Comparison of claims variables between beneficiaries in Optum with versus without successful Paul Coverdell National Acute Stroke Program-linkage
| Patient characteristics | Linked (n=5644) N (%) | Unlinked (n=98 896) N (%) | Standardised difference |
| Demographics | |||
| Age, mean (SD) | 69.7 (11.9) | 72.5 (12.3) | −0.23 |
| Female | 2797 (49.6) | 51 821 (52.4) | −0.06 |
| Comorbidities* | |||
| Combined comorbidity index, mean (SD) | 1.4 (2.5) | 1.5 (2.4) | −0.03 |
| Hypertension | 3866 (68.5) | 64 675 (65.4) | 0.07 |
| Diabetes | 1974 (35.0) | 31 964 (32.3) | 0.06 |
| Dyslipidaemia | 2710 (48.0) | 43 584 (44.1) | 0.08 |
| Prior ischaemic stroke | 1192 (21.1) | 17 852 (18.1) | 0.08 |
| Prior transient ischaemic attack | 526 (9.3) | 8802 (8.9) | 0.01 |
| History of atrial fibrillation | 820 (14.5) | 17 384 (17.6) | −0.08 |
| Carotid stenosis | 411 (7.3) | 6342 (6.4) | 0.03 |
| Prior haemorrhagic stroke | 83 (1.5) | 1067 (1.1) | 0.03 |
| Ischaemic heart disease or procedure | 1341 (23.8) | 22 974 (23.2) | 0.01 |
| Peripheral vascular disease (PVD) or PVD surgery | 497 (8.8) | 10 024 (10.1) | −0.05 |
| Congestive heart failure | 786 (13.9) | 14 487 (14.7) | −0.02 |
| Chronic kidney disease | 699 (12.4) | 13 338 (13.5) | −0.03 |
| Chronic obstructive pulmonary disease | 694 (12.3) | 12 772 (12.9) | −0.02 |
| Pneumonia | 346 (6.1) | 5890 (6.0) | 0.01 |
| Dementia | 575 (10.2) | 12 087 (12.2) | −0.06 |
| Cancer or history of malignant neoplasm | 661 (11.7) | 11 328 (11.5) | 0.01 |
| Obesity | 811 (14.4) | 13 357 (13.5) | 0.02 |
| Smoking | 455 (8.1) | 6411 (6.5) | 0.06 |
| Alcohol abuse or dependence | 76 (1.4) | 1221 (1.2) | 0.01 |
| Drug abuse or dependence | 61 (1.1) | 991 (1.0) | 0.01 |
| Depression | 556 (9.9) | 9194 (9.3) | 0.02 |
| Medication use* | |||
| Any antihypertensives† | 3437 (60.9) | 62 519 (63.2) | −0.05 |
| Angiotensin-converting enzyme inhibitors | 1556 (27.6) | 28 447 (28.8) | −0.03 |
| Angiotensin II receptor blockers | 738 (13.1) | 12 944 (13.1) | 0.00 |
| Beta-blockers | 1980 (35.1) | 35 563 (36.0) | −0.02 |
| Calcium channel blockers | 1361 (24.1) | 23 941 (24.2) | 0.00 |
| Thiazide diuretics | 1147 (20.3) | 18 151 (18.4) | 0.05 |
| Loop diuretics | 837 (14.8) | 15 521 (15.7) | −0.02 |
| Other antihypertensives | 458 (8.1) | 8045 (8.1) | 0.00 |
| Nitrates and other antianginal therapies | 389 (6.9) | 6088 (6.2) | 0.03 |
| Antiarrhythmics | 105 (1.9) | 2044 (2.1) | −0.01 |
| Digoxin | 176 (3.1) | 4329 (4.4) | −0.07 |
| Any lipid-lowering agents‡ | 2144 (38.0) | 36 294 (36.7) | 0.03 |
| Statins | 2016 (35.7) | 33 977 (34.4) | 0.03 |
| Other lipid-lowering agents | 340 (6.0) | 5231 (5.3) | 0.03 |
| Antiplatelets§ | 694 (12.3) | 10 480 (10.6) | 0.05 |
| Anticoagulants¶ | 491 (8.7) | 9163 (9.3) | −0.02 |
| Warfarin | 383 (6.8) | 7778 (7.9) | −0.04 |
| Direct oral anticoagulants | 94 (1.7) | 1198 (1.2) | 0.04 |
| Heparin, LMWH or fondaparinux | 66 (1.2) | 935 (1.0) | 0.02 |
| Insulin | 622 (11.0) | 8937 (9.0) | 0.07 |
| Non-insulin glucose-lowering medications | 1034 (18.3) | 17 429 (17.6) | 0.02 |
