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Wang S, Zou XL, Wu LX, Zhou HF, Xiao L, Yao T, Zhang Y, Ma J, Zeng Y, Zhang L. Epidemiology of intracerebral hemorrhage: A systematic review and meta-analysis. Front Neurol 2022; 13:915813. [PMID: 36188383 PMCID: PMC9523083 DOI: 10.3389/fneur.2022.915813] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Sai Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xue-Lun Zou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Lian-Xu Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hui-Fang Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Linxiao Xiao
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Tianxing Yao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yupeng Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Junyi Ma
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Zeng
- Department of Geriatrics, Second Xiangya Hospital, Central South University, Changsha, China
| | - Le Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Multi-Modal Monitoring Technology for Severe Cerebrovascular Disease of Human Engineering Research Center, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Le Zhang
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Li X, Zhang L, Wolfe CDA, Wang Y. Incidence and Long-Term Survival of Spontaneous Intracerebral Hemorrhage Over Time: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:819737. [PMID: 35359654 PMCID: PMC8960718 DOI: 10.3389/fneur.2022.819737] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose Recent epidemiological data indicate that the absolute number of hemorrhagic stroke cases increased by 47% between 1990 and 2010 and continued to cause high rates of death and disability. The last systematic review and meta-analysis of incidence and long-term survival of intracerebral hemorrhage (ICH) were published 11 and 7 years ago, respectively, and lacked comparison between different income groups, therefore, a more up to date analysis is needed. We aim to investigate the ICH incidence and long-term survival data in countries of different income groups. Materials Methods We systematically searched Ovid Medline for population-based longitudinal studies of first-ever spontaneous ICH published from January 2000 to December 2020. We performed meta-analyses on the incidence and survival rate in countries of 4 different income groups with random-effects models (severe inconsistency). The I2 was used to measure the heterogeneity. Heterogeneity was further investigated by conducting the meta-regression on the study mid-year. Time trends of the survival rate were assessed by weighted linear regression. Results We identified 84 eligible papers, including 68 publications reporting incidence and 24 publications on the survival rate. The pooled incidence of ICH per 100,000 per person-years was 26.47 (95% CI: 21.84–32.07) worldwide, 25.9 (95% CI: 22.63–29.63) in high-income countries (HIC), 28.45 (95% CI: 15.90–50.88) in upper-middle-income countries, and 31.73 (95% CI: 18.41–54.7) in lower-middle-income countries. The 1-year pooled survival rate was from 50% (95% CI: 47–54%; n = 4,380) worldwide to 50% (95% CI: 47–54%) in HIC, and 46% (95% CI: 38–55%) in upper-middle income countries. The 5-year pooled survival rate was 41% (95% CI: 35–48%; n = 864) worldwide, 41% (95% CI: 32–50%) in high-income and upper-middle countries. No publications were found reporting the long-term survival in lower-middle-income and low-income countries. No time trends in incidence or survival were found by meta-regression. Conclusion The pooled ICH incidence was highest in lower-middle-income countries. About half of ICH patients survived 1 year, and about two-fifths survived 5 years. Reliable population-based studies estimating the ICH incidence and long-term survival in low-income and low-middle-income countries are needed to help prevention of ICH. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170140, PROSPERO CRD42020170140.
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Affiliation(s)
- Xianqi Li
- School of Life Course and Population Sciences, King's College London, London, United Kingdom
- *Correspondence: Xianqi Li
| | - Li Zhang
- School of Life Course and Population Sciences, King's College London, London, United Kingdom
| | - Charles D. A. Wolfe
- School of Life Course and Population Sciences, King's College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
- NIHR Applied Research Collaboration (ARC) South London, London, United Kingdom
| | - Yanzhong Wang
- School of Life Course and Population Sciences, King's College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
- NIHR Applied Research Collaboration (ARC) South London, London, United Kingdom
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3
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Wang X, Phan HT, Li J, Reeves MJ, Thrift AG, Cadilhac DA, Sturm J, Konstantinos V, Parmar P, Krishnamurthi R, Barker-Collo S, Feigin V, Cabral NL, Carolei A, Marini C, Sacco S, Correia M, Appelros P, Kõrv J, Vibo R, Yang SC, Carcel C, Woodward M, Sandset EC, Anderson C, Gall S. Sex Differences in Disease Profiles, Management, and Outcomes Among People with Atrial Fibrillation After Ischemic Stroke: Aggregated and Individual Participant Data Meta-Analyses. WOMEN'S HEALTH REPORTS 2020; 1:190-202. [PMID: 33786481 PMCID: PMC7784810 DOI: 10.1089/whr.2020.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objectives: To examine sex differences in disease profiles, management, and survival at 1 and 5 years after ischemic stroke (IS) among people with atrial fibrillation (AF). Methods: We performed a systematic literature search of reports of AF at IS onset according to sex. We undertook an individual participant data meta-analysis (IPDMA) of nine population-based stroke incidence studies conducted in Australasia, Europe, and South America (1993–2014). Poisson regression was used to estimate women:men mortality rate ratios (MRRs). Study-specific MRRs were combined using random effects meta-analysis. Results: In our meta-analysis based on aggregated data from 101 studies, the pooled AF prevalence was 23% (95% confidence interval [CI]: 22%–25%) in women and 17% (15%–18%) in men. Our IPDMA is of 1,862 IS-AF cases, with women (79.2 ± 9.1, years) being older than men (76.5 ± 9.5, years). Crude pooled mortality rate was greater for women than for men (1-year MRR 1.24; 1.01–1.51; 5-year 1.12; 1.03–1.22). However, the sex difference was greatly attenuated after accounting for age, prestroke function, and stroke severity (1-year 1.09; 0.97–1.22; 5-year 0.98; 0.84–1.16). Women were less likely to have anticoagulant prescription at discharge (odds ratio [OR] 0.94; 95% CI: 0.89–0.98) than men when pooling IPDMA and aggregated data. Conclusions: AF was more prevalent after IS among women than among men. Among IS-AF cases, women were less likely to receive anticoagulant agents at discharge; however, greater mortality rate in women was mostly attributable to prestroke factors. Further information needs to be collected in population-based studies to understand the reasons for lower treatment of AF in women.
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Hoang T Phan
- Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia.,Department of Health Management and Health Economics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Jingwei Li
- Department of Cardiology, People's Liberation Army General Hospital, Beijing, China.,Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, China
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Jonathan Sturm
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Vemmos Konstantinos
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | | | - Valery Feigin
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Norberto L Cabral
- Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Joinville, Brazil
| | - Antonio Carolei
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
| | - Carmine Marini
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
| | - Manuel Correia
- InstitutodeCiênciasBiomédicasdeAbelSalazar, UniversidadedoPorto, Porto, Portugal
| | - Peter Appelros
- Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Riina Vibo
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Sook Ching Yang
- Department of Cardiology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Cheryl Carcel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Neurology, Royal Prince Alfred Hospital, the University of Sydney, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | | | - Craig Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Cardiology, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.,The George Institute China at Peking University Health Science Centre, Beijing, PR China
| | - Seana Gall
- Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia
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4
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Bryndziar T, Sedova P, Brown RD, Fiserova E, Zvolsky M, Bednarik J, Mikulik R. Trends in One Month and One Year Hemorrhagic Stroke Case Fatality Rates in the Czech Republic between 1998 and 2015. J Stroke Cerebrovasc Dis 2020; 29:104762. [PMID: 32268973 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This retrospective cross-sectional study reports 1 month and 1 year intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) case fatality rates and their temporal trends in the Czech Republic between 1998 and 2015. METHODS Utilizing the National Register of Hospitalized Patients, we randomly selected 600 patients hospitalized for ICH and 600 patients hospitalized for SAH for each year from 1998 to 2015, and identified those who died, regardless of cause, using the Czech National Mortality Registry. We calculated crude and age-adjusted 1 month and 1 year case fatality rates for ICH and SAH. Long-term trends of the crude rates were analyzed using a one-sided Cochran Armitage test. RESULTS A total of 21,600 cases hospitalized for SAH and ICH (10,800 for each) between 1998 and 2015 were randomly selected for analysis. One month case fatality of SAH overall and in women has decreased by 0.2% (P = .006) and 0.3% per year (P = .04), respectively. Overall 1 year case fatality of SAH has decreased by 0.2% per year (P = .03). One month case fatality rate of ICH overall and in men has decreased by 0.2% (p=0.01) and 0.4% (P = .0007), respectively. One year case fatality of ICH in men has decreased by 0.2% per year (P = .047). CONCLUSIONS One month and 1 year case fatality rates for SAH and ICH have been decreasing in the Czech Republic between 1998 and 2015, and are similar or lower than those reported from other developed European countries.
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Affiliation(s)
- Tomas Bryndziar
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petra Sedova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic; Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eva Fiserova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, Palacky University Olomouc, Olomouc, Czech Republic
| | - Miroslav Zvolsky
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno, Brno, Czech Republic
| | - Robert Mikulik
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic.
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5
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Kim J, Thayabaranathan T, Donnan GA, Howard G, Howard VJ, Rothwell PM, Feigin V, Norrving B, Owolabi M, Pandian J, Liu L, Cadilhac DA, Thrift AG. Global Stroke Statistics 2019. Int J Stroke 2020; 15:819-838. [PMID: 32146867 DOI: 10.1177/1747493020909545] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Data on stroke epidemiology and availability of hospital-based stroke services around the world are important for guiding policy decisions and healthcare planning. AIMS To provide the most current incidence, mortality and case-fatality data on stroke and describe current availability of stroke units around the world by country. METHODS We searched multiple databases (based on our existing search strategy) to identify new original manuscripts and review articles published between 1 June 2016 and 31 October 2018 that met the ideal criteria for data on stroke incidence and case-fatality. For data on the availability of hospital-based stroke services, we searched PubMed for all literature published up until 31 June 2018. We further screened reference lists, citation history of manuscripts and gray literature for this information. Mortality codes for International Classification of Diseases-9 and International Classification of Diseases-10 were extracted from the World Health Organization mortality database for each country providing these data. Population denominators were obtained from the World Health Organization, and when these were unavailable within a two-year period of mortality data, population denominators within a two-year period were obtained from the United Nations. Using country-specific population denominators and the most recent years of mortality data available for each country, we calculated both the crude mortality from stroke and mortality adjusted to the World Health Organization world population. RESULTS Since our last report in 2017, there were two countries with new incidence studies, China (n = 1) and India (n = 2) that met the ideal criteria. New data on case-fatality were found for Estonia and India. The most current mortality data were available for the year 2015 (39 countries), 2016 (43 countries), and 2017 (7 countries). No new data on mortality were available for six countries. Availability of stroke units was noted for 63 countries, and the proportion of patients treated in stroke units was reported for 35/63 countries. CONCLUSION Up-to-date data on stroke incidence, case-fatality, and mortality statistics provide evidence of variation among countries and changing magnitudes of burden among high and low-middle income countries. Reporting of hospital-based stroke units remains limited and should be encouraged.
