Epidemiology of intracerebral hemorrhage: A systematic review and meta-analysis

Background

Intracerebral hemorrhage (ICH) is associated with high mortality and disability rates. This study aimed to investigate the relationship between sex, age, study year, risk factors, bleeding site, median year of study, and the incidence of ICH.

Method

Literature on the incidence of ICH published on 1 January 1980 and 1 January 2020, was systematically retrieved from PubMed and Embase databases. The random-effects model and subgroup analysis were used to explore the relationship between the incidence of ICH and different ages, sex, bleeding sites, and risk factors.

Results

We summarized the epidemiological changes in ICH in the past 40 years according to 52 studies and found that the total incidence of ICH is 29.9 per 100,000 person-years (95% CI: 26.5–33.3), which has not decreased worldwide. The incidence of ICH in the Asian population is much higher than in other continents. In addition, the incidence of ICH increases with age and differs at the 85-year-old boundary. Men are more likely to develop ICH than women, and the basal ganglia region is the most common area for ICH. Of the 10 risk factors examined in this study, those with hypertension had the highest incidence of ICH, followed by those with excessive alcohol consumption and heart disease.

Conclusion

The prevention and treatment of ICH still need to be improved continuously according to age, sex, risk factors, and other factors, and targeted and normative strategies should be gradually developed in the future.

Relationship of leisure-time and household physical activity level and type with cardiovascular disease: secondary analysis of the Takashima Study data

Background

High levels of participation in leisure-time and household physical activity lower the risk of cardiovascular disease (CVD), although it is unclear whether the number of activity types is related to new-onset CVD. We aimed to evaluate the effect of the amount of leisure-time physical activity and the number of types of leisure-time physical activities on the risk of CVD incidence.

Methods

From 2002 to 2003, 3,741 participants without any history of CVD participated in the Takashima Study. Data on the amount of leisure-time and household physical activity and the types of leisure-time and household physical activity were obtained from a self-administered questionnaire. Hazard ratios for CVD (acute myocardial infarction and stroke) incidence (follow-up data from 2002 to 2013), according to the participation level and number of activity types, were calculated using Cox proportional hazards models.

Results

The mean age of the subjects was 58.7 ± 13.1 years. During the mean follow-up period of 8.0 ± 1.1 years, 92 participants developed CVD. An inverse dose–response relationship was noted between the amount of leisure-time and household physical activity and CVD events. After adjusting for baseline characteristics, lifestyle-related diseases, and the amount of physical activity other than leisure-time and household, the risk of CVD onset was compared by dividing the participants into two groups by the level of participation; the highest activity group had an adjusted hazard ratio (95% confidence interval) of 0.40 (0.20–0.82) compared to the lowest activity group. Compared to participants who engaged in 0–1 type of activity, participants who engaged in two or more types of activities had a multivariable-adjusted hazard ratio (95% confidence interval) of 0.31 (0.12–0.79).

Conclusion

Increasing the amount of leisure-time and household physical activity and promoting engagement in two or more types of such activities may reduce the rate of CVD incidence in the Japanese general population.

Eating Slowly Is Associated with Undernutrition among Community-Dwelling Adult Men and Older Adult Women

The double burden of malnutrition refers to the co-occurrence of overweight and obesity and undernutrition. Eating quickly has been linked to overweight and obesity. However, no study has examined the association between eating speed and undernutrition. This retrospective, cross-sectional study analyzed data from 3529 community-dwelling residents. Eating speed was divided into three categories: fast, medium, and slow. Undernutrition was defined as body mass index (BMI) of <18.5 kg/m² in adults aged < 70 years (adults) and as <20 kg/m² in adults aged ≥ 70 years (older adults), in accordance with the Global Leadership Initiative on Malnutrition criteria for Asians. Multivariable logistic regression analysis was used to examine the association between eating speed and undernutrition. Among adult men, compared with eating quickly, eating slowly was associated with elevated prevalence of undernutrition (odds ratio (OR) 9.68, 95% confidence interval (CI) 2.32–40.51, p = 0.001). Among older adult women, the prevalence of undernutrition in the slow-eating group was higher than that in the fast-eating group (OR 3.82, 95% Cl 1.51–9.69, p = 0.005). Eating slowly is independently associated with the prevalence of undernutrition among community-dwelling adult men and older adult women in Japan.

