Doug Brunk

HONOLULU – Traditional risk factors and socioeconomic status account for less than half of the underlying causes of differences in the incidence of stroke between blacks and whites, results from a large ongoing study demonstrated.

"We’re halfway there in understanding why these disparities might exist," George Howard, Dr.PH., said at the annual meeting of the American Academy of Neurology.

The magnitude of the racial disparities in stroke "are nothing short of striking," said Dr. Howard, professor and chair of biostatistics at the University of Alabama at Birmingham. "For African Americans below age 65, the black to white mortality ratio is two to three times greater than their white counterparts. With increasing age, this disparity diminishes so that at age 85 there are no racial disparities in stroke."

Data from the Greater Cincinnati/Northern Kentucky Stroke Study suggest that the excess stroke mortality among blacks in the United States is a product of higher incidence, not higher case fatality. "Most people jump to the conclusion that that’s because of a higher prevalence of hypertension and diabetes among blacks and a lower socioeconomic status among blacks," Dr. Howard said. "While these disparities have existed for more than 60 years, there are few data to assess whether these differences explain the disparity."

During 2003-2007, he and his colleagues enrolled 30,239 black and white adults aged 45 years and older in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal study to provide insights into the excess stroke mortality among African Americans and Southerners. They conducted follow-up visits with the participants at 6-month intervals. To date, there have been 489 physician-adjudicated incident stroke events in the cohort over an average follow-up of 4.5 years.

At the meeting, Dr. Howard, the principal investigator, presented results on 25,727 study participants who were stroke free at baseline and for whom he and his associates had full data. The analysis included the estimated stroke risk among whites vs. blacks and an assessment of the proportion of risk attributable to traditional risk factors and socioeconomic status (SES).

The average age of whites and blacks was 65 years and 64 years. There were significant differences in the prevalence of many traditional risk factors between the groups. For example, 29% of blacks had diabetes compared with 15% of whites. Blacks also differed from whites in terms of having a higher mean systolic blood pressure (131 mm Hg vs. 125 mm Hg), and were more likely to be on antihypertensive medications (62% vs. 42%), to have left ventricular hypertrophy (15% vs. 6%), and to be a current smoker (17% vs. 12%).

Some SES factors also were significantly different between white and black individuals. A higher proportion of whites than blacks completed college (42% vs. 27%) and reported a household income of more than $75,000 per year (22% vs. 10%).

Dr. Howard reported that blacks were 2.84 times more likely than whites to have an incident stroke at age 45 and 1.67 times more likely than whites to have an incident stroke at age 65. "This disparity diminished by age 85," he said.

Adjustment for traditional risk factors attenuated these excesses by 38% at age 45 and 45% at age 65, resulting in black vs. white relative stroke risks of 2.14 and 1.37. "Approximately one-half of this mediation by risk factors is attributable to racial differences in systolic blood pressure," Dr. Howard said.

Further adjustment for SES factors attenuated these excesses by 46% at age 45 and 54% at age 65, resulting in black vs. white relative stroke risks of 2.00 and 1.31.

"We can explain almost half of the reasons for the disparity in stroke incidence between blacks and whites," Dr. Howard concluded. About half of this is attributable to racial differences in systolic blood pressure, he said, while much of the remaining half of the mediation is attributable to the use of antihypertensives, to having diabetes, and to SES.

"What can be done to address the hall-full portion that we understand?" Dr. Howard asked. "For most risk factors we are examining prevalence, not effectiveness of treatment. This implies that risk factor treatment is not the key, but rather risk factor prevention is."

This suggests, he continued, "that instead of focusing on racial disparities in stroke, perhaps we should be focusing on racial disparities in the development of stroke risk factors. The exception is controlled systolic blood pressure, where control is important. We think that differential susceptibility to blood pressure – particularly systolic blood pressure – could be a promising route to try to reduce these disparities."

Dr. Howard noted that several factors could be contributing to the unexplained differences in stroke incidence that remain between these two groups, including differential susceptibility to risk factors, residual confounding, impact of "nontraditional" risk factors, and measurement error.

The study is supported by the National Institute for Neurological Disorders and Stroke. Dr. Howard disclosed that he has received personal compensation from Bayer Healthcare and has received research support from Amgen and Bayer Healthcare.

HONOLULU – Traditional risk factors and socioeconomic status account for less than half of the underlying causes of differences in the incidence of stroke between blacks and whites, results from a large ongoing study demonstrated.

"We’re halfway there in understanding why these disparities might exist," George Howard, Dr.PH., said at the annual meeting of the American Academy of Neurology.

The magnitude of the racial disparities in stroke "are nothing short of striking," said Dr. Howard, professor and chair of biostatistics at the University of Alabama at Birmingham. "For African Americans below age 65, the black to white mortality ratio is two to three times greater than their white counterparts. With increasing age, this disparity diminishes so that at age 85 there are no racial disparities in stroke."

Data from the Greater Cincinnati/Northern Kentucky Stroke Study suggest that the excess stroke mortality among blacks in the United States is a product of higher incidence, not higher case fatality. "Most people jump to the conclusion that that’s because of a higher prevalence of hypertension and diabetes among blacks and a lower socioeconomic status among blacks," Dr. Howard said. "While these disparities have existed for more than 60 years, there are few data to assess whether these differences explain the disparity."

During 2003-2007, he and his colleagues enrolled 30,239 black and white adults aged 45 years and older in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal study to provide insights into the excess stroke mortality among African Americans and Southerners. They conducted follow-up visits with the participants at 6-month intervals. To date, there have been 489 physician-adjudicated incident stroke events in the cohort over an average follow-up of 4.5 years.

At the meeting, Dr. Howard, the principal investigator, presented results on 25,727 study participants who were stroke free at baseline and for whom he and his associates had full data. The analysis included the estimated stroke risk among whites vs. blacks and an assessment of the proportion of risk attributable to traditional risk factors and socioeconomic status (SES).

The average age of whites and blacks was 65 years and 64 years. There were significant differences in the prevalence of many traditional risk factors between the groups. For example, 29% of blacks had diabetes compared with 15% of whites. Blacks also differed from whites in terms of having a higher mean systolic blood pressure (131 mm Hg vs. 125 mm Hg), and were more likely to be on antihypertensive medications (62% vs. 42%), to have left ventricular hypertrophy (15% vs. 6%), and to be a current smoker (17% vs. 12%).

Some SES factors also were significantly different between white and black individuals. A higher proportion of whites than blacks completed college (42% vs. 27%) and reported a household income of more than $75,000 per year (22% vs. 10%).

Dr. Howard reported that blacks were 2.84 times more likely than whites to have an incident stroke at age 45 and 1.67 times more likely than whites to have an incident stroke at age 65. "This disparity diminished by age 85," he said.

Adjustment for traditional risk factors attenuated these excesses by 38% at age 45 and 45% at age 65, resulting in black vs. white relative stroke risks of 2.14 and 1.37. "Approximately one-half of this mediation by risk factors is attributable to racial differences in systolic blood pressure," Dr. Howard said.

Further adjustment for SES factors attenuated these excesses by 46% at age 45 and 54% at age 65, resulting in black vs. white relative stroke risks of 2.00 and 1.31.

"We can explain almost half of the reasons for the disparity in stroke incidence between blacks and whites," Dr. Howard concluded. About half of this is attributable to racial differences in systolic blood pressure, he said, while much of the remaining half of the mediation is attributable to the use of antihypertensives, to having diabetes, and to SES.

"What can be done to address the hall-full portion that we understand?" Dr. Howard asked. "For most risk factors we are examining prevalence, not effectiveness of treatment. This implies that risk factor treatment is not the key, but rather risk factor prevention is."

This suggests, he continued, "that instead of focusing on racial disparities in stroke, perhaps we should be focusing on racial disparities in the development of stroke risk factors. The exception is controlled systolic blood pressure, where control is important. We think that differential susceptibility to blood pressure – particularly systolic blood pressure – could be a promising route to try to reduce these disparities."