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Affiliation(s)
- Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, University of Melbourne, Parkville, Victoria, Australia
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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6
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Etminan N, Chang HS, Hackenberg K, de Rooij NK, Vergouwen MDI, Rinkel GJE, Algra A. Worldwide Incidence of Aneurysmal Subarachnoid Hemorrhage According to Region, Time Period, Blood Pressure, and Smoking Prevalence in the Population: A Systematic Review and Meta-analysis. JAMA Neurol 2020; 76:588-597. [PMID: 30659573 DOI: 10.1001/jamaneurol.2019.0006] [Citation(s) in RCA: 381] [Impact Index Per Article: 95.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Importance Subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms is a subset of stroke with high fatality and morbidity. Better understanding of a change in incidence over time and of factors associated with this change could facilitate primary prevention. Objective To assess worldwide SAH incidence according to region, age, sex, time period, blood pressure, and smoking prevalence. Data Sources We searched PubMed, Web of Science, and Embase for studies on SAH incidence published between January 1960 and March 2017. Worldwide blood pressure and smoking prevalence data were extracted from the Noncommunicable Disease Risk Factor and Global Burden of Disease data sets. Study Selection Population-based studies with prospective designs representative of the entire study population according to predefined criteria. Data Extraction and Synthesis Two reviewers independently extracted data according to PRISMA guidelines. Incidence of SAH was calculated per 100 000 person-years, and risk ratios (RRs) including 95% CIs were calculated with multivariable random-effects binomial regression. The association of SAH incidence with blood pressure and smoking prevalence was assessed with linear regression. Main Outcomes and Measures Incidence of SAH. Results A total of 75 studies from 32 countries were included. These studies comprised 8176 patients with SAH were studied over 67 746 051 person-years. Overall crude SAH incidence across all midyears was 7.9 (95% CI, 6.9-9.0) per 100 000 person-years; the RR for women was 1.3 (95% CI, 0.98-1.7). Compared with men aged 45 to 54 years, the RR in Japanese women older than 75 years was 2.5 (95% CI, 1.8-3.4) and in European women older than 75 years was 1.5 (95% CI, 0.9-2.5). Global SAH incidence declined from 10.2 (95% CI, 8.4-12.5) per 100 000 person-years in 1980 to 6.1 (95% CI, 4.9-7.5) in 2010 or by 1.7% (95% CI, 0.6-2.8) annually between 1955 and 2014. Incidence of SAH declined between 1980 and 2010 by 40.6% in Europe, 46.2% in Asia, and 14.0% in North America and increased by 59.1% in Japan. The global SAH incidence declined with every millimeter of mercury decrease in systolic blood pressure by 7.1% (95% CI, 5.8-8.4) and with every percentage decrease in smoking prevalence by 2.4% (95% CI, 1.6-3.3). Conclusions and Relevance Worldwide SAH incidence and its decline show large regional differences and parallel the decrease in blood pressure and smoking prevalence. Understanding determinants for regional differences and further reducing blood pressure and smoking prevalence may yield a diminished SAH burden.
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Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, Mannheim University Hospital, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Han-Sol Chang
- Department of Neurosurgery, Mannheim University Hospital, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina Hackenberg
- Department of Neurosurgery, Mannheim University Hospital, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nicolien K de Rooij
- Department of Rehabilitation, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Mervyn D I Vergouwen
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gabriel J E Rinkel
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ale Algra
- Brain Centre Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
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7
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Phan HT, Reeves MJ, Blizzard CL, Thrift AG, Cadilhac DA, Sturm J, Otahal P, Rothwell P, Bejot Y, Cabral NL, Appelros P, Kõrv J, Vibo R, Minelli C, Gall SL. Sex Differences in Severity of Stroke in the INSTRUCT Study: a Meta-Analysis of Individual Participant Data. J Am Heart Assoc 2020; 8:e010235. [PMID: 30590965 PMCID: PMC6405721 DOI: 10.1161/jaha.118.010235] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Women have worse outcomes after stroke than men, and this may be partly explained by stroke severity. We examined factors contributing to sex differences in severity of acute stroke assessed by the National Institutes of Health Stroke Scale. Methods and Results We pooled individual participant data with National Institutes of Health Stroke Scale assessment (N=6343) from 8 population‐based stroke incidence studies (1996–2014), forming part of INSTRUCT (International Stroke Outcomes Study). Information on sociodemographics, stroke‐related clinical factors, comorbidities, and pre‐stroke function were obtained. Within each study, relative risk regression using log‐binominal modeling was used to estimate the female:male relative risk (RR) of more severe stroke (National Institutes of Health Stroke Scale>7) stratified by stroke type (ischemic stroke and intracerebral hemorrhage). Study‐specific unadjusted and adjusted RRs, controlling for confounding variables, were pooled using random‐effects meta‐analysis. National Institutes of Health Stroke Scale data were recorded in 5326 (96%) of 5570 cases with ischemic stroke and 773 (90%) of 855 participants with intracerebral hemorrhage. The pooled unadjusted female:male RR for severe ischemic stroke was 1.35 (95% CI 1.24–1.46). The sex difference in severity was attenuated after adjustment for age, pre‐stroke dependency, and atrial fibrillation but remained statistically significant (pooled RRadjusted 1.20, 95% CI 1.10–1.30). There was no sex difference in severity for intracerebral hemorrhage (RRcrude 1.08, 95% CI 0.97–1.21; RRadjusted 1.08, 95% CI 0.96–1.20). Conclusions Although women presented with more severe ischemic stroke than men, much although not all of the difference was explained by pre‐stroke factors. Sex differences could potentially be ameliorated by strategies to improve pre‐stroke health in the elderly, the majority of whom are women. Further research on the potential biological origin of sex differences in stroke severity may also be warranted.
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Affiliation(s)
- Hoang T Phan
- 1 Menzies Institute for Medical Research Tasmania University of Tasmania Hobart Australia.,2 Department of Health Management and Health Economics Pham Ngoc Thach University of Medicine Ho Chi Minh City Vietnam
| | - Mathew J Reeves
- 3 Department of Epidemiology and Biostatistics Michigan State University East Lansing MI
| | - Christopher L Blizzard
- 1 Menzies Institute for Medical Research Tasmania University of Tasmania Hobart Australia
| | - Amanda G Thrift
- 4 Department of Medicine School of Clinical Sciences at Monash Health Monash University Clayton Vic. Australia
| | - Dominique A Cadilhac
- 4 Department of Medicine School of Clinical Sciences at Monash Health Monash University Clayton Vic. Australia.,5 Florey Institute Neuroscience and Mental Health, Heidelberg University of Melbourne Vic. Australia
| | - Jonathan Sturm
- 6 Faculty of Health and Medicine University of Newcastle NSW Australia
| | - Petr Otahal
- 1 Menzies Institute for Medical Research Tasmania University of Tasmania Hobart Australia
| | - Peter Rothwell
- 7 Stroke Prevention Research Unit Nuffield Department of Clinical Neurosciences John Radcliffe Hospital Oxford United Kingdom
| | - Yannick Bejot
- 8 University of Burgundy University Hospital of Dijon France
| | - Norberto L Cabral
- 9 Clinica Neurológica de Joinville Joinville Stroke Registry University of Joinville Region-Univille Joinville Brazil
| | - Peter Appelros
- 10 Department of Neurology Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Janika Kõrv
- 11 Department of Neurology and Neurosurgery University of Tartu Tartu Estonia
| | - Riina Vibo
- 11 Department of Neurology and Neurosurgery University of Tartu Tartu Estonia
| | - Cesar Minelli
- 12 Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation Matão SP Brazil
| | - Seana L Gall
- 1 Menzies Institute for Medical Research Tasmania University of Tasmania Hobart Australia
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8
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Sheth SA, Lee S, Warach SJ, Gralla J, Jahan R, Goyal M, Nogueira RG, Zaidat OO, Pereira VM, Siddiqui A, Lutsep H, Liebeskind DS, McCullough LD, Saver JL. Sex Differences in Outcome After Endovascular Stroke Therapy for Acute Ischemic Stroke. Stroke 2019; 50:2420-2427. [PMID: 31412752 DOI: 10.1161/strokeaha.118.023867] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background and Purpose- We determined the effect of sex on outcome after endovascular stroke thrombectomy in acute ischemic stroke, including lifelong disability outcomes. Methods- We analyzed patients treated with the Solitaire stent retriever in the combined SWIFT (Solitaire FR With the Intention for Thrombectomy), STAR (Solitaire FR Thrombectomy for Acute Revascularization), and SWIFT PRIME (Solitaire FR With the Intention for Thrombectomy as Primary Endovascular Treatment) cohorts. Ordinal and logistic regression were used to examine known factors influencing outcome after endovascular stroke thrombectomy and study the effect of sex on the association between these factors and outcomes, including age and time to reperfusion. Years of optimal life after thrombectomy were defined as disability-adjusted life years and calculated by projecting disability through adjusted poststroke life expectancy by sex. Results- Among 389 patients treated with endovascular stroke thrombectomy, 55% were females, and median National Institutes of Health Stroke Scale was 17 (interquartile range, 8-28). There were no differences between females versus males in presenting deficit severity (National Institutes of Health Stroke Scale score, 17 versus 17, P=0.21), occlusion location (69% versus 64% M1, P=0.62), presenting infarct extent (Alberta Stroke Program Early CT Score 8 versus 8, P=0.24), rate of substantial reperfusion (Thrombolysis in Cerebral Infarction 2b/3, 87% versus 83%, P=0.37), onset to reperfusion time (294 versus 302 minutes, P=0.46). Despite older ages (69 versus 64, P<0.001) and higher rate of atrial fibrillation (45% versus 30%, P=0.002) for females compared with males, adjusted rates of functional independence at 90 days were similar (odds ratio, 1.0; 95% CI, 0.6-1.6). After adjusting for age at presentation and stroke severity, females had more years of optimal life (disability-adjusted life year) after endovascular stroke thrombectomy, 10.6 versus 8.5 years (P<0.001). Conclusions- Despite greater age and higher rate of atrial fibrillation, females experienced comparable functional outcomes and greater years of optimal life after intervention compared with males.
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Affiliation(s)
- Sunil A Sheth
- From the Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston (S.A.S., S.L., L.D.M.)
| | - Songmi Lee
- From the Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston (S.A.S., S.L., L.D.M.)
| | - Steven J Warach
- Department of Neurology, Dell School of Medicine, University of Texas at Austin (S.J.W.)
| | - Jan Gralla
- Department of Neuroradiology, Inselspital, University Hospital, Berne, Switzerland (J.G.)
| | - Reza Jahan
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Santa Monica (R.J.)
| | - Mayank Goyal
- Department of Radiology and Clinical Neurosciences, University of Calgary, AB, Canada (M.G.)
| | - Raul G Nogueira
- Department of Neurology, Emory School of Medicine, Atlanta, GA (R.G.N.)
| | - Osama O Zaidat
- Department of Neurosurgery, Mercy Health, Toledo, OH (O.O.Z.)
| | - Vitor M Pereira
- Department of Medical Imaging, Toronto Western Hospital, ON, Canada (V.M.P.)
| | - Adnan Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, NY (A.S.)
| | - Helmi Lutsep
- Department of Neurology, Oregon Health and Science University, Portland (H.L.)
| | - David S Liebeskind
- Department of Neurology, Ronald Reagan UCLA Medical Center, Santa Monica (D.S.L., J.L.S.)
| | - Louise D McCullough
- From the Department of Neurology, McGovern School of Medicine, University of Texas Health Science Center at Houston (S.A.S., S.L., L.D.M.)
| | - Jeffrey L Saver
- Department of Neurology, Ronald Reagan UCLA Medical Center, Santa Monica (D.S.L., J.L.S.)
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Alhazzani AA, Mahfouz AA, Abolyazid AY, Awadalla NJ, Aftab R, Faraheen A, Khalil SN. Study of Stroke Incidence in the Aseer Region, Southwestern Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E215. [PMID: 29373563 PMCID: PMC5858284 DOI: 10.3390/ijerph15020215] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/12/2018] [Accepted: 01/22/2018] [Indexed: 11/16/2022]
Abstract
Recent data regarding first-stroke incidence in Saudi Arabia in general and in the Aseer region in particular are scarce and even lacking. The aim of this work was to study the first-time stroke incidence in the Aseer region, southwestern Saudi Arabia. All first-stroke patients admitted to all hospitals in the Aseer region over a one-year period (January through December 2016) were included. Stroke patients outside the Aseer region were excluded from the study. The incidence per 100,000 patients and the concomitant 95% CI (Confidence Intervals) were computed. The present study included 1249 first-time stroke patients and calculated an overall minimal incidence rate of hospitalized first-time stroke of 57.64 per 100,000 persons per year (95% CI: 57.57-57.70). A steady increase was noticed depending on the patients' age, reaching a figure of 851.81 (95% CI: 849.2-854.5) for those patients aged 70 years and more. Overall, the incidence rate for females (48.14; 95% CI: 48.04-48.24) was lower compared to males (65.52; 95% CI: 65.1-66.0). Taking into consideration the expected rise of the elderly because of the prominent medical services provided by the Saudi government, leading to a subsequent change in the horizontal and vertical age distribution structure of the population, an increase in the number of stroke patients is expected. It is suggested to establish a nationwide stroke surveillance system in the Kingdom, with the objective to report, analyze, and maintain an updated overview of the stroke status in Saudi Arabia.
