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Examining Vertebrobasilar Artery Stroke in Two Canadian Provinces

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Study Design

Ecological study.

Objectives

To determine the annual incidence of hospitalized vertebrobasilar artery (VBA) stroke and chiropractic utilization in Saskatchewan and Ontario between 1993 and 2004. To determine whether at an ecological level, the incidence of VBA stroke parallels the incidence of chiropractic utilization.

Summary of Background Data

Little is known about the incidence and time trends of VBA stroke diagnoses in the population. Chiropractic manipulation to the neck is believed to be a risk factor for VBA stroke. No study has yet found an association between chiropractic utilization and VBA diagnoses at the population level.

Methods

All hospitalizations with discharge diagnoses of VBA stroke were extracted from administrative databases for Saskatchewan and Ontario. We included incident cases that were diagnosed between January 1993 and December 2004 for Saskatchewan and from April 1993 to March 2002 for Ontario. VBA cases that had previously been hospitalized for any stroke or transient ischemic attack (TIA) were excluded. Chiropractic utilization was measured using billing data from Saskatchewan Health and Ontario Health Insurance Plan. Denominators were derived from Statistics Canada's annual population estimates.

Results

The incidence rate of VBA stroke was 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario. The annual incidence rate spiked dramatically with a 360% increase for Saskatchewan in 2000. There was a 38% increase for the 2000 incidence rate in Ontario. The rate of chiropractic utilization did not increase significantly during the study period.

Conclusion

In Saskatchewan, we observed a dramatic increase in the incidence rate in 2000 and there was a corresponding relatively small increase in chiropractic utilization. In Ontario, there was a small increase in the incidence rate; however, chiropractic utilization decreased. At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.

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References

  1. Lee VH, Brown RD Jr, Mandrekar JN, et al. (2006) Incidence and outcome of cervical artery dissection: a population-based study. Neurology 67:1809–12

    Article  PubMed  Google Scholar 

  2. Norris JW, Beletsky V, Nadareishvili ZG. (2000) Sudden neck movement and cervical artery dissection. The Canadian Stroke Consortium. CMAJ 163:38–40

    PubMed  CAS  Google Scholar 

  3. Laeeque H, Boon H. (2004) Print media coverage on the Lana Dale Lewis Inquest Verdict: exaggerated claims or accurate reporting?. Health Law Rev 13: 7–15

    Google Scholar 

  4. Canada. Statistics Canada. ANSIM II: Canadian socio-economic information management system [computer file]. Ottawa, Ontario: Statistics Canada [producer]; Toronto, Ontario: University of Toronto. Computing in the Humanities and Social Sciences [distributor],April 3, 2007. http://dc1.chass.utoronto.ca/cansim2/index.jsp>.

  5. Saskatchewan Health Medical Services Branch. Services, Payments, Patients and Doctors by Service Code, by Type of Practitioner. Complete Chiro-Opto Program. Internal Documents prepared quarterly and annually—1990–91 to 2006 – 07. Provided to the authors by the Chiropractic Association of Saskatchewan 2007.

  6. Liu L, Reeder B, Shuaib A, et al. (1999) Validity of stroke diagnosis on hospital discharge records in Saskatchewan, Canada: implications for stroke surveillance. Cerebrovasc Dis 9:224–30

    Article  PubMed  CAS  Google Scholar 

  7. Cassidy JD, Boyle E, Côté P, et al. (2008) Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case control and case-crossover study. Spine 33(Suppl):S176–183

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Centre of Research Expertise for Improved Disability Outcomes (CREIDO), University Health Network Rehabilitation Solutions, Toronto Western Hospital, Toronto, Canada

    Eleanor Boyle PhD, Pierre Côté DC, PhD & J. David Cassidy DC, PhD, DrMedSc

  2. Division of Heath Care and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada

    Eleanor Boyle PhD, Pierre Côté DC, PhD & J. David Cassidy DC, PhD, DrMedSc

  3. Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada

    Pierre Côté DC, PhD & J. David Cassidy DC, PhD, DrMedSc

  4. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Pierre Côté DC, PhD & J. David Cassidy DC, PhD, DrMedSc

  5. Institute for Work & Health, Toronto, Ontario, Canada

    Pierre Côté DC, PhD

  6. Saskatoon Musculoskeletal Rehabilitation Centre, Saskatoon, Saskatchewan, Canada

    Alexander R. Grier DC, MBA

  7. Centre of Research Expertise in Improved Disability Outcomes, Toronto Western Hospital, 399 Bathurst Street, Fell Pavilion, 4th Floor, Room 4-118, Toronto, Ontario, M5T 2S8, Canada

    Eleanor Boyle PhD

Authors
  1. Eleanor Boyle PhD
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  2. Pierre Côté DC, PhD
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  3. Alexander R. Grier DC, MBA
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  4. J. David Cassidy DC, PhD, DrMedSc
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Corresponding author

Correspondence to Eleanor Boyle PhD.

Additional information

The manuscript submitted does not contain information about medical device(s)/drug(s).

Other funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

This study was funded by the Ontario Ministry of Health and Long-Term Care, and the Decade of the Bone and Joint 2000–2010 Task Force on Neck Pain and its Associate Disorders. Also supported by the Canadian Institute of Health Research through a New Investigator Award (to P.C.).

The opinions, results and conclusions are those of the authors and no endorsement by the Ontario Ministry is intended or should be inferred. This study is based in part on de-identified data provided by Saskatchewan Health. The interpretation and conclusions contained herein do not necessarily represent those of the Government of Saskatchewan or Saskatchewan Health.

University Health Network Research Ethics Board Approval number 05-0533-AE and 06-0041-AE.

Reprinted with permission from Lippincott Williams & Wilkins, Boyle E, Côté P, Grier AR, et al., Examining Vertebrobasilar Artery Stroke in Two Canadian Provinces, SPINE, Volume 33, Number 4S, pp S170–S175

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Boyle, E., Côté, P., Grier, A.R. et al. Examining Vertebrobasilar Artery Stroke in Two Canadian Provinces. Eur Spine J 17 (Suppl 1), 170–175 (2008). https://doi.org/10.1007/s00586-008-0633-x

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  • DOI: https://doi.org/10.1007/s00586-008-0633-x

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