Dr. Howard noted that several factors could be contributing to the unexplained differences in stroke incidence that remain between these two groups, including differential susceptibility to risk factors, residual confounding, impact of "nontraditional" risk factors, and measurement error.

The study is supported by the National Institute for Neurological Disorders and Stroke. Dr. Howard disclosed that he has received personal compensation from Bayer Healthcare and has received research support from Amgen and Bayer Healthcare.

HONOLULU – Traditional risk factors and socioeconomic status account for less than half of the underlying causes of differences in the incidence of stroke between blacks and whites, results from a large ongoing study demonstrated.

"We’re halfway there in understanding why these disparities might exist," George Howard, Dr.PH., said at the annual meeting of the American Academy of Neurology.

The magnitude of the racial disparities in stroke "are nothing short of striking," said Dr. Howard, professor and chair of biostatistics at the University of Alabama at Birmingham. "For African Americans below age 65, the black to white mortality ratio is two to three times greater than their white counterparts. With increasing age, this disparity diminishes so that at age 85 there are no racial disparities in stroke."

Data from the Greater Cincinnati/Northern Kentucky Stroke Study suggest that the excess stroke mortality among blacks in the United States is a product of higher incidence, not higher case fatality. "Most people jump to the conclusion that that’s because of a higher prevalence of hypertension and diabetes among blacks and a lower socioeconomic status among blacks," Dr. Howard said. "While these disparities have existed for more than 60 years, there are few data to assess whether these differences explain the disparity."

During 2003-2007, he and his colleagues enrolled 30,239 black and white adults aged 45 years and older in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal study to provide insights into the excess stroke mortality among African Americans and Southerners. They conducted follow-up visits with the participants at 6-month intervals. To date, there have been 489 physician-adjudicated incident stroke events in the cohort over an average follow-up of 4.5 years.

At the meeting, Dr. Howard, the principal investigator, presented results on 25,727 study participants who were stroke free at baseline and for whom he and his associates had full data. The analysis included the estimated stroke risk among whites vs. blacks and an assessment of the proportion of risk attributable to traditional risk factors and socioeconomic status (SES).

The average age of whites and blacks was 65 years and 64 years. There were significant differences in the prevalence of many traditional risk factors between the groups. For example, 29% of blacks had diabetes compared with 15% of whites. Blacks also differed from whites in terms of having a higher mean systolic blood pressure (131 mm Hg vs. 125 mm Hg), and were more likely to be on antihypertensive medications (62% vs. 42%), to have left ventricular hypertrophy (15% vs. 6%), and to be a current smoker (17% vs. 12%).

Some SES factors also were significantly different between white and black individuals. A higher proportion of whites than blacks completed college (42% vs. 27%) and reported a household income of more than $75,000 per year (22% vs. 10%).

Dr. Howard reported that blacks were 2.84 times more likely than whites to have an incident stroke at age 45 and 1.67 times more likely than whites to have an incident stroke at age 65. "This disparity diminished by age 85," he said.

Adjustment for traditional risk factors attenuated these excesses by 38% at age 45 and 45% at age 65, resulting in black vs. white relative stroke risks of 2.14 and 1.37. "Approximately one-half of this mediation by risk factors is attributable to racial differences in systolic blood pressure," Dr. Howard said.

Further adjustment for SES factors attenuated these excesses by 46% at age 45 and 54% at age 65, resulting in black vs. white relative stroke risks of 2.00 and 1.31.

"We can explain almost half of the reasons for the disparity in stroke incidence between blacks and whites," Dr. Howard concluded. About half of this is attributable to racial differences in systolic blood pressure, he said, while much of the remaining half of the mediation is attributable to the use of antihypertensives, to having diabetes, and to SES.

"What can be done to address the hall-full portion that we understand?" Dr. Howard asked. "For most risk factors we are examining prevalence, not effectiveness of treatment. This implies that risk factor treatment is not the key, but rather risk factor prevention is."

This suggests, he continued, "that instead of focusing on racial disparities in stroke, perhaps we should be focusing on racial disparities in the development of stroke risk factors. The exception is controlled systolic blood pressure, where control is important. We think that differential susceptibility to blood pressure – particularly systolic blood pressure – could be a promising route to try to reduce these disparities."

Dr. Howard noted that several factors could be contributing to the unexplained differences in stroke incidence that remain between these two groups, including differential susceptibility to risk factors, residual confounding, impact of "nontraditional" risk factors, and measurement error.

The study is supported by the National Institute for Neurological Disorders and Stroke. Dr. Howard disclosed that he has received personal compensation from Bayer Healthcare and has received research support from Amgen and Bayer Healthcare.

HONOLULU – Traditional risk factors and socioeconomic status account for less than half of the underlying causes of differences in the incidence of stroke between blacks and whites, results from a large ongoing study demonstrated.

"We’re halfway there in understanding why these disparities might exist," George Howard, Dr.PH., said at the annual meeting of the American Academy of Neurology.

The magnitude of the racial disparities in stroke "are nothing short of striking," said Dr. Howard, professor and chair of biostatistics at the University of Alabama at Birmingham. "For African Americans below age 65, the black to white mortality ratio is two to three times greater than their white counterparts. With increasing age, this disparity diminishes so that at age 85 there are no racial disparities in stroke."

Data from the Greater Cincinnati/Northern Kentucky Stroke Study suggest that the excess stroke mortality among blacks in the United States is a product of higher incidence, not higher case fatality. "Most people jump to the conclusion that that’s because of a higher prevalence of hypertension and diabetes among blacks and a lower socioeconomic status among blacks," Dr. Howard said. "While these disparities have existed for more than 60 years, there are few data to assess whether these differences explain the disparity."

During 2003-2007, he and his colleagues enrolled 30,239 black and white adults aged 45 years and older in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal study to provide insights into the excess stroke mortality among African Americans and Southerners. They conducted follow-up visits with the participants at 6-month intervals. To date, there have been 489 physician-adjudicated incident stroke events in the cohort over an average follow-up of 4.5 years.

At the meeting, Dr. Howard, the principal investigator, presented results on 25,727 study participants who were stroke free at baseline and for whom he and his associates had full data. The analysis included the estimated stroke risk among whites vs. blacks and an assessment of the proportion of risk attributable to traditional risk factors and socioeconomic status (SES).

The average age of whites and blacks was 65 years and 64 years. There were significant differences in the prevalence of many traditional risk factors between the groups. For example, 29% of blacks had diabetes compared with 15% of whites. Blacks also differed from whites in terms of having a higher mean systolic blood pressure (131 mm Hg vs. 125 mm Hg), and were more likely to be on antihypertensive medications (62% vs. 42%), to have left ventricular hypertrophy (15% vs. 6%), and to be a current smoker (17% vs. 12%).

Some SES factors also were significantly different between white and black individuals. A higher proportion of whites than blacks completed college (42% vs. 27%) and reported a household income of more than $75,000 per year (22% vs. 10%).

Dr. Howard reported that blacks were 2.84 times more likely than whites to have an incident stroke at age 45 and 1.67 times more likely than whites to have an incident stroke at age 65. "This disparity diminished by age 85," he said.

Adjustment for traditional risk factors attenuated these excesses by 38% at age 45 and 45% at age 65, resulting in black vs. white relative stroke risks of 2.14 and 1.37. "Approximately one-half of this mediation by risk factors is attributable to racial differences in systolic blood pressure," Dr. Howard said.

Further adjustment for SES factors attenuated these excesses by 46% at age 45 and 54% at age 65, resulting in black vs. white relative stroke risks of 2.00 and 1.31.

"We can explain almost half of the reasons for the disparity in stroke incidence between blacks and whites," Dr. Howard concluded. About half of this is attributable to racial differences in systolic blood pressure, he said, while much of the remaining half of the mediation is attributable to the use of antihypertensives, to having diabetes, and to SES.

"What can be done to address the hall-full portion that we understand?" Dr. Howard asked. "For most risk factors we are examining prevalence, not effectiveness of treatment. This implies that risk factor treatment is not the key, but rather risk factor prevention is."