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Affiliation(s)
- Adel A Alhazzani
- Department of Internal Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Ahmed A Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21511, Egypt.
| | - Ahmed Y Abolyazid
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Community Medicine, College of Medicine, Mansoura University, Mansoura 35516, Egypt.
| | - Nabil J Awadalla
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Community Medicine, College of Medicine, Mansoura University, Mansoura 35516, Egypt.
| | - Razia Aftab
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Aesha Faraheen
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Shamsun Nahar Khalil
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
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Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL, Norrving B, Donnan GA, Cadilhac DA. Global stroke statistics. Int J Stroke 2016; 12:13-32. [PMID: 27794138 DOI: 10.1177/1747493016676285] [Citation(s) in RCA: 268] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Up to date data on incidence, mortality, and case-fatality for stroke are important for setting the agenda for prevention and healthcare. Aims and/or hypothesis We aim to update the most current incidence and mortality data on stroke available by country, and to expand the scope to case-fatality and explore how registry data might be complementary. Methods Data were compiled using two approaches: (1) an updated literature review building from our previous review and (2) direct acquisition and analysis of stroke events in the World Health Organization (WHO) mortality database for each country providing these data. To assess new and/or updated data on incidence, we searched multiple databases to identify new original papers and review articles that met ideal criteria for stroke incidence studies and were published between 15 May 2013 and 31 May 2016. For data on case-fatality, we searched between 1980 and 31 May 2016. We further screened reference lists and citation history of papers to identify other studies not obtained from these sources. Mortality codes for ICD-8, ICD-9, and ICD-10 were extracted. Using population denominators provided for each country, we calculated both the crude mortality from stroke and mortality adjusted to the WHO world population. We used only the most recent year reported to the WHO for which both population and mortality data were available. Results Fifty-one countries had data on stroke incidence, some with data over many time periods, and some with data in more than one region. Since our last review, there were new incidence studies from 12 countries, with four meeting pre-determined quality criteria. In these four studies, the incidence of stroke, adjusted to the WHO World standard population, ranged from 76 per 100,000 population per year in Australia (2009-10) up to 119 per 100,000 population per year in New Zealand (2011-12), with the latter being in those aged at least 15 years. Only in Martinique (2011-12) was the incidence of stroke greater in women than men. In countries either lacking or with old data on stroke incidence, eight had national clinical registries of hospital based data. Of the 128 countries reporting mortality data to the WHO, crude mortality was greatest in Kazhakstan (in 2003), Bulgaria, and Greece. Crude mortality and crude incidence of stroke were both positively correlated with the proportion of the population aged ≥ 65 years, but not with time. Data on case-fatality were available in 42 studies in 22 countries, with large variations between regions. Conclusions In this updated review, we describe the current data on stroke incidence, case-fatality and mortality in different countries, and highlight the growing trend for national clinical registries to provide estimates in lieu of community-based incidence studies.
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Affiliation(s)
- Amanda G Thrift
- 1 Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Tharshanah Thayabaranathan
- 1 Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - George Howard
- 2 Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Virginia J Howard
- 3 Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Peter M Rothwell
- 4 Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences (Clinical Neurology), University of Oxford, Oxford, UK
| | - Valery L Feigin
- 5 National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Bo Norrving
- 6 Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
| | - Geoffrey A Donnan
- 7 Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.,8 Neurology Department, The University of Melbourne, Melbourne, Australia
| | - Dominique A Cadilhac
- 1 Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,7 Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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12
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Global burden of stroke in 2010: a pooling analysis of worldwide population-based data on stroke incidence. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0748-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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13
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Backes D, Rinkel GJE, Algra A, Vaartjes I, Donker GA, Vergouwen MDI. Increased incidence of subarachnoid hemorrhage during cold temperatures and influenza epidemics. J Neurosurg 2016; 125:737-45. [DOI: 10.3171/2015.8.jns151473] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
This study investigated whether the increased incidence of aneurysmal subarachnoid hemorrhage (SAH) in winter is related to temperature or increased incidence of influenza. Such relationships may elucidate the pathogenesis of intracranial aneurysm rupture.
METHODS
A nationwide sample of 18,714 patients with SAH was linked with weekly temperature and influenza-like illness consultation data. Poisson regression analyses were used to calculate incidence density ratios (IDRs) with corresponding 95% CIs for the association of SAH incidence with temperature and influenza epidemics; IDRs were adjusted for study year (aIDR). In addition, SAH incidence data from 30 European population-based studies were linked with daily temperature data from the European Climate Assessment.
RESULTS
The aIDR for SAH during influenza epidemics was 1.061 (95% CI 1.022–1.101) in the univariable and 1.030 (95% CI 0.989–1.074) in the multivariable analysis. This association declined gradually during the weeks after epidemics. Per 1°C temperature drop, the aIDR was 1.005 (95% CI 1.003–1.008) in the univariable and 1.004 (95% CI 1.002–1.007) in the multivariable analysis. In the European population-based studies, the IDR was 1.143 (95% CI 1.129–1.157) per 1°C temperature drop.
CONCLUSIONS
The incidence of SAH is increased during cold temperatures and epidemic influenza. Future studies with individual patient data are needed to investigate causality between temperature or influenza and SAH.
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Affiliation(s)
- Daan Backes
- 1Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, and
| | | | - Ale Algra
- 1Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, and
- 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht; and
| | - Ilonca Vaartjes
- 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht; and
| | - Gé A. Donker
- 3Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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Bergman EM, Henriksson KM, Åsberg S, Farahmand B, Terént A. National registry-based case-control study: comorbidity and stroke in young adults. Acta Neurol Scand 2015; 131:394-9. [PMID: 25684429 DOI: 10.1111/ane.12265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Stroke is overrepresented in cohorts of young adults with chronic diseases. The prevalence and impact of comorbidity among young stroke patients have not been compared with individuals without stroke. Our aim was to investigate the association between comorbidity and stroke in young adults. MATERIALS AND METHODS A nationwide cohort of patients (aged 15-44 years), registered in the Swedish Stroke Register, (Riksstroke) 2001-2009, was identified. Age- and sex-matched controls were randomly selected from the Population Register of Sweden. Discharge diagnoses were retrieved from the National Patient Register and grouped by chapter in the International Classification of Diseases 10th revision. Associations between ICD-10 chapters and stroke were stratified (age, sex, and stroke type) and analyzed by multivariable logistic regression. RESULTS In 2599 stroke patients analyzed, the prevalence of vascular risk factors (hypertension 25.3%, dyslipidemia 13.0%, diabetes 9.7%, heart failure 3.2%, and atrial fibrillation 2.8%), all ICD-10 chapters (except pregnancy) and prestroke hospitalizations were more frequent among cases than controls. Independent associations were found between stroke and eight ICD-10 chapters: neoplasms (odds ratios (OR) 1.53, 95% CI 1.15-2.05), blood (OR 1.61, 1.11-2.34), endocrine (OR 2.28, 1.77-2.93), psychiatric (OR 1.50, 1.24-1.81), nervous (OR 1.91, 1.46-2.50), eye (OR 1.67, 1.05-2.64), circulatory (OR 3.05, 2.45-3.80), and symptoms (OR 1.31, 1.13-1.52). The risk of stroke increased by 26% per ICD-10 chapter diagnosed. CONCLUSIONS In addition to vascular risk factors, comorbidity (represented by ICD-10 chapters) was associated with increased risk of stroke in young individuals. The risk of stroke was further increased with the number of diagnosed ICD-10 chapters.
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Affiliation(s)
- E.-M. Bergman
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
| | - K. M. Henriksson
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
- AstraZeneca R&D; Mölndal Sweden
| | - S. Åsberg
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
| | - B. Farahmand
- Department of Neurobiology; Care Sciences and Society; Alzheimer Disease Research Center; Karolinska Institutet; Stockholm Sweden
| | - A. Terént
- Department of Medical Sciences; Uppsala University; Uppsala Sweden
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15
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Thrift AG, Cadilhac DA, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Donnan GA. Global stroke statistics. Int J Stroke 2014; 9:6-18. [PMID: 24350870 DOI: 10.1111/ijs.12245] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In many countries, stroke is a lower priority than other diseases despite its public health impact. One issue is a lack of readily accessible comparative data to help make the case for the development of national stroke strategies. To assist in this process, we need to have a common repository of the latest published information on the impact of stroke worldwide. We aim to provide a repository of the most current incidence and mortality data on stroke available by country and illustrate the gaps in these data. We plan to update this repository annually and expand the scope to address other aspects of the burden of stroke. Data were compiled using two approaches: (1) an extensive literature review with a major focus on published systematic reviews on stroke incidence (between 1980 and May 14, 2013); and (2) direct acquisition and collation of data from the World Health Organization to present the most current estimates of stroke mortality for each country recognized by the World Health Organization. For mortality, ICD8, ICD9, and ICD10 mortality codes were extracted. Using population denominators crude stroke mortality was calculated, as well as adjusting for the World Health Organization world population. We used only the most recent year reported to the World Health Organization. Incidence rates for stroke were available for 52 countries, with some countries having incidence studies undertaken in more than one region. When adjusted to the World Health Organization world standard population, incidence rates for stroke ranged from 41 per 100 000 population per year in Nigeria (1971-74) to 316/ 100 000/year in urban Dar-es-Salaam (Tanzania). Some regions had three to fivefold greater incidence than other countries. Of the 123 countries reporting mortality data, crude mortality was greatest in Kazhakstan (in 2003). In many regions data were very old or nonexistent. Such country-level data are important for citizens, clinicians, and policy makers so that local and global strategies to reduce the overall burden of stroke can be implemented. Through this first annual review of country-specific stroke epidemiology, we hope to promote discussion and provide insights into the worldwide burden of stroke.
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Affiliation(s)
- Amanda G Thrift
- Department of Medicine, Stroke and Ageing Research Centre, Southern Clinical School, Monash University, Clayton, Vic., Australia; Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia
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Kisialiou A, Grella R, Carrizzo A, Pelone G, Bartolo M, Zucchella C, Rozza F, Grillea G, Colonnese C, Formisano L, Lembo M, Puca AA, Vecchione C. Risk factors and acute ischemic stroke subtypes. J Neurol Sci 2014; 339:41-6. [DOI: 10.1016/j.jns.2014.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/09/2013] [Accepted: 01/09/2014] [Indexed: 11/26/2022]
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Correia M, Magalhães R, Silva MR, Matos I, Silva MC. Stroke types in rural and urban northern portugal: incidence and 7-year survival in a community-based study. Cerebrovasc Dis Extra 2013; 3:137-49. [PMID: 24348498 PMCID: PMC3843922 DOI: 10.1159/000354851] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Differences in stroke incidence and mortality between regions could stem from differences in the incidence of particular stroke types and long-term prognosis. The aim of this study was to investigate whether different risk profiles and stroke types underlie the difference in stroke incidence and patient long-term survival in rural and urban populations. METHODS All suspected first-ever-in-a-lifetime strokes occurring between October 1998 and September 2000 in 37,290 residents of rural municipalities and in 86,023 individuals living in the city of Porto were entered into a population-based registry. Standard definitions of stroke types and overlapping comprehensive sources of information were used for patient identification. Patients were examined by neurologists at 3 months, 1 year and 7 years after the index event. RESULTS From a total of 688 patients included (226 in rural and 462 in urban areas), 76.2% had an ischaemic stroke (IS; 75.3 vs. 77.9%), 16.1% a primary intracerebral haemorrhage (PICH; 16.3 vs. 14.6%) and 3.3% a subarachnoid haemorrhage (SAH; 2.7 vs. 3.7%); in 4.4% (4.9 vs. 4.1%), the stroke type could not be determined. The annual incidence rate per 1,000 was 2.13 (95% CI, 1.95-2.31), 0.45 (95% CI, 0.37-0.53), 0.09 (95% CI, 0.06-0.14) and 0.12 (95% CI, 0.08-0.17), respectively. The age-specific rural/urban incidence rate ratios for IS in the youngest group (<55 years) was 0.27 (95% CI, 0.11-0.69), increasing to 1.47 (95% CI, 1.07-2.01) for those aged 65-74 years and to 1.87 (95% CI, 1.39-2.52) for those between 75 and 84 years. Rural compared to urban patients with an IS were predominantly men, had a prevalence ratio (PR) of 1.28 (95% CI, 1.05-1.56), were 65 years or older (PR = 1.18; 95% CI, 1.08-1.30) and had in general a lower prevalence of risk factors. There was no evidence of rural/urban differences in 28-day case fatality for the stroke types, although IS tended to be less fatal among urban patients (10.3 vs. 13.1%), whereas PICH (33.3 vs. 24.2%) and SAH (35.3 vs. 16.7%) were less fatal among rural patients. Independently of rural/urban residence, predictors of poor survival after the acute phase (28 days) were age >65 years (HR = 3.57; 95% CI, 2.6-4.9), diabetes (HR = 1.5; 95% CI, 1.2-1.9), ischaemic heart disease (HR = 1.8; 95% CI, 1.3-2.6), atrial fibrillation (HR = 1.5; 95% CI, 1.1-2.0) and smoking habits (HR = 1.6; 95% CI, 1.1-2.3). CONCLUSIONS The age pattern of IS incidence marks the difference between rural and urban populations; the youngest urban and the oldest rural residents were at a higher risk. Although patients from rural areas were older, the relatively lower prevalence of simultaneously occurring risk and prognostic factors among them as well as the similar management of rural and urban patients may justify why rurality is not associated with long-term survival.
