{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T21:19:22Z","timestamp":1793827162126,"version":"4.6.1"},"reference-count":50,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T00:00:00Z","timestamp":1670889600000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003968","name":"Iran National Science Foundation","doi-asserted-by":"publisher","award":["98029140"],"award-info":[{"award-number":["98029140"]}],"id":[{"id":"10.13039\/501100003968","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Stroke is the second most prevalent cardiovascular disease in Iran. This study investigates the estimation and predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke in Iranian hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Patients who had a stroke in Iran between 2019 and 2020 were identified through the data collected from the Iran Health Insurance Organization and the Ministry of Health and Medical Education. This study is the first to conduct a pervasive, nationwide investigation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>This is a cross-sectional, prevalence-based study. Generalised linear models and a multiple logistic regression model were used to determine the predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>A total of 19\u2009150 patients suffering from stroke were studied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean hospitalisation expenses per patient who had a stroke in Iran amounted to US$590.91\u00b1974.44 (mean\u00b1SD). Mean daily hospitalisation expenses per patient who had a stroke were US$55.18\u00b137.89. The in-hospital mortality for patients who had a stroke was 18.80%. Younger people (aged \u226449 years) had significantly higher expenses than older patients. The OR of in-hospital mortality in haemorrhagic stroke was significantly higher by 1.539 times (95%\u2009CI, 1.401 to 1.691) compared with ischaemic and unspecified strokes. Compared with patients covered by the rural fund, patients covered by Iranian health insurance had significantly higher costs by 1.14 times (95% CI, 1.186 to 1.097) and 1.319 times (95% CI, 1.099 to 1.582) higher mortality. There were also significant geographical variations in patients who had a stroke\u2019s expenses and mortality rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Applying cost-effective stroke prevention strategies among the younger population (\u226449 years old) is strongly recommended. Migration to universal health insurance can effectively reduce the inequality gap among all insured patients.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2022-067573","type":"journal-article","created":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T16:05:52Z","timestamp":1670947552000},"page":"e067573","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Estimation and predictors of direct hospitalisation expenses and in-hospital mortality for patients who had a stroke in a low-middle income country: evidence from a nationwide cross-sectional study in Iranian hospitals"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5852-9375","authenticated-orcid":false,"given":"Zohreh","family":"Kazemi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8654-6554","authenticated-orcid":false,"given":"Sara","family":"Emamgholipour Sefiddashti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajabali","family":"Daroudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Askar","family":"Ghorbani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2870-7433","authenticated-orcid":false,"given":"Masud","family":"Yunesian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Sadegh","family":"Hassanvand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Shahali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,13]]},"reference":[{"key":"2022121307552899000_12.12.e067573.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"2022121307552899000_12.12.e067573.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.10.009"},{"key":"2022121307552899000_12.12.e067573.3","doi-asserted-by":"crossref","first-page":"e748","DOI":"10.1016\/S2214-109X(19)30045-2","article-title":"Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the prospective urban rural epidemiologic (pure) study","volume":"7","author":"Rosengren","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2022121307552899000_12.12.e067573.4","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-10429-0"},{"key":"2022121307552899000_12.12.e067573.5","unstructured":"Alwan A . Global status report on noncommunicable diseases 2010. World Health Organization, 2011."},{"key":"2022121307552899000_12.12.e067573.6","first-page":"204","article-title":"Cardiovascular disease in Iran in the last 40 years: prevalence, mortality, morbidity, challenges and strategies for cardiovascular prevention","volume":"22","author":"Sarrafzadegan","year":"2019","journal-title":"Arch Iran Med"},{"key":"2022121307552899000_12.12.e067573.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2009.10.002"},{"key":"2022121307552899000_12.12.e067573.8","article-title":"The cost-effectiveness and cost-utility of statin drug for the treatment of patients with cardiovascular disease, a systematic review","volume":"12","author":"Eisavi","year":"2021","journal-title":"Int J Prev Med"},{"key":"2022121307552899000_12.12.e067573.