Truncated negative binomial mixed regression modelling of ischaemic stroke hospitalizations

A zero-truncated negative binomial mixed regression model is presented to analyse overdispersed positive count data. The study is motivated by the determination of pertinent risk factors associated with ischaemic stroke hospitalizations. Random effects are incorporated in the linear predictor to adjust for inter-hospital variations and the dependency of clustered observations using the generalized linear mixed model approach. The method assists hospital administrators and clinicians to estimate the number of subsequent readmissions based on characteristics of the patient at the index stroke. The findings have important implications on resource usage, rehabilitation planning and management of acute stroke care.

[1]  G. Hankey 1: Transient ischaemic attacks and stroke , 2000, The Medical journal of Australia.

[2]  L. Goldstein Accuracy of ICD-9-CM coding for the identification of patients with acute ischemic stroke: effect of modifier codes. , 1998, Stroke.

[3]  P. Trivedi,et al.  Overdispersion tests for truncated Poisson regression models , 1992 .

[4]  P. Austin,et al.  Sex differences and similarities in the management and outcome of stroke patients. , 2000, Stroke.

[5]  T. Olsen,et al.  Acute stroke with atrial fibrillation. The Copenhagen Stroke Study. , 1996, Stroke.

[6]  C. Anderson,et al.  Patterns of Acute Hospital Care, Rehabilitation, and Discharge Disposition after Acute Stroke: The Perth Community Stroke Study 1989–1990 , 1994 .

[7]  J. Nelder,et al.  Hierarchical Generalized Linear Models , 1996 .

[8]  C. Mcgilchrist Estimation in Generalized Mixed Models , 1994 .

[9]  D. Lindenmayer,et al.  Modelling the abundance of rare species: statistical models for counts with extra zeros , 1996 .

[10]  A. Welsh,et al.  Methodology for Estimating the Abundance of Rare Animals: Seabird Nesting on North East Herald Cay , 2000, Biometrics.

[11]  A. Dromerick,et al.  Predictors of acute hospital costs for treatment of ischemic stroke in an academic center. , 1999, Stroke.

[12]  R. Sacco,et al.  Predictors of resource use after acute hospitalization , 2000, Neurology.

[13]  D R Appleton,et al.  An application of the truncated Poisson distribution to immunogold assay. , 1993, Biometrics.

[14]  M Aickin,et al.  A truncated poisson regression model with applications to occurrence of adenomatous polyps. , 1997, Statistics in medicine.

[15]  Andy H. Lee,et al.  Zero‐inflated Poisson regression with random effects to evaluate an occupational injury prevention programme , 2001, Statistics in medicine.

[16]  G. McLachlan,et al.  On the EM algorithm for overdispersed count data , 1997, Statistical methods in medical research.

[17]  T. Olsen,et al.  Acute stroke care and rehabilitation: an analysis of the direct cost and its clinical and social determinants. The Copenhagen Stroke Study. , 1997, Stroke.