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Affiliation(s)
- Manuel Correia
- Serviço de Neurologia, Hospital de Santo António - Centro Hospitalar do Porto, Portugal ; UNIFAI, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Rui Magalhães
- UNIFAI, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Mário Rui Silva
- Serviço de Neurologia, Hospital de S. Pedro - Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Mirandela, Portugal
| | - Ilda Matos
- Serviço de Neurologia, Hospital de Mirandela - Centro Hospitalar do Nordeste, Mirandela, Portugal
| | - Maria Carolina Silva
- UNIFAI, Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
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Fisher A, Martin J, Srikusalanukul W, Davis M. Trends in stroke survival incidence rates in older Australians in the new millennium and forecasts into the future. J Stroke Cerebrovasc Dis 2013; 23:759-70. [PMID: 23928347 DOI: 10.1016/j.jstrokecerebrovasdis.2013.06.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 06/04/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022] Open
Abstract
AIMS The objective of this study is (i) to evaluate trends in the incidence rates of stroke survivors aged 60 years and older over a 11-year period in the Australian Capital Territory (ACT) and (ii) to forecast future trends in Australia until 2051. METHODS Analysis of age- and sex-specific standardized incidence rates of older first-ever stroke survivors in ACT from 1999-2000 to 2009-2010 and projections of number of stroke survivors (NSS) in 2021 and 2051 using 2 models based only on (i) demographic changes and (ii) assuming changing of both incidence rates and demography. RESULTS In the ACT in the first decade of the 21st century, the absolute numbers and age-adjusted standardized incidence rates of stroke survivors (measured as a function of age and period) increased among both men and women aged 60 years or older. The trend toward increased survival rates in both sexes was driven mainly by population aging, whereas the effect of stroke year was more pronounced in men compared with women. The absolute NSS (and the financial burden to the society) in Australia is predicted to increase by 35.5%-59.3% in 2021 compared with 2011 and by 1.6- to 4.6-fold in 2051 if current only demographic (first number) or both demographic and incidence trends (second number) continue. CONCLUSIONS Our study demonstrates favorable trends in stroke survivor rates in Australia in the first decade of the new millennium and projects in the foreseeable future significant increases in the absolute numbers of older stroke survivors, especially among those aged 70 years or older and men.
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Affiliation(s)
- Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, Australia; Australian National University Medical School, Canberra, Australia.
| | - Jodie Martin
- Australian National University Medical School, Canberra, Australia
| | | | - Michael Davis
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, Australia; Australian National University Medical School, Canberra, Australia
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Hip fractures in persons with stroke. Stroke Res Treat 2013; 2013:954279. [PMID: 23691433 PMCID: PMC3649805 DOI: 10.1155/2013/954279] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 12/22/2012] [Accepted: 03/15/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Our aim was to determine the incidence of hip fractures within two years after stroke, to identify associated factors, to evaluate which test instruments that best could identify people at risk, and to describe the circumstances that prevailed when they sustained their hip fractures. Method. A total of 377 persons with first-ever stroke were followed up for a 24-month period. Stroke severity, cognition, and associated medical conditions were registered. The following test instruments were used: National Institutes of Health Stroke Scale, Mini-Mental State Examination, Berg Balance Scale, Timed Up & Go, and Stops Walking When Talking. Result. Sixteen of the persons fractured their hip within the study period, which corresponds to an incidence of 32 hip fractures per 1000 person-years. Persons with fractures more often had impaired vision and cognitive impairment and more had had previous fractures. Of the investigated test instruments, Timed Up & Go was the best test to predict fractures. Conclusion. The incidence of hip fractures in persons with stroke was high in this study. Persons with previous fractures, and visual and cognitive defects are at the greatest risk. Certain test instruments could be used in order to find people at risk, which should be targeted for fall preventive measures.
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Holzmann MJ, Aastveit A, Hammar N, Jungner I, Walldius G, Holme I. Renal dysfunction increases the risk of ischemic and hemorrhagic stroke in the general population. Ann Med 2012; 44:607-15. [PMID: 21612332 DOI: 10.3109/07853890.2011.582136] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The association between chronic kidney disease (CKD) and different subtypes of stroke is unclear, and previous studies have yielded conflicting results. We aimed to assess the impact of CKD on the risk of fatal or non-fatal ischemic and hemorrhagic stroke in both men and women. METHODS In 539,287 Swedish men and women, mainly undergoing health controls, with mean age 45 years, and no previous stroke or myocardial infarction, hazard ratios for stroke were calculated to assess the association between renal dysfunction and incidence of stroke. We estimated glomerular filtration rates (GFR) using the Mayo (GFR-Mayo) formula. Glomerular filtration rate 60-90, 30-60, and 15-30 mL per minute per 1.73 m(2) was defined as mildly, moderately, and severely decreased GFR, respectively. RESULTS There were 17,678 strokes, of which 72% were ischemic, 15% hemorrhagic, and 12% unspecified, during 12 years of follow-up. Hazard ratios (95% confidence intervals) for ischemic stroke were 1.09 (1.04-1.14) for mildly, 1.24 (1.10-1.39) for moderately, and 2.27 (1.63-3.17) for severely decreased GFR-Mayo. The corresponding figures for hemorrhagic stroke were 1.04 (0.93-1.15), 1.26 (0.96-1.64), and 2.31 (1.10-4.87). Ischemic stroke was related to all levels of decreased GFR-Mayo in both genders (P < 0.0003). Hemorrhagic stroke was only related to renal dysfunction among women; hazard ratios (95% confidence intervals) 1.38 (1.14-1.66) for mildly, 1.70 (1.13-2.57) for moderately, and 3.46 (1.09-10.9) for severely decreased GFR-Mayo. CONCLUSIONS Already mildly decreased GFR-Mayo increases the risk of ischemic fatal or non-fatal stroke and severely decreased GFR-Mayo the risk of hemorrhagic stroke in the general population. In gender-specific analyses ischemic stroke was related to a decreased GFR-Mayo in both genders. Hemorrhagic stroke was only related to renal dysfunction among women.
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Affiliation(s)
- Martin J Holzmann
- Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
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Tveiten A, Ljøstad U, Mygland Å, Thomassen L, Pripp AH, Naess H. Intracerebral Hemorrhage in Southern Norway – A Hospital-Based Incidence Study. Eur Neurol 2012; 67:240-5. [DOI: 10.1159/000336299] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 01/08/2012] [Indexed: 11/19/2022]
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Appelros P, Gunnarsson KE, Terént A. Ten-year risk for myocardial infarction in patients with first-ever stroke: a community-based study. Acta Neurol Scand 2011; 124:383-9. [PMID: 21355858 DOI: 10.1111/j.1600-0404.2011.01500.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stroke and coronary heart disease (CHD) share common risk factors. The risk for stroke patients to have a myocardial infarction (MI) has not been fully explored. METHODS Three hundred and seventy-seven first-ever stroke patients were ascertained prospectively. The 10-year incidence of MI was examined by register searches. The results were compared to the general Swedish population. Predictors for MI were identified using univariate and multivariate analysis. RESULTS The cumulative incidence of MI over 10 years was 25.0/100 (95% confidence interval (CI), 19.5-31.5), 26.5 for men, (95% CI, 18.9-45.8) and 23.4 for women (95% CI, 16.0-32.9). Compared to the general population, the relative risk for stroke patients having a MI was 1.6 for men (95% CI, 1.12-2.37) and 1.9 for women (95% CI, 1.27-2.90). In multivariate analysis, CHD before the stroke (MI, angina pectoris, coronary artery bypass grafting, or percutaneous transluminal coronary angioplasty) and peripheral artery disease were significant predictors for MI. CONCLUSION The risk for MI is significantly higher, for both male and female stroke patients, compared to the general population. Stroke patients with previous CHD and peripheral artery disease are at highest risk. Stroke patients should receive adequate secondary prevention, and cardiac complaints must be taken seriously.
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Affiliation(s)
- P Appelros
- Department of Neurology, Örebro University Hospital, Sweden.
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Appelros P, Terént A. Validation of the Swedish inpatient and cause-of-death registers in the context of stroke. Acta Neurol Scand 2011; 123:289-93. [PMID: 21361878 DOI: 10.1111/j.1600-0404.2010.01402.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quality follow-up within stroke care is important in times when stroke prevalence is increasing and health care funds are limited. Administrative data, such as data from the inpatient register (IPR) and the cause-of-death register (CDR) are often used for this purpose, but the validity of such data has not been ascertained. METHODS During the year 1999-2000, a community-based stroke register was established in a Swedish municipality. Data from that register was compared with two administrative registers, the IPR and the CDR. RESULTS Using multiple overlapping data sources, 377 patients with first-ever stroke were found in the community-based register. Forty-four of these (12%) were missing in the IPR/CDR. Non-hospitalized patients were less likely to be registered in the IPR/CDR, as were patients who were not initially treated in a stroke unit. Stroke severity was lower among non-registered patients. Thirty patients (8%) in the IPR/CDR were misclassified as stroke patients. CONCLUSIONS Quality follow-up within stroke care could be biased or have low comparability, when administrative data are used. Great caution should be taken when data are derived from the inpatient and cause-of-death registers, and more validation work needs to be carried out in the context of stroke.
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Affiliation(s)
- P Appelros
- Department of Neurology, Örebro University Hospital, Örebro, Sweden.
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24
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Delbari A, Salman Roghani R, Tabatabaei SS, Rahgozar M, Lokk J. Stroke Epidemiology and One-Month Fatality among an Urban Population in Iran. Int J Stroke 2011; 6:195-200. [DOI: 10.1111/j.1747-4949.2010.00562.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective Stroke is one of the most common causes of death and disability in Iran. This study evaluated stroke patient profiles with respect to rate, risk factors, and one-month fatality. Material and method A cross-sectional, hospital-based study on all stroke patients older than 45 years admitted to hospitals in the city of Qom throughout 2001. Results Four hundred and sixty patients older than 45 years were admitted as stroke. The annual stroke rate was estimated to 338/100 000 (95% confidence interval, 300–360) inhabitants older than 45 years. The annual rate of stroke was 384/100 000 (95% confidence interval, 381–386) when adjusted to the European population. Stroke subtypes were; ischaemic infarction 75%, intracranial haemorrhage 20·7%, subarachnoid haemorrhage 3%, and undetermined 1·3%. Main risk factors were hypertension in 74·6% and diabetes in 55·7%. Mortality rate was 24·6% within the first month. Conclusion Stroke incidence was higher than in Western countries. Hypertension and diabetes mellitus were considerably more frequent in our studied stroke patients than in other developing countries. Our findings need to be addressed in future health education programmes in Iran identifying patients at risk and focusing on more aggressive prevention programmes to lower stroke incidence.