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.010"},{"key":"2022121307552899000_12.12.e067573.10","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.11.018","article-title":"Five-Year case fatality following first-ever stroke in the Mashhad stroke incidence study: a population-based study of stroke in the middle East","volume":"27","author":"Farzadfard","year":"2018","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2022121307552899000_12.12.e067573.11","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1159\/000485509","article-title":"Five-Year recurrence rate and the predictors following stroke in the Mashhad stroke incidence study: a population-based cohort study of stroke in the middle East","volume":"50","author":"Salehi","year":"2018","journal-title":"Neuroepidemiology"},{"key":"2022121307552899000_12.12.e067573.12","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1159\/000494885","article-title":"Socioeconomic status and long-term stroke mortality, recurrence and disability in Iran: the Mashhad stroke incidence study","volume":"53","author":"Morovatdar","year":"2019","journal-title":"Neuroepidemiology"},{"key":"2022121307552899000_12.12.e067573.13","doi-asserted-by":"crossref","first-page":"969","DOI":"10.2147\/RMHP.S261612","article-title":"Direct and indirect costs associated with coronary artery (heart) disease in Tabriz, Iran","volume":"13","author":"Darba","year":"2020","journal-title":"Risk Manag Healthc Policy"},{"key":"2022121307552899000_12.12.e067573.14","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v7.23573"},{"key":"2022121307552899000_12.12.e067573.15","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1097\/JCN.0000000000000620","article-title":"Direct cost related to stroke: a longitudinal analysis of survivors after discharge from a rehabilitation Hospital","volume":"35","author":"Pucciarelli","year":"2020","journal-title":"J Cardiovasc Nurs"},{"key":"2022121307552899000_12.12.e067573.16","doi-asserted-by":"crossref","unstructured":"Aminde LN , Dzudie A , Mapoure YN , et al . Estimation and determinants of direct medical costs of ischaemic heart disease, stroke and hypertensive heart disease: evidence from two major hospitals in Cameroon. BMC Health Serv Res 2021;21:13.doi:10.1186\/s12913-021-06146-4","DOI":"10.1186\/s12913-021-06146-4"},{"key":"2022121307552899000_12.12.e067573.17","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/1747493020906872","article-title":"Cost of hospitalization for stroke in a low-middle-income country: findings from a public tertiary hospital in the Philippines","volume":"16","author":"Diestro","year":"2021","journal-title":"Int J Stroke"},{"key":"2022121307552899000_12.12.e067573.18","unstructured":"Shojaee A . Estimated pharmaceutical costs of the Iran Health Insurance Organization until 2030 to achieving universal health coverage [Ph.D. thesis in health policy. Tehran, Iran: Tehran University of Medical Sciences, School of Public Health, Department of Health Management and Economics, 2022.."},{"key":"2022121307552899000_12.12.e067573.19","doi-asserted-by":"publisher","DOI":"10.3350\/CMH.2014.20.4.327"},{"key":"2022121307552899000_12.12.e067573.20","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1002\/hpm.3090","article-title":"Factors affecting in-hospital cost and mortality of patients with stroke: evidence from a case study in a tertiary hospital in China","volume":"36","author":"Liu","year":"2021","journal-title":"Int J Health Plann Manage"},{"key":"2022121307552899000_12.12.e067573.21","doi-asserted-by":"crossref","unstructured":"Mosadeghrad AM . Iran: Hospital accreditation: future directions. healthcare systems. CRC Press, 2018: 297\u2013303.","DOI":"10.1201\/b22185-43"},{"key":"2022121307552899000_12.12.e067573.22","first-page":"1347","article-title":"An analysis of hospital accreditation policy in Iran","volume":"46","author":"Yousefinezhadi","year":"2017","journal-title":"Iran J Public Health"},{"key":"2022121307552899000_12.12.e067573.23","first-page":"239","article-title":"The place of health insurance in reducing catastrophic health expenditure","volume":"7","author":"Mehraban","year":"2018","journal-title":"Iranian Journal of Economic Studies"},{"key":"2022121307552899000_12.12.e067573.24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2006.00610.x"},{"key":"2022121307552899000_12.12.e067573.25","doi-asserted-by":"crossref","unstructured":"Zhu D , Shi X , Nicholas S , et al . Medical service utilization and direct medical cost of stroke in urban China. Int J Health Policy Manag 2020.doi:10.34172\/ijhpm.2020.111","DOI":"10.34172\/ijhpm.2020.111"},{"key":"2022121307552899000_12.12.e067573.26","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/j.eururo.2017.03.028","article-title":"Cost of new technologies in prostate cancer treatment: systematic review of costs and cost effectiveness of robotic-assisted laparoscopic prostatectomy, intensity-modulated radiotherapy, and proton beam therapy","volume":"72","author":"Schroeck","year":"2017","journal-title":"Eur Urol"},{"key":"2022121307552899000_12.12.e067573.