This suggests, he continued, "that instead of focusing on racial disparities in stroke, perhaps we should be focusing on racial disparities in the development of stroke risk factors. The exception is controlled systolic blood pressure, where control is important. We think that differential susceptibility to blood pressure – particularly systolic blood pressure – could be a promising route to try to reduce these disparities."

Dr. Howard noted that several factors could be contributing to the unexplained differences in stroke incidence that remain between these two groups, including differential susceptibility to risk factors, residual confounding, impact of "nontraditional" risk factors, and measurement error.

The study is supported by the National Institute for Neurological Disorders and Stroke. Dr. Howard disclosed that he has received personal compensation from Bayer Healthcare and has received research support from Amgen and Bayer Healthcare.

HONOLULU – Traditional risk factors and socioeconomic status account for less than half of the underlying causes of differences in the incidence of stroke between blacks and whites, results from a large ongoing study demonstrated.

"We’re halfway there in understanding why these disparities might exist," George Howard, Dr.PH., said at the annual meeting of the American Academy of Neurology.

The magnitude of the racial disparities in stroke "are nothing short of striking," said Dr. Howard, professor and chair of biostatistics at the University of Alabama at Birmingham. "For African Americans below age 65, the black to white mortality ratio is two to three times greater than their white counterparts. With increasing age, this disparity diminishes so that at age 85 there are no racial disparities in stroke."

Data from the Greater Cincinnati/Northern Kentucky Stroke Study suggest that the excess stroke mortality among blacks in the United States is a product of higher incidence, not higher case fatality. "Most people jump to the conclusion that that’s because of a higher prevalence of hypertension and diabetes among blacks and a lower socioeconomic status among blacks," Dr. Howard said. "While these disparities have existed for more than 60 years, there are few data to assess whether these differences explain the disparity."

During 2003-2007, he and his colleagues enrolled 30,239 black and white adults aged 45 years and older in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal study to provide insights into the excess stroke mortality among African Americans and Southerners. They conducted follow-up visits with the participants at 6-month intervals. To date, there have been 489 physician-adjudicated incident stroke events in the cohort over an average follow-up of 4.5 years.

At the meeting, Dr. Howard, the principal investigator, presented results on 25,727 study participants who were stroke free at baseline and for whom he and his associates had full data. The analysis included the estimated stroke risk among whites vs. blacks and an assessment of the proportion of risk attributable to traditional risk factors and socioeconomic status (SES).

The average age of whites and blacks was 65 years and 64 years. There were significant differences in the prevalence of many traditional risk factors between the groups. For example, 29% of blacks had diabetes compared with 15% of whites. Blacks also differed from whites in terms of having a higher mean systolic blood pressure (131 mm Hg vs. 125 mm Hg), and were more likely to be on antihypertensive medications (62% vs. 42%), to have left ventricular hypertrophy (15% vs. 6%), and to be a current smoker (17% vs. 12%).

Some SES factors also were significantly different between white and black individuals. A higher proportion of whites than blacks completed college (42% vs. 27%) and reported a household income of more than $75,000 per year (22% vs. 10%).

Dr. Howard reported that blacks were 2.84 times more likely than whites to have an incident stroke at age 45 and 1.67 times more likely than whites to have an incident stroke at age 65. "This disparity diminished by age 85," he said.

Adjustment for traditional risk factors attenuated these excesses by 38% at age 45 and 45% at age 65, resulting in black vs. white relative stroke risks of 2.14 and 1.37. "Approximately one-half of this mediation by risk factors is attributable to racial differences in systolic blood pressure," Dr. Howard said.

Further adjustment for SES factors attenuated these excesses by 46% at age 45 and 54% at age 65, resulting in black vs. white relative stroke risks of 2.00 and 1.31.

"We can explain almost half of the reasons for the disparity in stroke incidence between blacks and whites," Dr. Howard concluded. About half of this is attributable to racial differences in systolic blood pressure, he said, while much of the remaining half of the mediation is attributable to the use of antihypertensives, to having diabetes, and to SES.

"What can be done to address the hall-full portion that we understand?" Dr. Howard asked. "For most risk factors we are examining prevalence, not effectiveness of treatment. This implies that risk factor treatment is not the key, but rather risk factor prevention is."

This suggests, he continued, "that instead of focusing on racial disparities in stroke, perhaps we should be focusing on racial disparities in the development of stroke risk factors. The exception is controlled systolic blood pressure, where control is important. We think that differential susceptibility to blood pressure – particularly systolic blood pressure – could be a promising route to try to reduce these disparities."

Dr. Howard noted that several factors could be contributing to the unexplained differences in stroke incidence that remain between these two groups, including differential susceptibility to risk factors, residual confounding, impact of "nontraditional" risk factors, and measurement error.

The study is supported by the National Institute for Neurological Disorders and Stroke. Dr. Howard disclosed that he has received personal compensation from Bayer Healthcare and has received research support from Amgen and Bayer Healthcare.

HONOLULU – Traditional risk factors and socioeconomic status account for less than half of the underlying causes of differences in the incidence of stroke between blacks and whites, results from a large ongoing study demonstrated.

"We’re halfway there in understanding why these disparities might exist," George Howard, Dr.PH., said at the annual meeting of the American Academy of Neurology.

The magnitude of the racial disparities in stroke "are nothing short of striking," said Dr. Howard, professor and chair of biostatistics at the University of Alabama at Birmingham. "For African Americans below age 65, the black to white mortality ratio is two to three times greater than their white counterparts. With increasing age, this disparity diminishes so that at age 85 there are no racial disparities in stroke."

Data from the Greater Cincinnati/Northern Kentucky Stroke Study suggest that the excess stroke mortality among blacks in the United States is a product of higher incidence, not higher case fatality. "Most people jump to the conclusion that that’s because of a higher prevalence of hypertension and diabetes among blacks and a lower socioeconomic status among blacks," Dr. Howard said. "While these disparities have existed for more than 60 years, there are few data to assess whether these differences explain the disparity."

During 2003-2007, he and his colleagues enrolled 30,239 black and white adults aged 45 years and older in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal study to provide insights into the excess stroke mortality among African Americans and Southerners. They conducted follow-up visits with the participants at 6-month intervals. To date, there have been 489 physician-adjudicated incident stroke events in the cohort over an average follow-up of 4.5 years.

At the meeting, Dr. Howard, the principal investigator, presented results on 25,727 study participants who were stroke free at baseline and for whom he and his associates had full data. The analysis included the estimated stroke risk among whites vs. blacks and an assessment of the proportion of risk attributable to traditional risk factors and socioeconomic status (SES).

The average age of whites and blacks was 65 years and 64 years. There were significant differences in the prevalence of many traditional risk factors between the groups. For example, 29% of blacks had diabetes compared with 15% of whites. Blacks also differed from whites in terms of having a higher mean systolic blood pressure (131 mm Hg vs. 125 mm Hg), and were more likely to be on antihypertensive medications (62% vs. 42%), to have left ventricular hypertrophy (15% vs. 6%), and to be a current smoker (17% vs. 12%).

Some SES factors also were significantly different between white and black individuals. A higher proportion of whites than blacks completed college (42% vs. 27%) and reported a household income of more than $75,000 per year (22% vs. 10%).

Dr. Howard reported that blacks were 2.84 times more likely than whites to have an incident stroke at age 45 and 1.67 times more likely than whites to have an incident stroke at age 65. "This disparity diminished by age 85," he said.

Adjustment for traditional risk factors attenuated these excesses by 38% at age 45 and 45% at age 65, resulting in black vs. white relative stroke risks of 2.14 and 1.37. "Approximately one-half of this mediation by risk factors is attributable to racial differences in systolic blood pressure," Dr. Howard said.

Further adjustment for SES factors attenuated these excesses by 46% at age 45 and 54% at age 65, resulting in black vs. white relative stroke risks of 2.00 and 1.31.

