The Impact of Changes in Health Expenditures Per Capita, Population Growth, and Aging on Ischemic Stroke Deaths by Country, 1995–2014 (S33.002)

Objective: To evaluate the relationship between country-level health care expenditures per capita and ischemic stroke mortality. Background: Low- and middle-income countries (LMIC) carry the majority of the global ischemic stroke burden, but the precise relationship between country-level healthcare expenditures and ischemic stroke mortality is unclear. Design/Methods: We conducted a longitudinal study with country as the unit of analysis based on indicators and burden of disease data abstracted from the World Bank and Global Burden of Disease Study 2015. We compared observed changes in communicable disease and ischemic stroke mortality rates from 1995 to 2014 across 178 countries by quartiles of baseline (1995) health expenditures per capita. We then evaluated the contributions of population growth, aging, and age-specific mortality rates to observed changes in total ischemic stroke deaths among high-, upper-middle, lower-middle, and low-income countries. Results: Globally, age-standardized mortality rates for both communicable disease (−40%) and for ischemic stroke (−31%) decreased from 1995 to 2014. However, countries with lower baseline health expenditures per capita experienced greater relative improvements in age-standardized mortality rates for communicable disease than for ischemic stroke (For communicable disease, −43% in lowest quartile vs. −33% in highest quartile; for ischemic stroke, −8% in lowest quartile vs. −43% in highest quartile; p Conclusions: Population growth and aging have resulted in more ischemic stroke deaths in LMICs despite substantial relative increases in health expenditures per capita. Disclosure: Dr. Hemphill has nothing to disclose. Dr. Kim has nothing to disclose.