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Affiliation(s)
- Ahmad Delbari
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Sabzevar University of Medical Sciences, Sabzevar, Khorasan, Iran
| | - Reza Salman Roghani
- Department of Clinical Sciences, University of Social Welfare & Rehabilitation, Tehran, Iran
| | | | - Mehdi Rahgozar
- Department of Biostatistics and Computer, University of Social Welfare & Rehabilitation, Tehran, Iran
| | - Johan Lokk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Asplund K, Hulter Åsberg K, Appelros P, Bjarne D, Eriksson M, Johansson Å, Jonsson F, Norrving B, Stegmayr B, Terént A, Wallin S, Wester PO. The Riks-Stroke Story: Building a Sustainable National Register for Quality Assessment of Stroke Care. Int J Stroke 2010; 6:99-108. [DOI: 10.1111/j.1747-4949.2010.00557.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Riks-Stroke, the Swedish Stroke Register, is the world's longest-running national stroke quality register (established in 1994) and includes all 76 hospitals in Sweden admitting acute stroke patients. The development and maintenance of this sustainable national register is described. Methods Riks-Stroke includes information on the quality of care during the acute phase, rehabilitation and secondary prevention of stroke, as well as data on community support. Riks-Stroke is unique among stroke quality registers in that patients are followed during the first year after stroke. The data collected describe processes, and medical and patient-reported outcome measurements. The register embraces most of the dimensions of health-care quality (evidence-based, safe, provided in time, distributed fairly and patient oriented). Result Annually, approximately 25 000 patients are included. In 2009, approximately 320 000 patients had been accumulated (mean age 76-years). The register is estimated to cover 82% of all stroke patients treated in Swedish hospitals. Among critical issues when building a national stroke quality register, the delicate balance between simplicity and comprehensiveness is emphasised. Future developments include direct transfer of data from digital medical records to Riks-Stroke and comprehensive strategies to use the information collected to rapidly implement new evidence-based techniques and to eliminate outdated methods in stroke care. Conclusions It is possible to establish a sustainable quality register for stroke at the national level covering all hospitals admitting acute stroke patients. Riks-Stroke is fulfilling its main goals to support continuous quality improvement of Swedish stroke services and serve as an instrument for following up national stroke guidelines.
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Affiliation(s)
- Kjell Asplund
- Riks-Stroke, Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Peter Appelros
- Department of Neurology, University Hospital, Örebro, Sweden
| | | | - Marie Eriksson
- Riks-Stroke, Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Åsa Johansson
- Riks-Stroke, Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Fredrik Jonsson
- Riks-Stroke, Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bo Norrving
- Department of Neurology, University Hospital, Lund, Sweden
| | - Birgitta Stegmayr
- Epidemiologic Center, National Board of Health and Welfare, Stockholm, Sweden
| | - Andreas Terént
- Department of Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Sari Wallin
- Riks-Stroke, Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per-Olov Wester
- Riks-Stroke, Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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26
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Katzenellenbogen JM, Sanfilippo FM, Hobbs MST, Briffa TG, Ridout SC, Knuiman MW, Dimer L, Taylor KP, Thompson PL, Thompson SC. Variable effects of prevalence correction of population denominators on differentials in myocardial infarction incidence: a record linkage study in Aboriginal and non-Aboriginal Western Australians. J Clin Epidemiol 2010; 64:658-66. [PMID: 21109397 DOI: 10.1016/j.jclinepi.2010.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/19/2010] [Accepted: 08/27/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the impact of prevalence correction of population denominators on myocardial infarction (MI) incidence rates, rate ratios, and rate differences in Aboriginal vs. non-Aboriginal Western Australians aged 25-74 years during the study period 2000-2004. STUDY DESIGN AND SETTING Person-based linked hospital and mortality data sets were used to estimate the number of prevalent and first-ever MI cases each year from 2000 to 2004 using a 15-year look-back period. Age-specific and -standardized MI incidence rates were calculated using both prevalence-corrected and -uncorrected population denominators, by sex and Aboriginality. RESULTS The impact of prevalence correction on rates increased with age, was higher for men than women, and substantially greater for Aboriginal than non-Aboriginal people. Despite the systematic underestimation of incidence, prevalence correction had little impact on the Aboriginal to non-Aboriginal age-standardized rate ratios (6% and 4% underestimate in men and women, respectively), although the impact on rate differences was more marked (12% and 6%, respectively). The percentage underestimate of differentials was greater at older ages. CONCLUSION Prevalence correction of denominators, while more accurate, is difficult to apply and may add modestly to the quantification of relative disparities in MI incidence between populations. Absolute incidence disparities using uncorrected denominators may have an error >10%.
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Affiliation(s)
- Judith M Katzenellenbogen
- Centre for International Health, Curtin Health Innovation Research Institute, Curtin University of Technology, Bently, Perth, Western Australia,
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Flynn RWV, MacDonald TM, Murray GD, Ferguson C, Shah K, Doney ASF. The Tayside Stroke Cohort: exploiting advanced regional medical informatics to create a region-wide database for studying the pharmacoepidemiology of stroke. Pharmacoepidemiol Drug Saf 2010; 19:737-44. [PMID: 20583205 DOI: 10.1002/pds.1958] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE Observational studies can provide valuable information where data from randomised controlled trials is lacking. We aimed to generate a region-wide longitudinal register of stroke patients using record-linkage of existing clinical and research datasets. METHODS The population were residents of Tayside, Scotland from 1994-2005. Stroke cases were identified from hospital inpatient admission records, death certificates and prescribing data. These were augmented with data derived from free-text CT-brain scan reports. Strokes were classified as intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH) or ischaemic stroke (IS). The methodology was validated by audit of patient case-records. The incidence was calculated using direct standardisation to the standard European population for ages 45-84. Twenty-eight day case-fatality rates were calculated as percentages. RESULTS There were 12 620 all-cause incident strokes (ICH 1057; SAH 511; IS 6257; undetermined 4795). Standardised incidences per 100 000 by subtypes of stroke were: ICH 35 (95%CI 33-38), SAH 19 (17-22) and IS 210 (205-217). The 28-day case-fatality rates were: ICH 49% (95%CI 46-52), SAH 38% (34-43) and IS 19% (18-20). Comparisons with previous studies were favourable for ICH and SAH. For IS the incidence was lower and fatality rate higher than elsewhere. Three hundred and three sets of patient case records were audited. The positive predictive value (PPV) for identifying cases of stroke was 94.7% (95%CI 91.6-96.7). CONCLUSIONS The case ascertainment in the TSC compares favourably to established stroke cohorts. This cost effective resource can now be linked with multiple other clinical and research datasets in Tayside to further understanding of stroke and its treatment.
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Affiliation(s)
- Robert W V Flynn
- Medicines Monitoring Unit, Ninewells Hospital & Medical School, Dundee, UK
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Appelros P, Nydevik I, Terént A. Living setting and utilisation of ADL assistance one year after a stroke with special reference to gender differences. Disabil Rehabil 2010; 28:43-9. [PMID: 16393832 DOI: 10.1080/09638280500165278] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine living setting and need for ADL assistance before and one year after a first-ever stroke with special focus on gender differences. METHODS One-year survivors from a population-based stroke study (n = 377) were studied with regard to place of living, need for ADL assistance and who provided the help. Stroke severity, cognitive impairment, post-stroke depression as well as risk factors were evaluated. RESULTS Before the stroke 48 patients (13%) lived in special housing (service flats or nursing homes), and one year after the stroke, 50 of the survivors (20%) lived in such accommodations. Before the stroke, 80 (21%) of the patients needed help with their personal ADL, while 90 (36%) needed help after one year. The increased need was fulfilled by relatives. Female spouses more often helped their male counterparts, and they tended to accept a heavier burden. Age, living alone, stroke severity, cognitive impairment, pre-stroke ADL dependency and depression were predictors for special housing. CONCLUSIONS In a time when more and more stroke survivors are cared for at home, it is important to pay attention to the situation of the caregivers. Female caregivers seem to be in an especially exposed position by accepting a heavier burden.
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Affiliation(s)
- Peter Appelros
- Department of Urology, Orebro University Hospital, Sweden.
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Owolabi LF, Shehu MY, Shehu MN, Fadare J. Pattern of neurological admissions in the tropics: Experience at Kano, Northwestern Nigeria. Ann Indian Acad Neurol 2010; 13:167-70. [PMID: 21085525 PMCID: PMC2981752 DOI: 10.4103/0972-2327.70875] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Revised: 09/16/2009] [Accepted: 12/23/2009] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Kano is the most populated state in Nigeria with a population totaling 9,383,682. The pattern of neurologic diseases in this area is not known. OBJECTIVE To determine the of pattern of neurologic diseases warranting admission in a tertiary hospital in Kano and compare it with those elsewhere in the country with the view to using the data generated as a baseline for planning purposes and for future studies. MATERIALS AND METHODS The medical records of all cases admitted with neurologic diseases in the Aminu Kano Teaching Hospital, Kano between January 2005 and September 2008, were retrospectively reviewed and the frequency of neurologic diseases, sex, age, and outcome of these diseases analyzed. RESULT Stroke, predominantly ischemic, accounted for 77.6% of the neurological cases for the period of study. Central nervous system infections, comprising mainly of meningitis and tetanus, accounted for 6.6% (64) and 3% (29) of cases, respectively. The myelopathies were the cause of neurologic admissions in 5.4% (53) with paraplegia and quadriplegia resulting from myelopathies accounting for 5% (49) and 0.4% (4) of the cases. Hypertensive encephalopathy and status epilepticus as the causes of admissions accounted for 1.6% each. Gullain Barre syndrome, Parkinson's disease, and cerebral malaria were relatively rare causes of neurologic admissions in this study. The average duration of hospitalization was 25 days, and regarding outcome, 219 (22.4%) of these cases died. CONCLUSIONS Stroke appeared to be the most common neurologic admission and the most common cause of neurologic and medical death in Kano as observed in other regions of the country and a little over one-fifths of stroke patients die. Central nervous system infections mainly meningitis and tetanus are the next common cause of admission. In view of these findings, the provision of a regional stroke unit, the improvement of the sanitary conditions of the home and environment; the widespread use of immunizations against meningitis, tetanus cannot be over-emphasized. These interventions will go a long way to reduce morbidity and mortality of stroke and neurologic infections.
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Affiliation(s)
- L. F. Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital/Bayero University Kano, Nigeria
| | - M. Y. Shehu
- Department of Medicine, Aminu Kano Teaching Hospital/Bayero University Kano, Nigeria
| | - M. N. Shehu
- Department of Medicine, Aminu Kano Teaching Hospital/Bayero University Kano, Nigeria
| | - J. Fadare
- Department of Medicine, Aminu Kano Teaching Hospital/Bayero University Kano, Nigeria
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Lovelock CE, Rinkel GJE, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: Population-based study and systematic review. Neurology 2010; 74:1494-501. [PMID: 20375310 DOI: 10.1212/wnl.0b013e3181dd42b3] [Citation(s) in RCA: 318] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Treatment of aneurysmal subarachnoid hemorrhage (SAH) has changed substantially over the last 25 years but there is a lack of reliable population-based data on whether case-fatality or functional outcomes have improved. METHODS We determined changes in the standardized incidence and outcome of SAH in the same population between 1981 and 1986 (Oxford Community Stroke Project) and 2002 and 2008 (Oxford Vascular Study). In a meta-analysis with other population-based studies, we used linear regression to determine time trends in outcome. RESULTS There were no reductions in incidence of SAH (RR = 0.79, 95% confidence interval [CI] 0.48-1.29, p = 0.34) and in 30-day case-fatality (RR = 0.67, 95% CI 0.39-1.13, p = 0.14) in the Oxford Vascular Study vs Oxford Community Stroke Project, but there was a decrease in overall mortality (RR = 0.47, 0.23-0.97, p = 0.04). Following adjustment for age and baseline SAH severity, patients surviving to hospital had reduced risk of death or dependency (modified Rankin score > 3) at 12 months in the Oxford Vascular Study (RR = 0.51, 0.29-0.88, p = 0.01). Among 32 studies covering 39 study periods from 1980 to 2005, 7 studied time trends within single populations. Unadjusted case-fatality fell by 0.9% per annum (0.3-1.5, p = 0.007) in a meta-analysis of data from all studies, and by 0.9% per annum (0.2-1.6%, p = 0.01) within the 7 population studies. CONCLUSION Mortality due to subarachnoid hemorrhage fell by about 50% in our study population over the last 2 decades, due mainly to improved outcomes in cases surviving to reach hospital. This improvement is consistent with a significant decrease in case-fatality over the last 25 years in our pooled analysis of other similar population-based studies.
