To determine the financial burden of stroke on the national healthcare system for the past three decades.

This is a retrospective study of inpatient subjects from 1993-2019 with cerebrovascular disease that was collected from the Healthcare Cost and Utilization Project (HCUP). Patients were evaluated for demographics, length of stay (LOS), mortality, and hospital charges. Statistical Z-testing was conducted for the analysis.

During the study period, 17,041,026 stroke subjects were studied, with 52.6% female and mean age of 70.62 (± 0.16) years old. The mean rate of stroke discharges per 100,000 persons was 194.46 (± 3.74), with an increase from 203 to 209 during the study (p = 0.22). The mean percentage of deaths was 9.52% (± 0.17), which decreased from 12.87% to 5.52% (p = 0.00). The mean LOS was 6.63 days (± 0.08), decreased from 9.54 to 6.90 during the study (p = 0.00). During the study period, the aggregated national bill was $710 billion. The mean hospital charges per patient were $43,954.23 (± 1,185.90) with an increase from $14,392.06 to $111,279.50 during the study period (p = 0.00).

Our data show that the rate, LOS, and mortality of stroke have decreased, but its charges are increasing. The improvement in outcomes could be multifactorial such as establishment of comprehensive stroke centers and evolving treatment modalities. Ironically, the charges-per-patient increased nearly eight-fold with a national bill almost equal to the annual Medicare budget. Thus, the significance of preventive medicine, such as controlling hypertension, diabetes, and smoking cessation, cannot be understated. With such a dramatically increasing financial burden, improvements in mitigating risk factors, educational programs, and access to care may be a more cost-effective option.