Basic information and clinical characteristics of the participants
The final dataset included data from 22 hospitals in Shenzhen comprising a total of 2,638 cases. Among which, the percentage of patients with cerebral ischemia was 56%, while those with cerebral hemorrhage accounted for 44%. A total of 1,690 patients (64.1%) were treated in 16 public hospitals, while 948 patients (35.9%) received treatment in six private hospitals including specialized rehabilitation hospitals. Among the enrolled patients, 69.6% were male and 30.4% were female, with an average age of 59.2 years. Majority of the patients (60.4%) were in the recovery phase, whereas 16.0% and 23.6% were in the acute and subacute phases, respectively. All enrolled patients had movement disorders while speech disorders were observed in 53.2% of patients, followed by cognitive disorders (40.8%), swallowing disorders (35.0%), tracheostomy (9.1%), and consciousness disorders (5.4%).
It was observed that the prevalence of cerebral ischemia was higher in female patients (32.3% vs. 28%, p = 0.02), compared to the male counterparts who recorded a higher prevalence of cerebral hemorrhage (72.0% vs. 67.7%, p = 0.02). The average age of patients with ischemic stroke was higher than that of patients with hemorrhagic stroke (64.23 ± 4.12 vs. 52.89 ± 14.38, p < 0.001). Patients with cerebral ischemia had a higher rate of pure motor disorder (33.3% vs. 25.8%, p < 0.001) and lower rates of consciousness disorder (4.0% vs. 7.2%, p < 0.001), cognitive disorder (37.3% vs. 45.2%, p < 0.001), and tracheostomy (4.0% vs. 15.6%, p < 0.001) than patients with cerebral hemorrhage. For more details, please refer to Table 1.
Total hospitalization cost, length of stay, and average daily cost of the participants
From 2019 to 2021, the median total hospitalization costs for rehabilitation patients with ischemic stroke and hemorrhagic stroke in Shenzhen were 27306.64 CNY (4022.79 USD) and 32188.25 CNY (4806.24 USD), respectively. Meanwhile, the average daily costs for rehabilitation were 848.64 CNY (125.87 USD) and 828.23 CNY (122.71 USD) respectively and the median LOS were 30 and 41 days, respectively.
The data show that total hospitalization costs for hemorrhagic and ischemic stroke were higher in 2020 than in 2019, while costs declined in 2021. This pattern may be attributed to the impact of the coronavirus disease 2019 pandemic following its initial outbreak in late 2019. However, daily hospitalization costs progressively increased from 2019 to 2021.
Private hospitals exhibited significantly higher total costs than public hospitals (ischemic, 9270.79 vs. 3254.33 USD; hemorrhagic, 8675.16 vs. 3567.95 USD; p < 0.001, respectively), primarily driven by prolonged hospital stays (ischemic, 84 days vs. 24 days; hemorrhagic, 73 vs. 27 days, p < 0.001, respectively). Conversely, public hospitals demonstrated elevated daily costs compared to private hospitals (ischemic, 130.64 vs. 115.94 USD; hemorrhagic, 128.02 vs. 114.88 USD, p < 0.001, respectively), partly attributable to their predominant management of severe cases. This cost dichotomy reflects structural healthcare delivery differences, with public facilities prioritizing acute-phase resource intensity while private providers accommodate extended rehabilitation.
Hospitals were classified by grade, such as primary, secondary, or tertiary, and this were reflected in the median total hospitalization cost and LOS as they both decreased with increasing hospital grade. Specifically for ischemic stroke, the median total hospitalization costs were 62,900.09 CNY (9316.40 USD), 41,484.75 CNY (9316.40 USD), and 19,395.83 CNY (2857.67 USD) for primary, secondary, and tertiary hospitals, respectively, while LOS were 87, 53, and 20 days correspondingly. The median total hospitalization costs for hemorrhagic stroke were 61,392.52 CNY (9203.44 USD), 53,360.35 CNY (7858.78 USD), and 18,721.57 CNY (2780.58 USD) for primary, secondary, and tertiary hospitals, respectively and. LOS were 78, 73, and 20 days correspondingly.
Conversely, the average daily costs increased with higher hospital grades. For ischemic stroke, the daily average costs were 777.78 CNY (114.92 USD), 809.58 CNY (120.52 USD), and 926.45 CNY (137.03 USD) for primary, secondary, and tertiary hospitals, respectively. Meanwhile, for hemorrhagic stroke, the daily average costs were 766.62 CNY (113.22 USD), 802.13 CNY (118.96 USD), and 916.73 CNY (136.04 USD) for primary, secondary, and tertiary hospitals, respectively. In addition, patients were classified according to functional impairments and it was noted that patients with consciousness disorder had the highest median total costs (85512.16 CNY (12554.26 USD) for ischemic; 66733.66 CNY (10115.11 USD) for hemorrhagic), highest average daily costs (878.09 CNY, 129.59 USD) for ischemic; 856.15 CNY, 126.86 USD) for hemorrhagic) and longest median LOS (104 days for ischemic; 85.5 days for hemorrhagic). The median total hospitalization cost and LOS of patients with speech, cognitive, and swallowing disorders were observed to gradually increase (Table 2).
Proportion of hospitalization rehabilitation costs for participants
The rehabilitation treatment costs for patients with ischemic and hemorrhagic stroke accounted for the highest proportion of total costs (64% and 68%), followed by testing costs (8% and 6%), medication costs (7% and 5%), bed costs (6% and 6%), nursing costs (4% and 3%), and other expenses (2% and 2%). Notably, for patients with ischemic and hemorrhagic strokes, the proportion of medication costs for tracheotomy and patients with consciousness disorders (11% and 15% for ischemic, 8% and 9% for hemorrhagic) and the proportion of nursing costs (13% and 7% for ischemic, 12% and 16% for hemorrhagic) are significantly higher than those with other functional impairments. However, the proportion of rehabilitation costs for ischemic (56% and 58%) and hemorrhagic (58% and 52%) were significantly lower than those with other functional impairments (Table 3).
Path analysis of factors influencing hospitalization costs
Significant clinical indicators and variables closely related to hospitalization costs were included in a multiple linear regression model using stepwise regression. Two models representing the factors influencing hospitalization and daily average costs for patients with stroke were obtained. Model 1, which focused on total hospitalization costs, yielded a statistically significant F-value (F = 7055.730, P < 0.001) and high coefficient of determination (R2 = 0.951), indicating a good fit. Similarly, Model 2 for the daily average costs also showed statistically significant F-values (F = 106.956, P < 0.001) and moderate coefficients of determination (R2 = 0.198), suggesting an acceptable fit. Two-path-analysis equation models were used to explore these relationships.
The path analysis revealed that the factor with the largest direct impact on total hospitalization cost for patients with stroke is LOS (direct path coefficient: 1.004, p < 0.001), while the main indirect influence factors are hospital grades (indirect path coefficient: −0.56, p < 0.001), functional impairments levels (indirect path coefficient: 0.12, p < 0.001) and stage of disease (indirect path coefficient: 0.11, p < 0.001). Average daily costs were primarily directly influenced by hospital grades (direct path coefficient: 0.452, p < 0.001) and indirectly influenced by functional impairment levels (indirect path coefficient: −0.372, p < 0.001) and stage of disease (indirect path coefficient: −0.129, p < 0.001) (Table 4; Fig. 1).
Diagram of path analysis. A Path analysis diagram of influencing factors on total rehabilitation costs; B Path analysis diagram of influencing factors on daily costs