Relationship of Ambient Temperature Parameters to Stroke Incidence in a Japanese Population - Takashima Stroke Registry, Japan, 1988-2010

BACKGROUND

Using a population-based stroke registry system, we evaluated the relationship between ambient temperature parameters and stroke incidence in a Japanese population.

METHODS AND RESULTS

We analyzed data from the Takashima Stroke Registry, which records all stroke occurrences in Takashima City, Japan. The study period of 8,401 days was divided into quintiles of daily weather parameters, and the middle quintile was used as the reference category. Incidence rates (IR per 100,000 person-years) were calculated across the quintiles. Poisson regression analysis was used to calculate the effect of temperature parameters on stroke incidence. There were 2,405 first-ever strokes (1,294 men), including 1,625 ischemic, 545 cerebral hemorrhages, 213 subarachnoid hemorrhages, and 22 unclassified strokes. The stroke IR was higher in the middle quintile of average temperature, 357.3 (328.4-388.8), and for other parameters. After adjustment for age and sex, for all stroke, the incidence rate ratio (IRR) in the highest (Q5: IRR 0.81, 95% confidence interval (CI) 0.71-0.92) and the second-highest (Q4: IRR 0.80, 95% CI 0.71-0.91) quintile was lower than that in the middle quintile (Q3: Reference). Analogous results were observed for the minimum, maximum, and lag-days temperatures, also in the subtypes and across ≥65 years of age, also in females.

CONCLUSIONS

Higher temperatures, irrespective of the parameter (average, minimum, or maximum), had a protective effect against stroke occurrence in Japan.

Incidence, Management and Short-Term Outcome of Stroke in a General Population of 1.4 Million Japanese - Shiga Stroke Registry

BACKGROUND

This study determined the current status of the incidence, management, and prognosis of stroke in Japan using a population-based stroke registry.

METHODS AND RESULTS

Shiga Stroke Registry is an ongoing population-based registry that covers approximately 1.4 million residents of Shiga Prefecture. Cases of acute stroke were identified using standard definitions through surveillance of both all acute-care hospitals with neurology/neurosurgery facilities and death certificates in 2011. A total of 2,956 stroke cases and 2,176 first-ever stroke cases were identified. The age- and sex-adjusted incidence rate for first-ever stroke using the 2013 European Standard Population as standard was per 100,000 person-years: 91.3 for ischemic stroke, 36.4 for intracerebral hemorrhage, and 13.7 for subarachnoid hemorrhage. It was estimated that approximately 220,000 new strokes occurred in 2011 in Japan. Among the 2,956 cases, most stroke patients underwent neuroimaging, 268 received surgical or endovascular treatment, and 2,158 had rehabilitation therapy; 78 patients received intravenous thrombolysis. A total of 1,846 stroke patients had died or were dependent at hospital discharge, and 390 died within 28 days of onset.

CONCLUSIONS

Incidence rates of stroke by subtypes were clarified and the total number of new strokes in Japan was estimated. More than half of stroke patients die or become dependent after a stroke. This study re-emphasized the importance of public health measures in reducing the burden of stroke in Japan.

Acute Case-Fatality Rates of Stroke and Acute Myocardial Infarction in a Japanese Population: Takashima Stroke and AMI Registry, 1989–2005

Background

Few comprehensive stroke and acute myocardial infarction registries of long duration exist in Japan to illustrate trends in acute case-fatality of stroke and acute myocardial infarction with greater precision. We examined 17-year case-fatality rates of stroke and acute myocardial infarction using an entire community-monitoring registration system to investigate trends in these rates over time in a Japanese population.

Methods

Data were obtained from the Takashima Stroke and AMI Registry covering a stable population of approximately 55 000 residents of Takashima County in central Japan. We divided the total observation period of 17 years into four periods, 1989–1992, 1993–1996, 1997–2000, and 2001–2005. We calculated gender, age-specific and age-adjusted acute case-fatality rates (%) of stroke and acute myocardial infarction across these four periods.

Results

During the study period of 1989–2005, there were 341 fatal cases within 28 days of onset among 2239 first-ever stroke events and 163 fatal cases among 433 first-ever acute myocardial infarction events. The age-adjusted acute case-fatality rate of stroke was 14·9% in men and 15·7% in women. The age-adjusted acute case-fatality rate of acute myocardial infarction was 34·3% in men and 43·3% in women. The age-adjusted acute case-fatality rates of stroke and acute myocardial infarction showed insignificant differences across the four time periods. The average annual change in the acute case-fatality rate of stroke (–0·2%; 95% CI: −2·4–2·1) and acute myocardial infarction (2·7%; 95% CI: −0·7–6·1) did not change significantly across the study years.