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Affiliation(s)
- C E Lovelock
- University Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
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31
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van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010; 9:167-76. [PMID: 20056489 DOI: 10.1016/s1474-4422(09)70340-0] [Citation(s) in RCA: 1691] [Impact Index Per Article: 120.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Since the early 1980s, imaging techniques have enabled population-based studies of intracerebral haemorrhage. We aimed to assess the incidence, case fatality, and functional outcome of intracerebral haemorrhage in relation to age, sex, ethnic origin, and time period in studies published since 1980. METHODS From PubMed and Embase searches with predefined inclusion criteria, we identified population-based studies published between January, 1980, and November, 2008. We calculated incidence and case fatality. Incidences for multiple studies were pooled in a random-effects binomial meta-analysis. Time trends of case fatality were assessed with weighted linear-regression analysis. FINDINGS 36 eligible studies described 44 time periods (mid-year range 1983-2006). These studies included 8145 patients with intracerebral haemorrhage. Incidence did not decrease between 1980 and 2008. Overall incidence was 24.6 per 100 000 person-years (95% CI 19.7-30.7). Incidence was not significantly lower in women than in men (overall incidence ratio 0.85, 95% CI 0.61-1.18). Using the age group 45-54 years as reference, incidence ratios increased from 0.10 (95% CI 0.06-0.14) for people aged less than 45 years to 9.6 (6.6-13.9) for people older than 85 years. Median case fatality at 1 month was 40.4% (range 13.1-61.0) and did not decrease over time, and was lower in Japan (16.7%, 95% CI 15.0-18.5) than elsewhere (42.3%, 40.9-43.6). Six studies reported functional outcome, with independency rates of between 12% and 39%. Incidence of intracerebral haemorrhage per 100 000 person-years was 24.2 (95% CI 20.9-28.0) in white people, 22.9 (14.8-35.6) in black people, 19.6 (15.7-24.5) in Hispanic people, and 51.8 (38.8-69.3) in Asian people. INTERPRETATION Incidence of intracerebral haemorrhage increases with age and has not decreased between 1980 and 2006. Case fatality is lower in Japan than elsewhere, increases with age, and has not decreased over time. More data on functional outcome are needed. FUNDING Netherlands Heart Foundation.
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Affiliation(s)
- Charlotte Jj van Asch
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, Netherlands.
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Azarpazhooh MR, Etemadi MM, Donnan GA, Mokhber N, Majdi MR, Ghayour-Mobarhan M, Ghandehary K, Farzadfard MT, Kiani R, Panahandeh M, Thrift AG. Excessive Incidence of Stroke in Iran. Stroke 2010; 41:e3-e10. [PMID: 19926844 DOI: 10.1161/strokeaha.109.559708] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The epidemiology of stroke and its subtypes in the Middle East is unclear. Most previous studies have been performed in Western countries, and incidence rates are unlikely to apply in the Middle East. We aimed to determine the incidence of stroke in Mashhad, northeastern Iran.
Methods—
During a 12-month period (2006–2007), we prospectively ascertained all strokes occurring in a population of 450 229. Multiple overlapping sources were used to identify people with stroke. A large number of volunteers assisted in finding stroke patients not admitted to hospital. Potential cases were reviewed by a group of stroke experts before inclusion.
Results—
A total of 624 first-ever strokes occurred during the study period, 98.4% undergoing imaging. Despite a relatively low crude annual incidence rate of first-ever stroke FES (139; 95% CI, 128 to 149) per 100 000 residents, rates adjusted to the European population aged 45 to 84 years were higher than in most other countries: 616 (95% CI, 567 to 664) for ischemic stroke, 94 (95% CI, 75 to 113) for intracerebral hemorrhage, and 12 (95% CI, 5 to 19) for subarachnoid hemorrhage. Age-specific stroke incidence was higher in younger patients than is typically seen in Western countries. Comparison of age-specific incidence rates between regions revealed that stroke in Mashhad occurs approximately 1 decade earlier than in Western countries.
Conclusions—
The results of this study provide evidence that the incidence of stroke in Iran is considerably greater than in most Western countries, with stroke occurring at younger ages. Ischemic stroke incidence was also considerably greater than reported in other regions.
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Affiliation(s)
- Mahmoud Reza Azarpazhooh
- From the Department of Neurology (M.R.A., M.M.E., K.G., M.T.F., R.K., M.P.), Ghaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran; Florey Neuroscience Institutes (G.A.D.), University of Melbourne, Melbourne, Australia; Department of Psychogeriatrics and Psychiatry (N.M.), Avicenna Hospital; Department of Health (M.R.M.); and Department of Nutrition and Biochemistry (M.G.-M.), MUMS, Mashhad, Iran; and Baker IDI Heart and Diabetes Institute, Melbourne; Department of Epidemiology
| | - Mohammad Mehdi Etemadi
- From the Department of Neurology (M.R.A., M.M.E., K.G., M.T.F., R.K., M.P.), Ghaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran; Florey Neuroscience Institutes (G.A.D.), University of Melbourne, Melbourne, Australia; Department of Psychogeriatrics and Psychiatry (N.M.), Avicenna Hospital; Department of Health (M.R.M.); and Department of Nutrition and Biochemistry (M.G.-M.), MUMS, Mashhad, Iran; and Baker IDI Heart and Diabetes Institute, Melbourne; Department of Epidemiology
| | - Geoffrey A. Donnan
- From the Department of Neurology (M.R.A., M.M.E., K.G., M.T.F., R.K., M.P.), Ghaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran; Florey Neuroscience Institutes (G.A.D.), University of Melbourne, Melbourne, Australia; Department of Psychogeriatrics and Psychiatry (N.M.), Avicenna Hospital; Department of Health (M.R.M.); and Department of Nutrition and Biochemistry (M.G.-M.), MUMS, Mashhad, Iran; and Baker IDI Heart and Diabetes Institute, Melbourne; Department of Epidemiology
| | - Naghmeh Mokhber
- From the Department of Neurology (M.R.A., M.M.E., K.G., M.T.F., R.K., M.P.), Ghaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran; Florey Neuroscience Institutes (G.A.D.), University of Melbourne, Melbourne, Australia; Department of Psychogeriatrics and Psychiatry (N.M.), Avicenna Hospital; Department of Health (M.R.M.); and Department of Nutrition and Biochemistry (M.G.-M.), MUMS, Mashhad, Iran; and Baker IDI Heart and Diabetes Institute, Melbourne; Department of Epidemiology
| | - Mohammad Reza Majdi
- From the Department of Neurology (M.R.A., M.M.E., K.G., M.T.F., R.K., M.P.), Ghaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran; Florey Neuroscience Institutes (G.A.D.), University of Melbourne, Melbourne, Australia; Department of Psychogeriatrics and Psychiatry (N.M.), Avicenna Hospital; Department of Health (M.R.M.); and Department of Nutrition and Biochemistry (M.G.-M.), MUMS, Mashhad, Iran; and Baker IDI Heart and Diabetes Institute, Melbourne; Department of Epidemiology
| | - Majid Ghayour-Mobarhan
- From the Department of Neurology (M.R.A., M.M.E., K.G., M.T.F., R.K., M.P.), Ghaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran; Florey Neuroscience Institutes (G.A.D.), University of Melbourne, Melbourne, Australia; Department of Psychogeriatrics and Psychiatry (N.M.), Avicenna Hospital; Department of Health (M.R.M.); and Department of Nutrition and Biochemistry (M.G.-M.), MUMS, Mashhad, Iran; and Baker IDI Heart and Diabetes Institute, Melbourne; Department of Epidemiology
| | - Kavian Ghandehary
- From the Department of Neurology (M.R.A., M.M.E., K.G., M.T.F., R.K., M.P.), Ghaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran; Florey Neuroscience Institutes (G.A.D.), University of Melbourne, Melbourne, Australia; Department of Psychogeriatrics and Psychiatry (N.M.), Avicenna Hospital; Department of Health (M.R.M.); and Department of Nutrition and Biochemistry (M.G.-M.), MUMS, Mashhad, Iran; and Baker IDI Heart and Diabetes Institute, Melbourne; Department of Epidemiology
| | - Mohammad Taghi Farzadfard
- From the Department of Neurology (M.R.A., M.M.E., K.G., M.T.F., R.K., M.P.), Ghaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran; Florey Neuroscience Institutes (G.A.D.), University of Melbourne, Melbourne, Australia; Department of Psychogeriatrics and Psychiatry (N.M.), Avicenna Hospital; Department of Health (M.R.M.); and Department of Nutrition and Biochemistry (M.G.-M.), MUMS, Mashhad, Iran; and Baker IDI Heart and Diabetes Institute, Melbourne; Department of Epidemiology
| | - Reza Kiani
- From the Department of Neurology (M.R.A., M.M.E., K.G., M.T.F., R.K., M.P.), Ghaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran; Florey Neuroscience Institutes (G.A.D.), University of Melbourne, Melbourne, Australia; Department of Psychogeriatrics and Psychiatry (N.M.), Avicenna Hospital; Department of Health (M.R.M.); and Department of Nutrition and Biochemistry (M.G.-M.), MUMS, Mashhad, Iran; and Baker IDI Heart and Diabetes Institute, Melbourne; Department of Epidemiology
| | - Majid Panahandeh
- From the Department of Neurology (M.R.A., M.M.E., K.G., M.T.F., R.K., M.P.), Ghaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran; Florey Neuroscience Institutes (G.A.D.), University of Melbourne, Melbourne, Australia; Department of Psychogeriatrics and Psychiatry (N.M.), Avicenna Hospital; Department of Health (M.R.M.); and Department of Nutrition and Biochemistry (M.G.-M.), MUMS, Mashhad, Iran; and Baker IDI Heart and Diabetes Institute, Melbourne; Department of Epidemiology
| | - Amanda G. Thrift
- From the Department of Neurology (M.R.A., M.M.E., K.G., M.T.F., R.K., M.P.), Ghaem Hospital, Mashhad University of Medical Science (MUMS), Mashhad, Iran; Florey Neuroscience Institutes (G.A.D.), University of Melbourne, Melbourne, Australia; Department of Psychogeriatrics and Psychiatry (N.M.), Avicenna Hospital; Department of Health (M.R.M.); and Department of Nutrition and Biochemistry (M.G.-M.), MUMS, Mashhad, Iran; and Baker IDI Heart and Diabetes Institute, Melbourne; Department of Epidemiology
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33
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Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G. Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417,734 men and women in the Apolipoprotein MOrtality RISk study (AMORIS). J Intern Med 2009; 266:558-70. [PMID: 19563390 DOI: 10.1111/j.1365-2796.2009.02133.x] [Citation(s) in RCA: 196] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Few studies have simultaneously analysed the influence of elevated serum uric acid (UA) on acute myocardial infarction (AMI), ischaemic and haemorrhagic stroke (IS, HS) and congestive heart failure (CHF) in large healthy populations. We, here, examine UA as a risk factor for AMI, stroke and CHF by age and gender in the Apolipoprotein MOrtality RISk (AMORIS) Study. DESIGN Prospective study (11.8 years, range 7-17) of fatal and nonfatal acute myocardial infarction, stroke and CHF through linkage with Swedish hospital discharge and mortality registers. SETTINGS Measurements of uric acid in 417,734 men and women from health check-ups in Stockholm area. RESULTS There was a gradual increase in risk of AMI, stroke and CHF by increasing UA levels. Women had a stronger relationship between UA and both AMI and IS than men. Predictions of AMI were at least as powerful in the elderly as in the young, but not so for IS. Associations were markedly attenuated when adjusted for total cholesterol, triglycerides, hospital hypertension and diabetes status. The association between UA and HS was U-shaped in both genders. CHF was more strongly related to UA than AMI and stroke and less affected by the adjustment factors. CONCLUSIONS Already moderate levels of UA appear to be associated with an increased incidence of AMI, stroke and CHF in middle-aged subjects without prior cardiovascular disease. These associations seem to increase gradually from lower to higher levels of UA. UA may be an important complementary indicator of cardiovascular risk in the general population.
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Affiliation(s)
- I Holme
- Department of Preventive Cardiology, Centre of Preventive Medicine, Oslo, University Hospital, Ulleval, Oslo, Norway.