"We can explain almost half of the reasons for the disparity in stroke incidence between blacks and whites," Dr. Howard concluded. About half of this is attributable to racial differences in systolic blood pressure, he said, while much of the remaining half of the mediation is attributable to the use of antihypertensives, to having diabetes, and to SES.

"What can be done to address the hall-full portion that we understand?" Dr. Howard asked. "For most risk factors we are examining prevalence, not effectiveness of treatment. This implies that risk factor treatment is not the key, but rather risk factor prevention is."

This suggests, he continued, "that instead of focusing on racial disparities in stroke, perhaps we should be focusing on racial disparities in the development of stroke risk factors. The exception is controlled systolic blood pressure, where control is important. We think that differential susceptibility to blood pressure – particularly systolic blood pressure – could be a promising route to try to reduce these disparities."

Dr. Howard noted that several factors could be contributing to the unexplained differences in stroke incidence that remain between these two groups, including differential susceptibility to risk factors, residual confounding, impact of "nontraditional" risk factors, and measurement error.

The study is supported by the National Institute for Neurological Disorders and Stroke. Dr. Howard disclosed that he has received personal compensation from Bayer Healthcare and has received research support from Amgen and Bayer Healthcare.

HONOLULU – Patients with Parkinson’s disease who participated in a 1-hour exercise program twice a week for 6 months experienced improvements in certain cognitive deficits, results from a single-center study showed.

"Exercise should be considered adjunct therapy in Parkinson’s disease because it improves cognitive function in patients when not on medication," lead study author Jeffrey R. Olech said in an interview during a poster session at the annual meeting of the American Academy of Neurology.

Mr. Olech, a second-year student at the University of Illinois at Chicago, and his associates presented results from 48 Parkinson’s disease patients who completed 6 months of a strengthening and balance exercise program under the guidance of a personal trainer. The researchers administered cognitive assessments when patients were "on" and "off" Parkinson’s medication at baseline and at completion of the 6-month program.

Cognitive tests included the Stroop Color and Word Test, the Brief Test of Attention (BTA), and the Digit Span Forward and Backward Task. The researchers performed a two-way repeated measures analysis of variance on the cognitive measures with time (baseline vs. 6 months) and medication (on vs. off) as factors.

The mean age of patients was 59 years, and 58% were men. The mean baseline motor United Parkinson Disease Rating Scale score was 34.6 among those off medication and 21.3 among those on medication.

At 6 months, exercise and medication use significantly improved cognitive function based on results of the Stroop Color and Word Test. A significant interaction was observed between exercise and medication use based on results of the BTA test and the Digit Span Forward and Backward Task. Exercise improved performance on both of these tests when patients were off medication, but not while they were on medication.

"It was surprising to us that cognitive function was improved without medication over different domains of cognitive assessments," Mr. Olech said. "Previous research has demonstrated that Parkinson’s patients on medication without exercise will maintain their level of cognitive performance over a 6-month period of time. Reasons improvement on cognitive outcomes off medication were observed could potentially be due to increased neural plasticity as a result of exercise, or an improvement in dopaminergic output during periods throughout the day that the drug’s therapeutic benefit wanes."

He and his associates plan to collect data in this cohort of patients at 18 and 24 months of follow-up to determine if the associations persist.

Mr. Olech acknowledged certain limitations of the study, including its lack of an intervention control group and its single-center design.

The study was supported by an American Academy of Neurology Medical Student Summer Research Scholarship and by a grant from the National Institute of Neurological Disorders and Stroke.

HONOLULU – Patients with Parkinson’s disease who participated in a 1-hour exercise program twice a week for 6 months experienced improvements in certain cognitive deficits, results from a single-center study showed.

"Exercise should be considered adjunct therapy in Parkinson’s disease because it improves cognitive function in patients when not on medication," lead study author Jeffrey R. Olech said in an interview during a poster session at the annual meeting of the American Academy of Neurology.

Mr. Olech, a second-year student at the University of Illinois at Chicago, and his associates presented results from 48 Parkinson’s disease patients who completed 6 months of a strengthening and balance exercise program under the guidance of a personal trainer. The researchers administered cognitive assessments when patients were "on" and "off" Parkinson’s medication at baseline and at completion of the 6-month program.

Cognitive tests included the Stroop Color and Word Test, the Brief Test of Attention (BTA), and the Digit Span Forward and Backward Task. The researchers performed a two-way repeated measures analysis of variance on the cognitive measures with time (baseline vs. 6 months) and medication (on vs. off) as factors.

The mean age of patients was 59 years, and 58% were men. The mean baseline motor United Parkinson Disease Rating Scale score was 34.6 among those off medication and 21.3 among those on medication.

At 6 months, exercise and medication use significantly improved cognitive function based on results of the Stroop Color and Word Test. A significant interaction was observed between exercise and medication use based on results of the BTA test and the Digit Span Forward and Backward Task. Exercise improved performance on both of these tests when patients were off medication, but not while they were on medication.

"It was surprising to us that cognitive function was improved without medication over different domains of cognitive assessments," Mr. Olech said. "Previous research has demonstrated that Parkinson’s patients on medication without exercise will maintain their level of cognitive performance over a 6-month period of time. Reasons improvement on cognitive outcomes off medication were observed could potentially be due to increased neural plasticity as a result of exercise, or an improvement in dopaminergic output during periods throughout the day that the drug’s therapeutic benefit wanes."

He and his associates plan to collect data in this cohort of patients at 18 and 24 months of follow-up to determine if the associations persist.

Mr. Olech acknowledged certain limitations of the study, including its lack of an intervention control group and its single-center design.

The study was supported by an American Academy of Neurology Medical Student Summer Research Scholarship and by a grant from the National Institute of Neurological Disorders and Stroke.

HONOLULU – Patients with Parkinson’s disease who participated in a 1-hour exercise program twice a week for 6 months experienced improvements in certain cognitive deficits, results from a single-center study showed.

"Exercise should be considered adjunct therapy in Parkinson’s disease because it improves cognitive function in patients when not on medication," lead study author Jeffrey R. Olech said in an interview during a poster session at the annual meeting of the American Academy of Neurology.

Mr. Olech, a second-year student at the University of Illinois at Chicago, and his associates presented results from 48 Parkinson’s disease patients who completed 6 months of a strengthening and balance exercise program under the guidance of a personal trainer. The researchers administered cognitive assessments when patients were "on" and "off" Parkinson’s medication at baseline and at completion of the 6-month program.

Cognitive tests included the Stroop Color and Word Test, the Brief Test of Attention (BTA), and the Digit Span Forward and Backward Task. The researchers performed a two-way repeated measures analysis of variance on the cognitive measures with time (baseline vs. 6 months) and medication (on vs. off) as factors.

The mean age of patients was 59 years, and 58% were men. The mean baseline motor United Parkinson Disease Rating Scale score was 34.6 among those off medication and 21.3 among those on medication.

At 6 months, exercise and medication use significantly improved cognitive function based on results of the Stroop Color and Word Test. A significant interaction was observed between exercise and medication use based on results of the BTA test and the Digit Span Forward and Backward Task. Exercise improved performance on both of these tests when patients were off medication, but not while they were on medication.

"It was surprising to us that cognitive function was improved without medication over different domains of cognitive assessments," Mr. Olech said. "Previous research has demonstrated that Parkinson’s patients on medication without exercise will maintain their level of cognitive performance over a 6-month period of time. Reasons improvement on cognitive outcomes off medication were observed could potentially be due to increased neural plasticity as a result of exercise, or an improvement in dopaminergic output during periods throughout the day that the drug’s therapeutic benefit wanes."

He and his associates plan to collect data in this cohort of patients at 18 and 24 months of follow-up to determine if the associations persist.

Mr. Olech acknowledged certain limitations of the study, including its lack of an intervention control group and its single-center design.

The study was supported by an American Academy of Neurology Medical Student Summer Research Scholarship and by a grant from the National Institute of Neurological Disorders and Stroke.