Conclusions

The acute case-fatality rates of stroke and acute myocardial infarction have remained stable from 1989 to 2005 in a rural and semi-urban Japanese population.

The relationship of brachial-ankle pulse wave velocity to future cardiovascular disease events in the general Japanese population: the Takashima Study

Brachial-ankle pulse wave velocity (baPWV) is a non-invasive measure of arterial stiffness obtained using an automated system. Although baPWVs have been widely used as a non-invasive marker for evaluation of arterial stiffness, evidence for the prognostic value of baPWV in the general population is scarce. In this study, we assessed the association between baPWV and future cardiovascular disease (CVD) incidence in a Japanese population. From 2002 to 2009, baPWV was measured in a total of 4164 men and women without a history of CVD, and they were followed up until the end of 2009 with a median follow-up period of 6.5 years. Hazard ratios (HRs) for CVD incidence according to baPWV levels were calculated using a Cox proportional hazards model adjusted for potential confounding factors, including seated or supine blood pressure (BP). During the follow-up period, we observed 40 incident cases of CVD. In multivariable-adjusted model, baPWV as a continuous variable was not significantly associated with future CVD risk after adjustment for supine BP. However, compared with lower baPWV category (<18 m s(-1)), higher baPWV (< or = 18.0 m s(-1)) was significantly associated with an increased CVD risk (HR: 2.70, 95% confidence interval: 1.18-6.19). Higher baPWV (< or = 18.0 m s(-1)) would be an independent predictor of future CVD event in the general Japanese population.

Characteristics, risk factors and mortality of stroke patients in Kyoto, Japan

OBJECTIVES

The aim of the study was to evaluate the characteristics, risk factors and outcome of recent stroke patients in Kyoto, Japan.

DESIGN

We analysed stroke patients in the registry with regard to their characteristics, risk factors and mortality. Cox proportional hazards regressions were used to calculate adjusted HRs for death.

SETTINGS

The Kyoto prefecture of Japan has established a registry to enrol new stroke patients in cooperation with the Kyoto Medical Association and its affiliated hospitals

PARTICIPANTS

The registry now has data on 14 268 patients enrolled from 1 January 1999 to 31 December 2009. Of these, 12 774(89.5%) underwent CT, 9232 (64.7%) MRI, 2504 (17.5%) angiography and 342 (2.4%) scintigraphy. Excluding 480 (3.3%) unclassified patients, 13 788 (96.6%) patients formed the basis of further analyses which were divided into three subtypes: cerebral infarction (CI), cerebral haemorrhage (CH) and subarachnoid haemorrhage (SAH).

RESULTS

A total of 13 788 confirmed stroke patients in the study cohort comprised 9011 (86.3%) CI, 3549 (25.7%) CH and 1197 (8.7%) SAH cases. The mean age ±SD was 73.3±11.8, 69.1±13.6 and 62.7±13.5 in the CI, CH and SAH cases, respectively. Men were predominant in the CI and CH cases, whereas women were predominant in the SAH cases. The frequencies of risk factors were different among the subtypes. Mortality was worst in SAH, followed by CH, and least in CI. HRs for death adjusted for age, sex, histories of hypertension, arrhythmia, diabetes mellitus and hyperlipaemia and use of tobacco and/or alcohol showed a significant (p<0.001) difference among CI (as reference), CH (3.71; 3.11 to 4.43) and SAH (8.94; 7.21 to 11.11).

CONCLUSIONS

The characteristics, risk factors and mortality were evaluated in a quantitative manner in a large Japanese study cohort to shed light on the present status of stroke medicine.

Atrial fibrillation is a major risk factor for stroke, especially in women: the Jichi Medical School cohort study

Background

Only a few population-based cohort studies have investigated the impact of atrial fibrillation (AF) on stroke in Japan.

Methods

A total of 10 929 participants (4147 men and 6782 women) were included in this population-based prospective cohort study. Baseline data, including electrocardiograms (ECGs) to ascertain AF status, were obtained from April 1992 through July 1995 in 12 areas in Japan. Cox proportional hazards models were used to analyze the association of AF with stroke.