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Olai L, Omne-Pontén M, Borgquist L, Svärdsudd K. Survival, Hazard Function for a New Event, and Healthcare Utilization Among Stroke Patients ≥65 Years. Stroke 2009; 40:3585-90. [DOI: 10.1161/strokeaha.109.556720] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lena Olai
- From the Department of Public Health and Caring Sciences (L.O., K.S.), Family Medicine, and Clinical Epidemiology Section, Uppsala University, Uppsala, Sweden; the Centre for Clinical Research (L.O., M.O.-P.), Dalarna, Sweden; and the Department of Health and Community (L.B.), Family Medicine Section, Linköping University, Linköping, Sweden
| | - Marianne Omne-Pontén
- From the Department of Public Health and Caring Sciences (L.O., K.S.), Family Medicine, and Clinical Epidemiology Section, Uppsala University, Uppsala, Sweden; the Centre for Clinical Research (L.O., M.O.-P.), Dalarna, Sweden; and the Department of Health and Community (L.B.), Family Medicine Section, Linköping University, Linköping, Sweden
| | - Lars Borgquist
- From the Department of Public Health and Caring Sciences (L.O., K.S.), Family Medicine, and Clinical Epidemiology Section, Uppsala University, Uppsala, Sweden; the Centre for Clinical Research (L.O., M.O.-P.), Dalarna, Sweden; and the Department of Health and Community (L.B.), Family Medicine Section, Linköping University, Linköping, Sweden
| | - Kurt Svärdsudd
- From the Department of Public Health and Caring Sciences (L.O., K.S.), Family Medicine, and Clinical Epidemiology Section, Uppsala University, Uppsala, Sweden; the Centre for Clinical Research (L.O., M.O.-P.), Dalarna, Sweden; and the Department of Health and Community (L.B.), Family Medicine Section, Linköping University, Linköping, Sweden
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35
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Harmsen P, Wilhelmsen L, Jacobsson A. Stroke Incidence and Mortality Rates 1987 to 2006 Related to Secular Trends of Cardiovascular Risk Factors in Gothenburg, Sweden. Stroke 2009; 40:2691-7. [DOI: 10.1161/strokeaha.109.550814] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Per Harmsen
- From Institute of Clinical Neuroscience (P.H.), Department of Internal Medicine (L.W.), Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgren’s Academy (A.J.), University of Gothenburg, Gothenburg, Sweden, and Centre for Epidemiology, the National Board of Health and Welfare, Stockholm, Sweden
| | - Lars Wilhelmsen
- From Institute of Clinical Neuroscience (P.H.), Department of Internal Medicine (L.W.), Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgren’s Academy (A.J.), University of Gothenburg, Gothenburg, Sweden, and Centre for Epidemiology, the National Board of Health and Welfare, Stockholm, Sweden
| | - Anders Jacobsson
- From Institute of Clinical Neuroscience (P.H.), Department of Internal Medicine (L.W.), Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgren’s Academy (A.J.), University of Gothenburg, Gothenburg, Sweden, and Centre for Epidemiology, the National Board of Health and Welfare, Stockholm, Sweden
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Appelros P. Characteristics of the Frenchay Activities Index one year after a stroke: A population-based study. Disabil Rehabil 2009; 29:785-90. [PMID: 17457736 DOI: 10.1080/09638280600919715] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To further describe the properties of Frenchay Activities Index (FAI) with special emphasis on relationships with stroke severity and cognition. METHODS Survivors from a population-based first-ever stroke cohort (n = 246) were assessed with FAI one year post-stroke. At the same time patients were asked about their status pre-stroke. Stroke severity was assessed at baseline with the NIH stroke scale (NIHSS). Cognition was assessed at one year with the Mini Mental State Examination (MMSE). RESULTS Pre-stroke and post-stroke FAI averaged at 40.1 and 32.4, respectively. There was a floor effect post-stroke, where 17% had the lowest possible score. The sum score was related to age, but not to gender. Individual items, however, were gender-related. NIHSS was clearly related to the difference FAI pre-stroke - post-stroke, but individual variations were large. Individual NIHSS items differed regarding their impact on post-stroke FAI. MMSE post-stroke also has a clear relationship with FAI, but there are large individual variations. CONCLUSIONS This study establishes a population-based standard for FAI scores one year after a stroke. The effects of stroke severity and cognition have been demonstrated. FAI gives useful information that is not obtained from basic ADL scales, such as the Barthel Index.
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Affiliation(s)
- Peter Appelros
- Department of Neurology, Orebro University Hospital, Orebro, Sweden.
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Medin J, Nordlund A, Ekberg K. Sick leave, disability pension and health-care-seeking behaviour prior to stroke, among people aged 30–65: A case–control study. Brain Inj 2009; 21:457-63. [PMID: 17522985 DOI: 10.1080/02699050701317643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRIMARY OBJECTIVE To explore sick leave, disability pension and health-care-seeking behaviour among people 30-65 years of age prior to their stroke in 2001 in the county of Ostergötland, Sweden. RESEARCH DESIGN A register-based, retrospective case-control study for the period 1 January 1998-31 December 2000. Cases (n=212): patients aged 30-65 with first-ever stroke in 2001. Controls (n=4606): people aged 30-65, randomly selected from the same base population. MAIN OUTCOMES AND RESULTS More than 91 days of accumulated sick leave among women was associated with increased likelihood of developing stroke (OR=1.89). Among men, 29-90 days and more than 91 days on sick leave increased the likelihood of stroke (OR=2.34 and OR=3.43, respectively). CONCLUSION Frequent health-care-seeking behaviour is not a tool for identifying women who develop stroke, while it may be an indicator for men. Accumulated sick leave may be a tool for identifying men and women with higher risk of stroke.
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Affiliation(s)
- Jennie Medin
- National Centre of Work and Rehabilitation, Linköping University, Linköping, Sweden.
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38
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Nieuwkamp DJ, Setz LE, Algra A, Linn FHH, de Rooij NK, Rinkel GJE. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol 2009; 8:635-42. [PMID: 19501022 DOI: 10.1016/s1474-4422(09)70126-7] [Citation(s) in RCA: 853] [Impact Index Per Article: 56.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In a systematic review, published in 1997, we found that the case fatality of aneurysmal subarachnoid haemorrhage (SAH) decreased during the period 1960-95. Because diagnostic and treatment strategies have improved and new studies from previously non-studied regions have been published since 1995, we did an updated meta-analysis to assess changes in case fatality and morbidity and differences according to age, sex, and region. METHODS A new search of PubMed with predefined inclusion criteria for case finding and diagnosis identified reports on prospective population-based studies published between January, 1995, and July, 2007. The studies included in the previous systematic review were reassessed with the new inclusion criteria. Changes in case fatality over time and the effect of age and sex were quantified with weighted linear regression. Regional differences were analysed with linear regression analysis, and the regions of interest were subsequently defined as reference regions and compared with the other regions. FINDINGS 33 studies (23 of which were published in 1995 or later) were included that described 39 study periods. These studies reported on 8739 patients, of whom 7659 [88%] were reported on after 1995. 11 of the studies that were included in the previous review did not meet the current, more stringent, inclusion criteria. The mean age of patients had increased in the period 1973 to 2002 from 52 to 62 years. Case fatality varied from 8.3% to 66.7% between studies and decreased 0.8% per year (95% CI 0.2 to 1.3). The decrease was unchanged after adjustment for sex, but the decrease per year was 0.4% (-0.5 to 1.2) after adjustment for age. Case fatality was 11.8% (3.8 to 19.9) lower in Japan than it was in Europe, the USA, Australia, and New Zealand. The unadjusted decrease in case fatality excluding the data for Japan was 0.6% per year (0.0 to 1.1), a 17% decrease over the three decades. Six studies reported data on case morbidity, but these were insufficient to assess changes over time. INTERPRETATION Despite an increase in the mean age of patients with SAH, case-fatality rates have decreased by 17% between 1973 and 2002 and show potentially important regional differences. This decrease coincides with the introduction of improved management strategies. FUNDING Netherlands Organisation for Scientific Research; ZonMw.
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Affiliation(s)
- Dennis J Nieuwkamp
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, 3584 CX Utrecht, Netherlands.
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Feigin VL, Lawes CMM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 2009; 8:355-69. [PMID: 19233729 DOI: 10.1016/s1474-4422(09)70025-0] [Citation(s) in RCA: 1788] [Impact Index Per Article: 119.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This systematic review of population-based studies of the incidence and early (21 days to 1 month) case fatality of stroke is based on studies published from 1970 to 2008. Stroke incidence (incident strokes only) and case fatality from 21 days to 1 month post-stroke were analysed by four decades of study, two country income groups (high-income countries and low to middle income countries, in accordance with the World Bank's country classification) and, when possible, by stroke pathological type: ischaemic stroke, primary intracerebral haemorrhage, and subarachnoid haemorrhage. This Review shows a divergent, statistically significant trend in stroke incidence rates over the past four decades, with a 42% decrease in stroke incidence in high-income countries and a greater than 100% increase in stroke incidence in low to middle income countries. In 2000-08, the overall stroke incidence rates in low to middle income countries have, for the first time, exceeded the level of stroke incidence seen in high-income countries, by 20%. The time to decide whether or not stroke is an issue that should be on the governmental agenda in low to middle income countries has now passed. Now is the time for action.
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Affiliation(s)
- Valery L Feigin
- National Research Centre for Stroke, Applied Neurosciences and Neurorehabilitation, School of Rehabilitation and Occupation Studies, AUT University, North Shore Campus, AA254, Northcote 0627, Auckland 1142, New Zealand.
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Abstract
BACKGROUND AND PURPOSE Epidemiological studies, mainly based on Western European surveys, have shown that stroke is more common in men than in women. In recent years, sex-specific data on stroke incidence, prevalence, subtypes, severity and case-fatality have become available from other parts of the world. The purpose of this article is to give a worldwide review on sex differences in stroke epidemiology. METHODS We searched PubMed, tables-of-contents, review articles, and reference lists for community-based studies including information on sex differences. In some areas, such as secular trends, ischemic subtypes and stroke severity, noncommunity-based studies were also reviewed. Male/female ratios were calculated. RESULTS We found 98 articles that contained relevant sex-specific information, including 59 incidence studies from 19 countries and 5 continents. The mean age at first-ever stroke was 68.6 years among men, and 72.9 years among women. Male stroke incidence rate was 33% higher and stroke prevalence was 41% higher than the female, with large variations between age bands and between populations. The incidence rates of brain infarction and intracerebral hemorrhage were higher among men, whereas the rate of subarachnoidal hemorrhage was higher among women, although this difference was not statistically significant. Stroke tended to be more severe in women, with a 1-month case fatality of 24.7% compared with 19.7% for men. CONCLUSIONS Worldwide, stroke is more common among men, but women are more severely ill. The mismatch between the sexes is larger than previously described.
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Affiliation(s)
- Peter Appelros
- Department of Neurology, Orebro University Hospital, Orebro, Sweden.
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41
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Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G. Relationships between lipoprotein components and risk of ischaemic and haemorrhagic stroke in the Apolipoprotein MOrtality RISk study (AMORIS). J Intern Med 2009; 265:275-87. [PMID: 19019184 DOI: 10.1111/j.1365-2796.2008.02016.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare lipoprotein components associated with ischaemic and haemorrhagic stroke by age and gender in the Apolipoprotein MOrtality RISk (AMORIS) Study (n=148 600). DESIGN Prospective follow-up study (11.8, range 7-17 years) of fatal and nonfatal ischaemic and haemorrhagic stroke through linkage with Swedish hospital discharge and mortality registers. SETTING Measurements of lipoprotein components from health check-ups in the larger Stockholm area. RESULTS Ischaemic stroke was more common than haemorrhagic stroke (5 :1), but case fatality was higher in haemorrhagic stroke. An elevated apoB/apoA-1 ratio and triglycerides, non-HDL cholesterol, low HDL cholesterol, and the total cholesterol to high-density cholesterol (TC/HDL-C) ratio were associated with increased incidence of nonfatal and fatal ischaemic stroke as well as all cerebrovascular events (n=7480) in both genders. The associations were somewhat stronger for nonfatal than fatal events. In ischaemic stroke the apoB/apoA-1 ratio was a stronger predictor than the TC/HDL-C ratio in all subjects, in those below 65 years of age and in those with LDL-C below 3 mmol L(-1). Haemorrhagic stroke was not associated with elevated atherogenic lipoproteins except for increased risk of fatal haemorrhagic stroke in women with a high apoB/apoA-I ratio. CONCLUSIONS Dyslipidaemia is associated with an increased risk of ischaemic stroke but few relations were seen in haemorrhagic stroke. Use of the apoB/apoA-I ratio as a marker of dyslipidaemia is at least as efficient as conventional lipids, for the identification of subjects at increased risk of stroke, especially ischaemic stroke. Practical advantages, fasting is not needed, speak in favour of using apoB and apoA-1 in stroke risk prediction.