HONOLULU – Patients with Parkinson’s disease who participated in a 1-hour exercise program twice a week for 6 months experienced improvements in certain cognitive deficits, results from a single-center study showed.

"Exercise should be considered adjunct therapy in Parkinson’s disease because it improves cognitive function in patients when not on medication," lead study author Jeffrey R. Olech said in an interview during a poster session at the annual meeting of the American Academy of Neurology.

Mr. Olech, a second-year student at the University of Illinois at Chicago, and his associates presented results from 48 Parkinson’s disease patients who completed 6 months of a strengthening and balance exercise program under the guidance of a personal trainer. The researchers administered cognitive assessments when patients were "on" and "off" Parkinson’s medication at baseline and at completion of the 6-month program.

Cognitive tests included the Stroop Color and Word Test, the Brief Test of Attention (BTA), and the Digit Span Forward and Backward Task. The researchers performed a two-way repeated measures analysis of variance on the cognitive measures with time (baseline vs. 6 months) and medication (on vs. off) as factors.

The mean age of patients was 59 years, and 58% were men. The mean baseline motor United Parkinson Disease Rating Scale score was 34.6 among those off medication and 21.3 among those on medication.

At 6 months, exercise and medication use significantly improved cognitive function based on results of the Stroop Color and Word Test. A significant interaction was observed between exercise and medication use based on results of the BTA test and the Digit Span Forward and Backward Task. Exercise improved performance on both of these tests when patients were off medication, but not while they were on medication.

"It was surprising to us that cognitive function was improved without medication over different domains of cognitive assessments," Mr. Olech said. "Previous research has demonstrated that Parkinson’s patients on medication without exercise will maintain their level of cognitive performance over a 6-month period of time. Reasons improvement on cognitive outcomes off medication were observed could potentially be due to increased neural plasticity as a result of exercise, or an improvement in dopaminergic output during periods throughout the day that the drug’s therapeutic benefit wanes."

He and his associates plan to collect data in this cohort of patients at 18 and 24 months of follow-up to determine if the associations persist.

Mr. Olech acknowledged certain limitations of the study, including its lack of an intervention control group and its single-center design.

The study was supported by an American Academy of Neurology Medical Student Summer Research Scholarship and by a grant from the National Institute of Neurological Disorders and Stroke.

HONOLULU – Patients with Parkinson’s disease who participated in a 1-hour exercise program twice a week for 6 months experienced improvements in certain cognitive deficits, results from a single-center study showed.

"Exercise should be considered adjunct therapy in Parkinson’s disease because it improves cognitive function in patients when not on medication," lead study author Jeffrey R. Olech said in an interview during a poster session at the annual meeting of the American Academy of Neurology.

Mr. Olech, a second-year student at the University of Illinois at Chicago, and his associates presented results from 48 Parkinson’s disease patients who completed 6 months of a strengthening and balance exercise program under the guidance of a personal trainer. The researchers administered cognitive assessments when patients were "on" and "off" Parkinson’s medication at baseline and at completion of the 6-month program.

Cognitive tests included the Stroop Color and Word Test, the Brief Test of Attention (BTA), and the Digit Span Forward and Backward Task. The researchers performed a two-way repeated measures analysis of variance on the cognitive measures with time (baseline vs. 6 months) and medication (on vs. off) as factors.

The mean age of patients was 59 years, and 58% were men. The mean baseline motor United Parkinson Disease Rating Scale score was 34.6 among those off medication and 21.3 among those on medication.

At 6 months, exercise and medication use significantly improved cognitive function based on results of the Stroop Color and Word Test. A significant interaction was observed between exercise and medication use based on results of the BTA test and the Digit Span Forward and Backward Task. Exercise improved performance on both of these tests when patients were off medication, but not while they were on medication.

"It was surprising to us that cognitive function was improved without medication over different domains of cognitive assessments," Mr. Olech said. "Previous research has demonstrated that Parkinson’s patients on medication without exercise will maintain their level of cognitive performance over a 6-month period of time. Reasons improvement on cognitive outcomes off medication were observed could potentially be due to increased neural plasticity as a result of exercise, or an improvement in dopaminergic output during periods throughout the day that the drug’s therapeutic benefit wanes."

He and his associates plan to collect data in this cohort of patients at 18 and 24 months of follow-up to determine if the associations persist.

Mr. Olech acknowledged certain limitations of the study, including its lack of an intervention control group and its single-center design.

The study was supported by an American Academy of Neurology Medical Student Summer Research Scholarship and by a grant from the National Institute of Neurological Disorders and Stroke.

HONOLULU – Patients with Parkinson’s disease who participated in a 1-hour exercise program twice a week for 6 months experienced improvements in certain cognitive deficits, results from a single-center study showed.

"Exercise should be considered adjunct therapy in Parkinson’s disease because it improves cognitive function in patients when not on medication," lead study author Jeffrey R. Olech said in an interview during a poster session at the annual meeting of the American Academy of Neurology.

Mr. Olech, a second-year student at the University of Illinois at Chicago, and his associates presented results from 48 Parkinson’s disease patients who completed 6 months of a strengthening and balance exercise program under the guidance of a personal trainer. The researchers administered cognitive assessments when patients were "on" and "off" Parkinson’s medication at baseline and at completion of the 6-month program.

Cognitive tests included the Stroop Color and Word Test, the Brief Test of Attention (BTA), and the Digit Span Forward and Backward Task. The researchers performed a two-way repeated measures analysis of variance on the cognitive measures with time (baseline vs. 6 months) and medication (on vs. off) as factors.

The mean age of patients was 59 years, and 58% were men. The mean baseline motor United Parkinson Disease Rating Scale score was 34.6 among those off medication and 21.3 among those on medication.

At 6 months, exercise and medication use significantly improved cognitive function based on results of the Stroop Color and Word Test. A significant interaction was observed between exercise and medication use based on results of the BTA test and the Digit Span Forward and Backward Task. Exercise improved performance on both of these tests when patients were off medication, but not while they were on medication.

"It was surprising to us that cognitive function was improved without medication over different domains of cognitive assessments," Mr. Olech said. "Previous research has demonstrated that Parkinson’s patients on medication without exercise will maintain their level of cognitive performance over a 6-month period of time. Reasons improvement on cognitive outcomes off medication were observed could potentially be due to increased neural plasticity as a result of exercise, or an improvement in dopaminergic output during periods throughout the day that the drug’s therapeutic benefit wanes."

He and his associates plan to collect data in this cohort of patients at 18 and 24 months of follow-up to determine if the associations persist.

Mr. Olech acknowledged certain limitations of the study, including its lack of an intervention control group and its single-center design.

The study was supported by an American Academy of Neurology Medical Student Summer Research Scholarship and by a grant from the National Institute of Neurological Disorders and Stroke.

HONOLULU – Patients with Parkinson’s disease who participated in a 1-hour exercise program twice a week for 6 months experienced improvements in certain cognitive deficits, results from a single-center study showed.

"Exercise should be considered adjunct therapy in Parkinson’s disease because it improves cognitive function in patients when not on medication," lead study author Jeffrey R. Olech said in an interview during a poster session at the annual meeting of the American Academy of Neurology.

Mr. Olech, a second-year student at the University of Illinois at Chicago, and his associates presented results from 48 Parkinson’s disease patients who completed 6 months of a strengthening and balance exercise program under the guidance of a personal trainer. The researchers administered cognitive assessments when patients were "on" and "off" Parkinson’s medication at baseline and at completion of the 6-month program.

Cognitive tests included the Stroop Color and Word Test, the Brief Test of Attention (BTA), and the Digit Span Forward and Backward Task. The researchers performed a two-way repeated measures analysis of variance on the cognitive measures with time (baseline vs. 6 months) and medication (on vs. off) as factors.

The mean age of patients was 59 years, and 58% were men. The mean baseline motor United Parkinson Disease Rating Scale score was 34.6 among those off medication and 21.3 among those on medication.

