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84940734877
Start Page 437
End Page 443
Total Pages 7
Place of Publication Australia
Publisher C S I R O Publishing
Field of Research 1103 - Clinical Sciences
1117 - Public Health and Health Services
HERDC Category C1 - Journal Article (DIISR)
Abstract Objective The aim of the present study was to investigate changes in stroke survival among Indigenous and non-Indigenous patients in the Northern Territory (NT).

Methods A longitudinal study was undertaken of stroke patients admitted to NT public hospitals between 1992 and 2013. The Kaplan–Meier method and proportional hazards regression were used for survival analysis. A marginal structural model was applied to adjust for time-dependent confounders and informative censoring.

Results There were 4754 stroke in-patients over the period, with 3540 new cases and 837 stroke deaths. Mean age of onset for Indigenous patients (51.7 years) was 12.3 years younger than that for non-Indigenous patients. After adjustments for confounders and loss to follow-up, in-hospital deaths were more likely among Indigenous patients (hazard ratio (HR) = 1.56; P < 0.01) and less likely among males (HR = 0.86; P < 0.05) and patients from remote areas (HR = 0.72; P < 0.01). There was a 3% decrease annually in mortality hazard from 1992 to 2013. Renal disease, cancer and chronic obstructive pulmonary disease had deleterious effects on stroke survival.

Conclusions Stroke survival has improved in the NT over the past two decades. The marginal structural models provide a powerful methodological tool that can be applied to hospital administrative data to assess changes in quality of care and the impact of interventions.
DOI http://dx.doi.org/10.1071/AH14146   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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