In-Hospital Stroke Mortality is Associated with Day of Admittance and Type of Stroke

Asian, female doctor talking with a Black male patient who is in a hospital bed

Stroke is one of the leading causes of death in the United States and in-hospital mortality is associated with the arrival time of the patient. Prior studies have found that stroke mortality and other adverse outcomes in patients are more likely if that patient was admitted to the hospital on the weekend. This is known as the ‘weekend effect.’ Incidents of stroke mortality are also known to be higher in rural hospitals compared to urban hospitals. A recent study supported by NIMHD further examined this ‘weekend effect’ by assessing whether patients admitted on the weekend in either rural or urban hospitals had different mortality outcomes related to the type of stroke that they had suffered.

In this retrospective study, investigators used data from the 2016 National Inpatient Sample (NIS). They included patients 18 years of age or older in the U.S., who suffered hospitalization from either ischemic (e.g., blocked vessel) or hemorrhagic (e.g., bleeding in the brain) stroke. The investigators examined if either or both types of stroke were associated with the ‘weekend effect’ or with mortality in rural vs. urban hospital and in-patient settings.

The researchers found that all stroke (ischemic and hemorrhagic) mortality was significantly higher in patients admitted to hospitals on the weekend compared to weekdays, further validating the ‘weekend effect’. However, when looking at each stroke type separately, only hemorrhagic stroke mortality was significantly associated with weekend admission. This was also true regardless if the hospital was in a rural or urban area, but mortality rates were higher in rural hospitals when compared to urban. Ischemic stroke mortality was not associated with weekend hospital admittance or location of the hospital. The authors reported these significant findings while also accounting for patients’ sex, race or ethnicity, age, neighborhood median household income, and other potentially confounding sociodemographic variables.

These findings provide greater insight into the stroke ‘weekend effect’ by determining that the association is strongest with hemorrhagic stroke patients. This may ultimately help develop new approaches to improving stroke mortality during the weekend. The study authors discussed that the severity of pathology of hemorrhagic stroke (vs. ischemic) may contribute to these observations. As well, the stroke weekend effect may be influenced by staffing or other resource availability during the weekend. In addition to limited health infrastructure, it is possible that the higher prevalence of stroke-related risk factors, including smoking, obesity, and hypertension contribute to the rural health disparity in hemorrhagic in-hospital mortality. Future studies will need to examine these factors to help reduce stroke mortality.


Mekonnen, B., Wang, G., Rajbhandari-Thapa, J., Shi, L., Thapa, K., Zhang, Z., & Zhang, D. (2020). Weekend Effect on in-Hospital Mortality for Ischemic and Hemorrhagic Stroke in US Rural and Urban Hospitals. Journal of Stroke and Cerebrovascular Diseases, 29(10), 105106.

Page updated January 14, 2021