At 6 months, exercise and medication use significantly improved cognitive function based on results of the Stroop Color and Word Test. A significant interaction was observed between exercise and medication use based on results of the BTA test and the Digit Span Forward and Backward Task. Exercise improved performance on both of these tests when patients were off medication, but not while they were on medication.

"It was surprising to us that cognitive function was improved without medication over different domains of cognitive assessments," Mr. Olech said. "Previous research has demonstrated that Parkinson’s patients on medication without exercise will maintain their level of cognitive performance over a 6-month period of time. Reasons improvement on cognitive outcomes off medication were observed could potentially be due to increased neural plasticity as a result of exercise, or an improvement in dopaminergic output during periods throughout the day that the drug’s therapeutic benefit wanes."

He and his associates plan to collect data in this cohort of patients at 18 and 24 months of follow-up to determine if the associations persist.

Mr. Olech acknowledged certain limitations of the study, including its lack of an intervention control group and its single-center design.

The study was supported by an American Academy of Neurology Medical Student Summer Research Scholarship and by a grant from the National Institute of Neurological Disorders and Stroke.

HONOLULU – Patients with Parkinson’s disease who participated in a 1-hour exercise program twice a week for 6 months experienced improvements in certain cognitive deficits, results from a single-center study showed.

"Exercise should be considered adjunct therapy in Parkinson’s disease because it improves cognitive function in patients when not on medication," lead study author Jeffrey R. Olech said in an interview during a poster session at the annual meeting of the American Academy of Neurology.

Mr. Olech, a second-year student at the University of Illinois at Chicago, and his associates presented results from 48 Parkinson’s disease patients who completed 6 months of a strengthening and balance exercise program under the guidance of a personal trainer. The researchers administered cognitive assessments when patients were "on" and "off" Parkinson’s medication at baseline and at completion of the 6-month program.

Cognitive tests included the Stroop Color and Word Test, the Brief Test of Attention (BTA), and the Digit Span Forward and Backward Task. The researchers performed a two-way repeated measures analysis of variance on the cognitive measures with time (baseline vs. 6 months) and medication (on vs. off) as factors.

The mean age of patients was 59 years, and 58% were men. The mean baseline motor United Parkinson Disease Rating Scale score was 34.6 among those off medication and 21.3 among those on medication.

At 6 months, exercise and medication use significantly improved cognitive function based on results of the Stroop Color and Word Test. A significant interaction was observed between exercise and medication use based on results of the BTA test and the Digit Span Forward and Backward Task. Exercise improved performance on both of these tests when patients were off medication, but not while they were on medication.

"It was surprising to us that cognitive function was improved without medication over different domains of cognitive assessments," Mr. Olech said. "Previous research has demonstrated that Parkinson’s patients on medication without exercise will maintain their level of cognitive performance over a 6-month period of time. Reasons improvement on cognitive outcomes off medication were observed could potentially be due to increased neural plasticity as a result of exercise, or an improvement in dopaminergic output during periods throughout the day that the drug’s therapeutic benefit wanes."

He and his associates plan to collect data in this cohort of patients at 18 and 24 months of follow-up to determine if the associations persist.

Mr. Olech acknowledged certain limitations of the study, including its lack of an intervention control group and its single-center design.

The study was supported by an American Academy of Neurology Medical Student Summer Research Scholarship and by a grant from the National Institute of Neurological Disorders and Stroke.

HONOLULU – Patients with Parkinson’s disease who participated in a 1-hour exercise program twice a week for 6 months experienced improvements in certain cognitive deficits, results from a single-center study showed.

"Exercise should be considered adjunct therapy in Parkinson’s disease because it improves cognitive function in patients when not on medication," lead study author Jeffrey R. Olech said in an interview during a poster session at the annual meeting of the American Academy of Neurology.

Mr. Olech, a second-year student at the University of Illinois at Chicago, and his associates presented results from 48 Parkinson’s disease patients who completed 6 months of a strengthening and balance exercise program under the guidance of a personal trainer. The researchers administered cognitive assessments when patients were "on" and "off" Parkinson’s medication at baseline and at completion of the 6-month program.

Cognitive tests included the Stroop Color and Word Test, the Brief Test of Attention (BTA), and the Digit Span Forward and Backward Task. The researchers performed a two-way repeated measures analysis of variance on the cognitive measures with time (baseline vs. 6 months) and medication (on vs. off) as factors.

The mean age of patients was 59 years, and 58% were men. The mean baseline motor United Parkinson Disease Rating Scale score was 34.6 among those off medication and 21.3 among those on medication.

At 6 months, exercise and medication use significantly improved cognitive function based on results of the Stroop Color and Word Test. A significant interaction was observed between exercise and medication use based on results of the BTA test and the Digit Span Forward and Backward Task. Exercise improved performance on both of these tests when patients were off medication, but not while they were on medication.

"It was surprising to us that cognitive function was improved without medication over different domains of cognitive assessments," Mr. Olech said. "Previous research has demonstrated that Parkinson’s patients on medication without exercise will maintain their level of cognitive performance over a 6-month period of time. Reasons improvement on cognitive outcomes off medication were observed could potentially be due to increased neural plasticity as a result of exercise, or an improvement in dopaminergic output during periods throughout the day that the drug’s therapeutic benefit wanes."

He and his associates plan to collect data in this cohort of patients at 18 and 24 months of follow-up to determine if the associations persist.

Mr. Olech acknowledged certain limitations of the study, including its lack of an intervention control group and its single-center design.

The study was supported by an American Academy of Neurology Medical Student Summer Research Scholarship and by a grant from the National Institute of Neurological Disorders and Stroke.

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.

HONOLULU – The only factor associated with readmission within 30 days among patients with stroke or cerebrovascular disease was an index hospitalization that lasted more than 10 days, results from a large, single-center analysis found.

"One proposed mechanism to reduce 30-day readmissions has been early post-discharge outpatient follow-up," researchers led by Dr. Fadi Nahab wrote in a poster presented at the annual meeting of the American Academy of Neurology. "In our study population, only 5% of patients had an outpatient follow-up recommended within 1 week. Scheduling follow-up [within 1 week] in a specialty stroke clinic prior to discharge should be evaluated as a potential approach to reduce 30-day readmissions among patients discharged with a diagnosis of stroke or cerebrovascular disease."

Dr. Nahab of the department of neurology at Emory University, Atlanta, and his associates used University HealthSystem Consortium records to identify 2,706 patients discharged from Emory University Hospital with a diagnosis of stroke or cerebrovascular disease between Jan. 1, 2007, and Dec. 31, 2009. They excluded patients readmitted within 30 days for rehabilitation, chemotherapy, radiation therapy, dialysis, and delivery.

The study population included patients with a mean age of 62 years and most were white (55%) or black (33%). Their diagnoses at discharge were ischemic stroke (35%), subarachnoid hemorrhage (25%), intracerebral hemorrhage (16%), transient ischemic attack (7%), or other cerebrovascular diseases (17%).

Of the 2,706 patients studied, 174 had 178 readmissions within 30 days, for a rate of 7%. The top three discharging providers were neurologists (40%), neurosurgeons (33%), and vascular surgeons (16%).

Multivariate analysis revealed that an index hospital stay of more than 10 days was the only significant factor associated with readmission within 30 days (odds ratio of 2.34 when compared with an index hospital stay of less than 5 days). Age, gender, race, primary diagnosis, the specialty of the discharging clinicians, and the year of discharge were not significant predictors.

"Length of stay is often considered a representation of disease severity and our results add support to the previously mixed data showing that a prolonged hospital length of stay is associated with higher readmission rates among patients with stroke and cerebrovascular disease," Dr. Nahab said in an interview after the meeting.

Among nonsurgical specialties, the researchers observed a trend toward lower 30-day readmission rates by neurologists than by physicians from other specialties: 6% among neurologists, compared with 9% among internists and cardiologists.

The researchers also found that initial follow-up was recommended within 30 days for 57% of patients and within one week for 5% of patients. However, only 14% of patients had an outpatient follow-up appointment scheduled prior to discharge. In the study, a lack of early outpatient follow-up represented the most common contributor to unplanned avoidable readmissions.