| Antidepressants** | 1145 (20.3) | 19 146 (19.4) | 0.02 |
| Measures of healthcare utilisation* | |||
| Any hospitalisation, % | 1215 (21.5) | 17 462 (17.7) | 0.10 |
| Number of any hospitalisation, mean (SD) | 0.3 (0.7) | 0.3 (0.7) | 0.08 |
| Any hospitalisation within prior 30 days, % | 467 (8.3) | 6426 (6.5) | 0.07 |
| N hospital days, mean (SD) | 2.0 (6.1) | 1.6 (5.6) | 0.07 |
| Number of emergency department visits, mean (SD) | 0.8 (2.0) | 0.7 (1.9) | 0.09 |
| Number of any physician visit, mean (SD) | 12.8 (17.8) | 10.5 (15.7) | 0.14 |
| Total N distinct pharmacological agents prescribed, mean (SD) | 6.5 (6.0) | 6.3 (5.6) | 0.04 |
| Laboratory values* | |||
| LDL, mg/dL, mean (SD) | 105.3 (56.9) | 106.9 (44.7) | −0.03 |
| LDL, N (%) | 123 (2.2) | 2471 (2.5) | −0.02 |
| Total cholesterol, mg/dL, mean (SD) | 199.6 (61.9) | 193.3 (48.8) | 0.11 |
| Total cholesterol, N (%) | 120 (2.1) | 2514 (2.5) | −0.03 |
| INR, mean (SD) | 1.6 (0.9) | 1.7 (0.9) | −0.02 |
| INR, N (%) | 19 (0.3) | 384 (0.4) | −0.01 |
| Creatinine, mg/dL, mean (SD) | 1.1 (0.5) | 1.1 (2.1) | −0.05 |
| Creatinine, N (%) | 171 (3.0) | 3393 (3.4) | −0.02 |
| HbA1c, %, mean (SD) | 8.2 (2.5) | 7.8 (2.2) | 0.15 |
| HbA1c, N (%) | 90 (1.6) | 1530 (1.6) | 0.00 |
| Characteristics of stroke hospitalisation | |||
| Length of stay of index hospitalisation, mean (SD) | 5.7 (4.7) | 5.9 (6.8) | −0.05 |
| Discharge status | |||
| Home | 2691 (47.7) | 41 191 (41.7) | 0.12 |
| Home healthcare | 680 (12.1) | 10 376 (10.5) | 0.05 |
| Rehabilitation facility | 480 (8.5) | 8596 (8.7) | −0.01 |
| Skilled nursing facility | 935 (16.6) | 19 766 (20.0) | −0.09 |
| Other acute inpatient facility | 331 (5.9) | 6701 (6.8) | −0.04 |
| Hospice | 190 (3.4) | 4098 (4.1) | −0.04 |
| In-hospital mortality†† | 33 (0.6) | 516 (0.5) | 0.01 |
Values are N (%) unless otherwise specified.
*Unless otherwise specified, measured during the 6 months preceding the index stroke hospitalisation.
†Includes ACE-inhibitors, ARBs, beta-blockers, calcium channel blockers, thiazide diuretics, loop diuretics, and other antihypertensives.
‡Includes statins or other lipid-lowering medications.
§Includes aspirin, clopidogrel, prasugrel, ticagrelor, dipyridamole, aspirin–dipyridamole, ticlopidine.
¶Includes warfarin, dabigatran, rivaroxaban, apixaban, edoxaban, heparin, dalteparin, enoxaparin, tinzaparin, fondaparinux, argatroban, desirudin, lipirudin.
**Includes selective serotonin reuptake inhibitors (SSRIs) and non-SSRI antidepressants.
††Information on mortality is available in Optum through linkage with the Social Security Administration Death Master File. This capture is limited by a policy change in 2011 concerning the extent of the Social Security Administration disclosure of death records received from states (important notice: change in public death master file records. 2011; https://classic.ntis.gov/assets/pdf/import-change-dmf.pdf).
ARBs, angiotensin II receptor blockers; HbA1c, haemoglobin A1c; INR, international normalised ratio; LDL, low-density lipoprotein; LMWH, low-molecular-weight heparin.