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.07.017"},{"key":"2022121307552899000_12.12.e067573.28","doi-asserted-by":"crossref","DOI":"10.1186\/s12883-020-01870-6","article-title":"Magnitude of risk factors and in-hospital mortality of stroke in Ethiopia: a systematic review and meta-analysis","volume":"20","author":"Alene","year":"2020","journal-title":"BMC Neurol"},{"key":"2022121307552899000_12.12.e067573.29","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1159\/000488205","article-title":"Stroke mortality in Kenya's public tertiary hospitals: a prospective Facility-Based study","volume":"8","author":"Kaduka","year":"2018","journal-title":"Cerebrovasc Dis Extra"},{"key":"2022121307552899000_12.12.e067573.30","first-page":"1","article-title":"Intra-hospital mortality of stroke and its predictive factors in a reference hospital in Ouagadougou, Burkina Faso","volume":"1","author":"Labodi","year":"2017","journal-title":"Brain"},{"key":"2022121307552899000_12.12.e067573.31","first-page":"885","article-title":"Trends in acute inpatient stroke care in Germany--an observational study using administrative hospital data from 2005-2010","volume":"109","author":"Nimptsch","year":"2012","journal-title":"Dtsch Arztebl Int"},{"key":"2022121307552899000_12.12.e067573.32","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0092763"},{"key":"2022121307552899000_12.12.e067573.33","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.585455"},{"key":"2022121307552899000_12.12.e067573.34","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000211"},{"key":"2022121307552899000_12.12.e067573.35","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1212\/WNL.0000000000001635","article-title":"Hospital costs of ischemic stroke and TIA in the Netherlands","volume":"84","author":"Buisman","year":"2015","journal-title":"Neurology"},{"key":"2022121307552899000_12.12.e067573.36","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000237024.16438.20"},{"key":"2022121307552899000_12.12.e067573.37","doi-asserted-by":"publisher","DOI":"10.1159\/000441085"},{"key":"2022121307552899000_12.12.e067573.38","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-11592-0","article-title":"Analysing and quantifying the effect of predictors of stroke direct costs in South Africa using quantile regression","volume":"21","author":"Matizirofa","year":"2021","journal-title":"BMC Public Health"},{"key":"2022121307552899000_12.12.e067573.39","doi-asserted-by":"crossref","DOI":"10.1080\/16549716.2022.2045092","article-title":"Estimating the healthcare cost of overweight and obesity in South Africa","volume":"15","author":"Boachie","year":"2022","journal-title":"Glob Health Action"},{"key":"2022121307552899000_12.12.e067573.40","unstructured":"Compare GBD , 2019. Available: https:\/\/vizhub.healthdata.org\/gbd-compare\/ [Accessed 01 June 2022]."},{"key":"2022121307552899000_12.12.e067573.41","doi-asserted-by":"crossref","unstructured":"Hunt P , MacNaughton G . Impact assessments poverty and human rights: a case study using the right to the highest attainable standard of health, 2006.","DOI":"10.1353\/hrq.2006.0019"},{"key":"2022121307552899000_12.12.e067573.42","unstructured":"Nygren-Krug H . Questions and answers on health and human rights. Geneva: World Health Organization, 2002."},{"key":"2022121307552899000_12.12.e067573.43","doi-asserted-by":"crossref","unstructured":"Diestro JD , Omar A , Sarmiento RJ . Cost of hospitalization for stroke in a Low-Middle income country: findings from a public tertiary hospital in the Philippines. Int J Stroke doi:10.1177\/1747493020906872","DOI":"10.1177\/1747493020906872"},{"key":"2022121307552899000_12.12.e067573.44","doi-asserted-by":"crossref","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.105833","article-title":"Predictive factors of perioperative stroke-related mortality following vascular surgery: a retrospective analysis","volume":"30","author":"Patel","year":"2021","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2022121307552899000_12.12.e067573.45","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.018013","article-title":"Development and validation of a prediction model for stroke, cardiac, and mortality risk after non-cardiac surgery","volume":"10","author":"Woo","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"2022121307552899000_12.12.e067573.46","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1159\/000491091","article-title":"Inpatient cost of stroke in Beijing: a descriptive analysis","volume":"51","author":"Yin","year":"2018","journal-title":"Neuroepidemiology"},{"key":"2022121307552899000_12.12.e067573.47","doi-asserted-by":"crossref","DOI":"10.1186\/s12872-020-01724-6","article-title":"Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study","volume":"20","author":"Namale","year":"2020","journal-title":"BMC Cardiovasc Disord"},{"key":"2022121307552899000_12.12.e067573.48","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1590\/0004-282x20190056","article-title":"The cost of stroke in private hospitals in Brazil: a one-year prospective study","volume":"77","author":"Vieira","year":"2019","journal-title":"Arq Neuropsiquiatr"},{"key":"2022121307552899000_12.12.e067573.49","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1590\/0004-282x20190059","article-title":"The cost of stroke in a public hospital in Brazil: a one-year prospective study","volume":"77","author":"Safanelli","year":"2019","journal-title":"Arq Neuropsiquiatr"},{"key":"2022121307552899000_12.12.e067573.50","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.029318"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-067573","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T16:06:23Z","timestamp":1670947583000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-067573"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12]]},"references-count":50,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12,13]]},"published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1136\/bmjopen-2022-067573"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-067573","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12]]}}}