"While identifying patient characteristics that predict the likelihood of a readmission may help providers recognize patients who are at greatest risk for readmission, the significant heterogeneity among prior studies highlights the complexity of factors that contribute to readmission among stroke patients," Dr. Nahab said. "If we are to intervene and reduce readmissions, early (less than 1 week) outpatient follow-up scheduled prior to hospital discharge needs to be studied as one possible answer."

Dr. Nahab said that he had no relevant financial disclosures to make.

DENVER – Although new adolescent vaccine recommendations disseminated between 2005 and early 2007 for meningococcal, tetanus-diphtheria-pertussis, and human papillomavirus vaccines were anticipated to increase the proportion of adolescents with an annual preventive visit, no such impact has occurred, results from a large national survey demonstrated.

However, the rates of vaccination-only visits did increase, researchers led by Christina S. Albertin, M.P.H., reported during a poster session at the annual meeting of the Pediatric Academic Societies. The findings suggest that patterns of primary care delivery did not appear to change as a result of the new recommendations for this population.

"Additional methods, such as reminder recall interventions for annual well care visits, may be needed to bring additional adolescents in for recommended preventive care," the researchers wrote in their poster.

Ms. Albertin and her associates from the division of general pediatrics at the University of Rochester, N.Y., analyzed Medical Expenditure Panel Survey data for any medical visits, well-care visits, and vaccine-only visits made by adolescents, aged 11-21 years, during two time periods: 2004-2005 (before the vaccine recommendations) and 2007-2008 (after the recommendations). They compared visit rates overall and by age group (11-13 years, 14-17 years, and 18-21 years), sex, race/ethnic group, insurance status, and household income. They used chi square analysis to compare rates between the two time periods, controlling for the complex sample design.

Ms. Albertin presented findings from 2,693 adolescents studied in 2004-2005 and 1,988 adolescents studied in 2007-2008.

Between the two time periods, no significant changes in the percentage of adolescents with any medical visit overall were observed (73% vs. 72%, respectively), nor were any changes seen among any of the subgroups following the recommendations. In addition, the percentage of well child visits did not change significantly overall (they remained at 41% for both time periods), or among any of the subgroups.

The average number of visits with a vaccination overall increased significantly from 0.08% in 2004-2005 to 0.14% in 2007-2008. Likewise, the percentage of adolescents who reported a visit with a vaccination increased from 8% to 11%. The subgroups with significant increases included adolescents aged 14-17 years, females, whites, privately insured, and those from families with the highest income level.

"The data seem to show that in the initial 21 months or so following the recommendations, pediatricians focused on fitting vaccinations into existing visits, not expanding the number of [patient] visits," Ms. Albertin said in an interview. "I’m surprised by the results given that there are Tdap vaccine requirements in many states."

She went on to explain that through 2008, only 16 states had school requirements for the Tdap vaccine. "Now, projected through 2011 it looks like that’s going to more than double," she said. "As a result, I think that we will slowly see an increase in both immunization-only and preventive visits."

Ms. Albertin said that she had no relevant financial conflicts to disclose.

DENVER – Although new adolescent vaccine recommendations disseminated between 2005 and early 2007 for meningococcal, tetanus-diphtheria-pertussis, and human papillomavirus vaccines were anticipated to increase the proportion of adolescents with an annual preventive visit, no such impact has occurred, results from a large national survey demonstrated.

However, the rates of vaccination-only visits did increase, researchers led by Christina S. Albertin, M.P.H., reported during a poster session at the annual meeting of the Pediatric Academic Societies. The findings suggest that patterns of primary care delivery did not appear to change as a result of the new recommendations for this population.

"Additional methods, such as reminder recall interventions for annual well care visits, may be needed to bring additional adolescents in for recommended preventive care," the researchers wrote in their poster.

Ms. Albertin and her associates from the division of general pediatrics at the University of Rochester, N.Y., analyzed Medical Expenditure Panel Survey data for any medical visits, well-care visits, and vaccine-only visits made by adolescents, aged 11-21 years, during two time periods: 2004-2005 (before the vaccine recommendations) and 2007-2008 (after the recommendations). They compared visit rates overall and by age group (11-13 years, 14-17 years, and 18-21 years), sex, race/ethnic group, insurance status, and household income. They used chi square analysis to compare rates between the two time periods, controlling for the complex sample design.

Ms. Albertin presented findings from 2,693 adolescents studied in 2004-2005 and 1,988 adolescents studied in 2007-2008.

Between the two time periods, no significant changes in the percentage of adolescents with any medical visit overall were observed (73% vs. 72%, respectively), nor were any changes seen among any of the subgroups following the recommendations. In addition, the percentage of well child visits did not change significantly overall (they remained at 41% for both time periods), or among any of the subgroups.

The average number of visits with a vaccination overall increased significantly from 0.08% in 2004-2005 to 0.14% in 2007-2008. Likewise, the percentage of adolescents who reported a visit with a vaccination increased from 8% to 11%. The subgroups with significant increases included adolescents aged 14-17 years, females, whites, privately insured, and those from families with the highest income level.

"The data seem to show that in the initial 21 months or so following the recommendations, pediatricians focused on fitting vaccinations into existing visits, not expanding the number of [patient] visits," Ms. Albertin said in an interview. "I’m surprised by the results given that there are Tdap vaccine requirements in many states."

She went on to explain that through 2008, only 16 states had school requirements for the Tdap vaccine. "Now, projected through 2011 it looks like that’s going to more than double," she said. "As a result, I think that we will slowly see an increase in both immunization-only and preventive visits."

Ms. Albertin said that she had no relevant financial conflicts to disclose.

DENVER – Although new adolescent vaccine recommendations disseminated between 2005 and early 2007 for meningococcal, tetanus-diphtheria-pertussis, and human papillomavirus vaccines were anticipated to increase the proportion of adolescents with an annual preventive visit, no such impact has occurred, results from a large national survey demonstrated.

However, the rates of vaccination-only visits did increase, researchers led by Christina S. Albertin, M.P.H., reported during a poster session at the annual meeting of the Pediatric Academic Societies. The findings suggest that patterns of primary care delivery did not appear to change as a result of the new recommendations for this population.

"Additional methods, such as reminder recall interventions for annual well care visits, may be needed to bring additional adolescents in for recommended preventive care," the researchers wrote in their poster.

Ms. Albertin and her associates from the division of general pediatrics at the University of Rochester, N.Y., analyzed Medical Expenditure Panel Survey data for any medical visits, well-care visits, and vaccine-only visits made by adolescents, aged 11-21 years, during two time periods: 2004-2005 (before the vaccine recommendations) and 2007-2008 (after the recommendations). They compared visit rates overall and by age group (11-13 years, 14-17 years, and 18-21 years), sex, race/ethnic group, insurance status, and household income. They used chi square analysis to compare rates between the two time periods, controlling for the complex sample design.

Ms. Albertin presented findings from 2,693 adolescents studied in 2004-2005 and 1,988 adolescents studied in 2007-2008.

Between the two time periods, no significant changes in the percentage of adolescents with any medical visit overall were observed (73% vs. 72%, respectively), nor were any changes seen among any of the subgroups following the recommendations. In addition, the percentage of well child visits did not change significantly overall (they remained at 41% for both time periods), or among any of the subgroups.

The average number of visits with a vaccination overall increased significantly from 0.08% in 2004-2005 to 0.14% in 2007-2008. Likewise, the percentage of adolescents who reported a visit with a vaccination increased from 8% to 11%. The subgroups with significant increases included adolescents aged 14-17 years, females, whites, privately insured, and those from families with the highest income level.

"The data seem to show that in the initial 21 months or so following the recommendations, pediatricians focused on fitting vaccinations into existing visits, not expanding the number of [patient] visits," Ms. Albertin said in an interview. "I’m surprised by the results given that there are Tdap vaccine requirements in many states."