Results

A total of 54 participants had AF (0.49%). The mean follow-up period was 10.7 years, during which 405 strokes were identified; 12 of these occurred in participants with AF. The crude incidence of stroke in participants with and without AF was 14.9 and 4.5 per 1000 person-years in men, respectively, and 39.3 and 2.7 per 1000 person-years in women. After adjusting for geographical area, sex, age, smoking status, drinking status, obesity, hypertension, dyslipidemia, and diabetes mellitus, the hazard ratios (95% confidence interval) of AF in all participants and in male and female participants were 4.11 (2.28–7.41), 2.12 (0.77–5.84), and 10.6 (5.01–22.4), respectively. The population attributable fraction (PAF) of stroke caused by AF was 2.2%; the PAFs were 1.0% and 3.6% in men and women, respectively.

Conclusions

The present Japanese population-based prospective cohort study showed that AF is a major risk factor for stroke, especially in women.

Trend of Stroke Incidence in a Japanese Population: Takashima Stroke Registry, 1990-2001

Background

In Japan, stroke mortality and incidence started to decline during the 1960s. The recent unfavourably diverging trends in risk factors make it uncertain whether the decline will continue. Few comprehensive stroke registries of long research duration exist in Japan to illustrate the trends in stroke incidence.

Objective

We examined 12-year stroke registration data to evaluate the current trend in a Japanese population.

Methods

Data were obtained from the Takashima Stroke Registry, covering approximately 55000 residents of Takashima County in central Japan. We calculated the age-adjusted stroke incidence rates (/100 000 person-years) and 95% confidence intervals for 1990–1992, 1993–1995, 1996–1998, and 1999–2001. We applied the direct method to adjust for the age distribution among the four periods. The incidence time trend was determined by calculating the average annual change across the study years using negative binomial regression analysis.

Results

There were 1453 (men: 771 and women: 682) registered first-ever stroke cases during 1990–2001. The diagnosis was established by neuro-imaging in 93·6% of the cases. The average age was 69·4 years in men and 74·2 years in women. The age-adjusted incidence rates of stroke across the four observation periods were 143·1 (confidence interval: 127·4-158·8) in 1990–1992, 147·4 (confidence interval: 131·9–162·8) in 1993–1995, 120·4 (confidence interval: 106·7–134·0) in 1996–1998, and 122·9 (confidence interval: 109·6–136·2) in 1999–2001. The stroke incidence across the study years showed an insignificant time trend, with an average annual change of −0·33% (confidence interval: −2·44 to 1·78) per year. Similar trends were observed for both men and women and stroke subtypes.

Conclusions

The previously reported declining trend in stroke incidence may have levelled off or slowed down considerably in the Japanese population.

Incidence, admission and case-fatality of acute myocardial infarction: weekend versus weekday in a Japanese population: 16-year results from Takashima AMI Registry (1988-2003)

For acute myocardial infarction (AMI), "weekend" has been associated with higher incidence, admission, and fatality. But, very few studies in this regard are available in Japan. Day of the week variation in AMI was examined using an entire community covering 16-year AMI registration data from Japan. Data were obtained from the Takashima AMI Registry, which covers a stable population of approximately 55,000 in central Japan. There were 379 registered first ever AMI cases with 121 fatal events within 28 days of onset during 1988-2003. We divided the days into two groups: 'Weekend' (Saturday and Sunday) and 'Weekdays' (Monday to Friday). The incidence rate (per 100,000 person-year), admission rate (per 1,000 days) and 28-day case-fatality rates (per 100 events) as well as corresponding rate ratios were calculated with 95% confidence intervals. The distribution of the day of the week for onset, admission and fatality for all subjects was fairly random in our study population; incidence (chi (2) test, P = 0.8), admission (chi (2) test, P = 0.9) and case-fatality (chi (2) test, P = 0.8). The incidence, admission, and case-fatality rates were similar for the 2 day-groups. The incidence rate ratio 1.06 (95% CI: 0.9-1.3), admission ratio 1.03 (95% CI: 0.8-1.3), and case-fatality ratio 1.18 (95% CI: 0.7-1.9) showed no significant risk difference between weekend and weekday. After various adjustments, hazard ratio for weekend AMI in reference to weekday AMI was 1.07 (95% CI: 0.5-2.1). There were no obvious differences in occurrence, hospital admission and acute outcome for AMI patients in the weekday or weekend.