Clear socioeconomic disparities exist in stroke diagnosis and treatment thought to be related to biologic factors, access to resources, and control of modifiable vascular risk factors.  Geographic features may also play a role. 

We analyzed temporal trends of modifiable risk factors in adult patients hospitalized for AIS/TIA in the United States from 2005 to 2014 using the National Inpatient Sample (NIS). Primary analysis evaluated the prevalence of each risk factor stratified by geographic regions.  Survey-weighted logistic regression was used to estimate the rate for each year and compared across regions before and after adjusting for age and sex.

Of 1,194,232 admissions for AIS/TIA from 2005 to 2014, 18.5% were from Northeast, South 41.7%, Midwest 22.2%, West 17.6%. Overall prevalence of hypertension was 66.1%, diabetes 32.7%, dyslipidemia 48.4%, obesity 7.8% and smoking 23.8%. South had the highest prevalence of diabetes and hypertension (p <0.001 and 0.002, respectively). Comparatively, dyslipidemia, obesity, and smoking were most prevalent in the Midwest (p<0.001). Over ten years, the prevalence of diabetes (29.2% to 36.8%), dyslipidemia (34% to 58.8%), obesity (4.7% to 11.1%), and smoking (15.8% to 32.8%) increased significantly (p<0.001), but hypertension remained persistently high (65.7% to 67.1%). Comparing time-effect by region, the temporal change from 2005 to 2014 varied significantly across regions for diabetes (p=0.02), dyslipidemia (p=0.09), hypertension (p<0.001) and smoking (p<0.001), but not obesity (p=0.44).