She went on to explain that through 2008, only 16 states had school requirements for the Tdap vaccine. "Now, projected through 2011 it looks like that’s going to more than double," she said. "As a result, I think that we will slowly see an increase in both immunization-only and preventive visits."

Ms. Albertin said that she had no relevant financial conflicts to disclose.

DENVER – Although new adolescent vaccine recommendations disseminated between 2005 and early 2007 for meningococcal, tetanus-diphtheria-pertussis, and human papillomavirus vaccines were anticipated to increase the proportion of adolescents with an annual preventive visit, no such impact has occurred, results from a large national survey demonstrated.

However, the rates of vaccination-only visits did increase, researchers led by Christina S. Albertin, M.P.H., reported during a poster session at the annual meeting of the Pediatric Academic Societies. The findings suggest that patterns of primary care delivery did not appear to change as a result of the new recommendations for this population.

"Additional methods, such as reminder recall interventions for annual well care visits, may be needed to bring additional adolescents in for recommended preventive care," the researchers wrote in their poster.

Ms. Albertin and her associates from the division of general pediatrics at the University of Rochester, N.Y., analyzed Medical Expenditure Panel Survey data for any medical visits, well-care visits, and vaccine-only visits made by adolescents, aged 11-21 years, during two time periods: 2004-2005 (before the vaccine recommendations) and 2007-2008 (after the recommendations). They compared visit rates overall and by age group (11-13 years, 14-17 years, and 18-21 years), sex, race/ethnic group, insurance status, and household income. They used chi square analysis to compare rates between the two time periods, controlling for the complex sample design.

Ms. Albertin presented findings from 2,693 adolescents studied in 2004-2005 and 1,988 adolescents studied in 2007-2008.

Between the two time periods, no significant changes in the percentage of adolescents with any medical visit overall were observed (73% vs. 72%, respectively), nor were any changes seen among any of the subgroups following the recommendations. In addition, the percentage of well child visits did not change significantly overall (they remained at 41% for both time periods), or among any of the subgroups.

The average number of visits with a vaccination overall increased significantly from 0.08% in 2004-2005 to 0.14% in 2007-2008. Likewise, the percentage of adolescents who reported a visit with a vaccination increased from 8% to 11%. The subgroups with significant increases included adolescents aged 14-17 years, females, whites, privately insured, and those from families with the highest income level.

"The data seem to show that in the initial 21 months or so following the recommendations, pediatricians focused on fitting vaccinations into existing visits, not expanding the number of [patient] visits," Ms. Albertin said in an interview. "I’m surprised by the results given that there are Tdap vaccine requirements in many states."

She went on to explain that through 2008, only 16 states had school requirements for the Tdap vaccine. "Now, projected through 2011 it looks like that’s going to more than double," she said. "As a result, I think that we will slowly see an increase in both immunization-only and preventive visits."

Ms. Albertin said that she had no relevant financial conflicts to disclose.

DENVER – Although new adolescent vaccine recommendations disseminated between 2005 and early 2007 for meningococcal, tetanus-diphtheria-pertussis, and human papillomavirus vaccines were anticipated to increase the proportion of adolescents with an annual preventive visit, no such impact has occurred, results from a large national survey demonstrated.

However, the rates of vaccination-only visits did increase, researchers led by Christina S. Albertin, M.P.H., reported during a poster session at the annual meeting of the Pediatric Academic Societies. The findings suggest that patterns of primary care delivery did not appear to change as a result of the new recommendations for this population.

"Additional methods, such as reminder recall interventions for annual well care visits, may be needed to bring additional adolescents in for recommended preventive care," the researchers wrote in their poster.

Ms. Albertin and her associates from the division of general pediatrics at the University of Rochester, N.Y., analyzed Medical Expenditure Panel Survey data for any medical visits, well-care visits, and vaccine-only visits made by adolescents, aged 11-21 years, during two time periods: 2004-2005 (before the vaccine recommendations) and 2007-2008 (after the recommendations). They compared visit rates overall and by age group (11-13 years, 14-17 years, and 18-21 years), sex, race/ethnic group, insurance status, and household income. They used chi square analysis to compare rates between the two time periods, controlling for the complex sample design.

Ms. Albertin presented findings from 2,693 adolescents studied in 2004-2005 and 1,988 adolescents studied in 2007-2008.

Between the two time periods, no significant changes in the percentage of adolescents with any medical visit overall were observed (73% vs. 72%, respectively), nor were any changes seen among any of the subgroups following the recommendations. In addition, the percentage of well child visits did not change significantly overall (they remained at 41% for both time periods), or among any of the subgroups.

The average number of visits with a vaccination overall increased significantly from 0.08% in 2004-2005 to 0.14% in 2007-2008. Likewise, the percentage of adolescents who reported a visit with a vaccination increased from 8% to 11%. The subgroups with significant increases included adolescents aged 14-17 years, females, whites, privately insured, and those from families with the highest income level.

"The data seem to show that in the initial 21 months or so following the recommendations, pediatricians focused on fitting vaccinations into existing visits, not expanding the number of [patient] visits," Ms. Albertin said in an interview. "I’m surprised by the results given that there are Tdap vaccine requirements in many states."

She went on to explain that through 2008, only 16 states had school requirements for the Tdap vaccine. "Now, projected through 2011 it looks like that’s going to more than double," she said. "As a result, I think that we will slowly see an increase in both immunization-only and preventive visits."

Ms. Albertin said that she had no relevant financial conflicts to disclose.

DENVER – Although new adolescent vaccine recommendations disseminated between 2005 and early 2007 for meningococcal, tetanus-diphtheria-pertussis, and human papillomavirus vaccines were anticipated to increase the proportion of adolescents with an annual preventive visit, no such impact has occurred, results from a large national survey demonstrated.

However, the rates of vaccination-only visits did increase, researchers led by Christina S. Albertin, M.P.H., reported during a poster session at the annual meeting of the Pediatric Academic Societies. The findings suggest that patterns of primary care delivery did not appear to change as a result of the new recommendations for this population.

"Additional methods, such as reminder recall interventions for annual well care visits, may be needed to bring additional adolescents in for recommended preventive care," the researchers wrote in their poster.

Ms. Albertin and her associates from the division of general pediatrics at the University of Rochester, N.Y., analyzed Medical Expenditure Panel Survey data for any medical visits, well-care visits, and vaccine-only visits made by adolescents, aged 11-21 years, during two time periods: 2004-2005 (before the vaccine recommendations) and 2007-2008 (after the recommendations). They compared visit rates overall and by age group (11-13 years, 14-17 years, and 18-21 years), sex, race/ethnic group, insurance status, and household income. They used chi square analysis to compare rates between the two time periods, controlling for the complex sample design.

Ms. Albertin presented findings from 2,693 adolescents studied in 2004-2005 and 1,988 adolescents studied in 2007-2008.

Between the two time periods, no significant changes in the percentage of adolescents with any medical visit overall were observed (73% vs. 72%, respectively), nor were any changes seen among any of the subgroups following the recommendations. In addition, the percentage of well child visits did not change significantly overall (they remained at 41% for both time periods), or among any of the subgroups.

The average number of visits with a vaccination overall increased significantly from 0.08% in 2004-2005 to 0.14% in 2007-2008. Likewise, the percentage of adolescents who reported a visit with a vaccination increased from 8% to 11%. The subgroups with significant increases included adolescents aged 14-17 years, females, whites, privately insured, and those from families with the highest income level.

"The data seem to show that in the initial 21 months or so following the recommendations, pediatricians focused on fitting vaccinations into existing visits, not expanding the number of [patient] visits," Ms. Albertin said in an interview. "I’m surprised by the results given that there are Tdap vaccine requirements in many states."

She went on to explain that through 2008, only 16 states had school requirements for the Tdap vaccine. "Now, projected through 2011 it looks like that’s going to more than double," she said. "As a result, I think that we will slowly see an increase in both immunization-only and preventive visits."

Ms. Albertin said that she had no relevant financial conflicts to disclose.