Decrease in hospital ischemic strokes in older adults in France since 2019: a retrospective cohort study

Background This study aimed to update the epidemiology of ischemic stroke in one French region, the Centre-Val de Loire (CVL), to provide a comprehensive understanding of how stroke patterns evolved in an aging population with uneven access to medical care, compared to national data. Methods Patients hospitalized for ischemic stroke between 2014 and 2022 were included from the national Hospital Discharge Database ( PMSI - ICD-10 code I63). The crude hospitalization rates were stratified by sex and age. For the population ≥75 y.o., the average annual percentage changes of hospitalisation rates were calculated for two periods: 2014-2019 and 2020-2022, both for the CVL region and the national levels. Results Similar trends were observed at the regional and national scale: after a rising period, the national number of patients with ischemic stroke stabilized around 90,000 by 2022 in France, giving an hospitalisation rate of 137/100,000 inhabitants, higher in men (151/100,000) and patients ≥75 y.o. (735/100,000). For the latter, a decreasing trend was observed after 2019, with average annual decreases of hospitalization rates of -2.8% and -4%, respectively. Discussion This study was the first to document a consistent decline in hospital admissions for ischemic stroke in older adults from 2019 onwards, both in the CVL region and in France. This decline could be attributable, at least in part, to the loss of high-risk stroke patients during the COVID-19 pandemic.