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Affiliation(s)
- I Holme
- Department of Preventive Cardiology, Centre of Preventive Medicine, Ullevål University Hospital, Oslo, Norway.
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Lundström E, Smits A, Terént A, Borg J. Risk factors for stroke-related pain 1 year after first-ever stroke. Eur J Neurol 2009; 16:188-93. [DOI: 10.1111/j.1468-1331.2008.02378.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G. Haptoglobin and risk of myocardial infarction, stroke, and congestive heart failure in 342,125 men and women in the Apolipoprotein MOrtality RISk study (AMORIS). Ann Med 2009; 41:522-32. [PMID: 19657769 DOI: 10.1080/07853890903089453] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Few studies have analysed the importance of haptoglobin (Hp) as a risk factor for acute myocardial infarction (AMI), stroke, and heart failure (HF) in large healthy populations. AIMS We examined Hp as risk factor for AMI, stroke, and HF in the Apolipoprotein MOrtality RISk (AMORIS) Study and compared its predictive strength with that of total serum cholesterol (TC). METHODS Prospective study (11.8 years) of AMI, stroke, and HF through linkage with Swedish hospital discharge and mortality registers with measurements of Hp in 342,125 subjects. RESULTS Hp is a significant risk factor of AMI, stroke, and HF. Relationships were stronger for men than women with regard to stroke and HF, but not AMI. Hp was almost as predictive as TC for AMI and about equally predictive of stroke with a stronger relationship to ischaemic than haemorrhagic stroke. A 4.2-fold increase in risk of AMI was observed comparing subjects in the joint lower quartiles of TC and Hp to those in the upper. For stroke, the risk increase was 2-fold, and 1.5-fold for HF. INTERPRETATION The inflammation marker Hp carried as much additional predictive information value on AMI and stroke as TC. Hp was also a risk factor of HF.
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Affiliation(s)
- Ingar Holme
- Department of Preventive Cardiology, Centre of Preventive Medicine, Oslo University Hospital, Ulleval, Oslo, Norway.
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Manobianca G, Zoccolella S, Petruzzellis A, Miccoli A, Logroscino G. Low Incidence of Stroke in Southern Italy. Stroke 2008; 39:2923-8. [DOI: 10.1161/strokeaha.108.519421] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although a lower incidence of stroke has been observed in the Mediterranean area compared to other European countries, this is based on only a few studies. We sought to determine the incidence and 28-day case-fatality of stroke through a population-based stroke register in a rural area in Southern Italy, characterized by a stroke unit in the referral hospital.
Methods—
We established a multisource prospective population-based register in a well defined geographic area of 38 735 inhabitants in Puglia, Southern Italy. We identified all subjects in the study area with a first-ever stroke between January 1, 2001 and December 31, 2002.
Results—
We identified 127 first-ever strokes (77 males, 50 females) during the two-year study period. Hospitalization was 95%: 92 cases (72.4%) were cerebral infarction, 24 (18.9%) intracerebral hemorrhage, 3 (2.4%) subarachnoid hemorrhage, and 8 (6.3%) were unclassifiable strokes. The overall crude annual incidence was 1.6 per 1000 (95%CI: 1.4 to 1.9), 2.0 for males (95% CI:1.6 to 2.5), and 1.3 for females (95% CI:0.9 to 1.6). The incidence rates standardized to the 2001 European and world populations were respectively 1.5 (2.0 for males and 1.3 for females) and 0.8 (0.9 for males and 0.6 for females). Incidence rates progressively increased with age in both sexes, reaching their peak at 85 years or more (21.4/1000 overall, 35.0 for men and 13.4 for women). The 28-day case-fatality was 18.1%.
Conclusions—
Our study supports previous findings of lower incidence of stroke in the Mediterranean area, whereas the case-fatality in our study was lower than in previous studies from Italy. Further studies are needed to determine the role of prompt referral and stroke units on prognosis in population-based setting.
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Affiliation(s)
- Giovanni Manobianca
- From the Department of Neurology (G.M., A.P., A.M.), Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy; Azienda Ospedaliero-Universitaria Ospedali Riuniti (S.Z.), Medical and Neurological Sciences, Clinic of Nervous System Diseases, University of Foggia, Italy; and the Department of Neurology and Psychiatry (G.L.), University of Bari, Italy
| | - Stefano Zoccolella
- From the Department of Neurology (G.M., A.P., A.M.), Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy; Azienda Ospedaliero-Universitaria Ospedali Riuniti (S.Z.), Medical and Neurological Sciences, Clinic of Nervous System Diseases, University of Foggia, Italy; and the Department of Neurology and Psychiatry (G.L.), University of Bari, Italy
| | - Antonella Petruzzellis
- From the Department of Neurology (G.M., A.P., A.M.), Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy; Azienda Ospedaliero-Universitaria Ospedali Riuniti (S.Z.), Medical and Neurological Sciences, Clinic of Nervous System Diseases, University of Foggia, Italy; and the Department of Neurology and Psychiatry (G.L.), University of Bari, Italy
| | - Annamaria Miccoli
- From the Department of Neurology (G.M., A.P., A.M.), Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy; Azienda Ospedaliero-Universitaria Ospedali Riuniti (S.Z.), Medical and Neurological Sciences, Clinic of Nervous System Diseases, University of Foggia, Italy; and the Department of Neurology and Psychiatry (G.L.), University of Bari, Italy
| | - Giancarlo Logroscino
- From the Department of Neurology (G.M., A.P., A.M.), Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy; Azienda Ospedaliero-Universitaria Ospedali Riuniti (S.Z.), Medical and Neurological Sciences, Clinic of Nervous System Diseases, University of Foggia, Italy; and the Department of Neurology and Psychiatry (G.L.), University of Bari, Italy
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Fear of falling in stroke patients: relationship with previous falls and functional characteristics. Int J Rehabil Res 2008; 31:261-4. [DOI: 10.1097/mrr.0b013e3282fba390] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Bent Indredavik
- Stroke Unit, Department of Medicine, Trondheim University Hospital, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hanne Ellekjær
- Stroke Unit, Department of Medicine, Trondheim University Hospital, Trondheim, Norway
| | - Randi Selmer
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
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Abstract
OBJECTIVE To estimate the prevalence of disabling spasticity (DS) 1 year after first-ever stroke. DESIGN Cross-sectional survey 1 year after first-ever stroke. METHODS Patients above 18 years from one county with first-ever stroke were identified by use of the national stroke registry. A representative sample of 163 patients was created and 140 of these were followed up. Assessments of motor function and ability with the modified Ashworth Scale, the modified Rankin Scale (mRS), the Barthel Index (BI) and clinical evaluation were performed in order to identify patients with spasticity-related disability. RESULTS The observed prevalence of any spasticity was 17% and of DS 4%. Patients with DS scored significantly worse than those with no DS on the mRS (P = 0.009) and the BI (P = 0.005). DS was more frequent in the upper extremity, correlated positively with other indices of motor impairment and inversely with age. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9-125) and age below 65 years (OR 9.5, CI 1.5-60). CONCLUSIONS The prevalence of DS after first-ever stroke is low but corresponds to a large number of patients and deserves further attention with regards to prevention and treatment.
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Affiliation(s)
- E Lundström
- Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala, Sweden.
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Hallström B, Jönsson AC, Nerbrand C, Norrving B, Lindgren A. Stroke incidence and survival in the beginning of the 21st century in southern Sweden: comparisons with the late 20th century and projections into the future. Stroke 2007; 39:10-5. [PMID: 18063825 DOI: 10.1161/strokeaha.107.491779] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We report trends of stroke incidence and survival up to year 2001/2002 in Lund-Orup, Sweden, and projections of future stroke incidence in Sweden. METHODS Lund Stroke Register, a prospective population-based study, included all first-ever stroke patients, between March 1, 2001 and February 28, 2002, in the Lund-Orup health care district. Institution-based studies for 1983 to 1985 and 1993 to 1995 were used for comparison. We calculated age-standardized incidence and Cox proportional hazards analysis of survival (stroke subtype, sex, age group, and study period in the analysis). Minimum follow-up was 46 months. Based on our register's stroke incidence and the official Swedish population projection, a projection for future stroke incidence on a national basis was calculated. RESULTS We included 456 patients with first-ever stroke in 2001/2002. The age-standardized incidence (to the European population) was 144 per 100 000 person-years (95%CI 130 to 158) in 2001/2002, 158 (95%CI 149 to 168) in 1993 to 1995, and 134 (95%CI 126 to 143) in 1983 to 1985. Cox proportional hazard analysis indicated decreased risk of death after stroke in 2001/2002 (hazard ratio 0.80; 95%CI 0.67 to 0.94) compared with 1993 to 1995. Up to year 2050, the annual number of new stroke patients in Sweden may increase by 59% based solely on demographic changes. CONCLUSIONS Despite possible underestimation of stroke incidence during the previous institution-based studies, the increased stroke incidence between 1983 to 1985 and 1993 to 1995 did not continue in 2001/2002. The long-term survival after stroke continues to improve. As the elderly population is growing in Sweden, stable incidence and increasing survival will result in a rapidly increasing prevalence of stroke patients in Sweden.
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Affiliation(s)
- Björn Hallström
- Department of Clinical Sciences, Lund, Neurology, Lund University Hospital, S-221 85 Lund, Sweden
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de Rooij NK, Linn FHH, van der Plas JA, Algra A, Rinkel GJE. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry 2007; 78:1365-72. [PMID: 17470467 PMCID: PMC2095631 DOI: 10.1136/jnnp.2007.117655] [Citation(s) in RCA: 744] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIM To update our 1996 review on the incidence of subarachnoid haemorrhage (SAH) and assess the relation of incidence with region, age, gender and time period. METHODS We searched for studies on the incidence of SAH published until October 2005. The overall incidences with corresponding 95% confidence intervals were calculated. We determined the relationship between the incidence of SAH and determinants by means of univariate Poisson regression. RESULTS We included 51 studies (33 new), describing 58 study populations in 21 countries, observing 45,821,896 person-years. Incidences per 100,000 person-years were 22.7 (95% CI 21.9 to 23.5) in Japan, 19.7 (18.1 to 21.3) in Finland, 4.2 (3.1 to 5.7) in South and Central America, and 9.1 (8.8 to 9.5) in the other regions. With age category 45-55 years as the reference, incidence ratios increased from 0.10 (0.08 to 0.14) for age groups younger than 25 years to 1.61 (1.24 to 2.07) for age groups older than 85 years. The incidence in women was 1.24 (1.09 to 1.42) times higher than in men; this gender difference started at age 55 years and increased thereafter. Between 1950 and 2005, the incidence decreased by 0.6% (1.3% decrease to 0.1% increase) per year. CONCLUSIONS The overall incidence of SAH is approximately 9 per 100,000 person-years. Rates are higher in Japan and Finland and increase with age. The preponderance of women starts only in the sixth decade. The decline in incidence of SAH over the past 45 years is relatively moderate compared with that for stroke in general.
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Affiliation(s)
- N K de Rooij
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, The Netherlands
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50
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Skånér Y, Nilsson GH, Sundquist K, Hassler E, Krakau I. Self-rated health, symptoms of depression and general symptoms at 3 and 12 months after a first-ever stroke: a municipality-based study in Sweden. BMC FAMILY PRACTICE 2007; 8:61. [PMID: 17941995 PMCID: PMC2174472 DOI: 10.1186/1471-2296-8-61] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 10/17/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Self-rated health is an important indicator of quality of life as well as a good predictor of future health. The purpose of the study was to follow up the self-rated health and the prevalence of symptoms of depression and general symptoms in a population of first-ever stroke patients 3 and 12 months after stroke. METHODS All patients surviving their first-ever stroke and residing in Nacka municipality in Stockholm County Council were included using a multiple overlapping search strategy during an 18-month period (n = 187). Our study group comprised the 145 patients who survived the first 3 months after stroke. Three and 12 months after their stroke, the patients were assessed regarding self-rated health and general symptoms using parts of the Göteborg Quality of Life Instrument (GQLI), and regarding symptoms of depression using the Montgomery Asberg Depression Scale (MADRS-S). RESULTS Self-rated health was rated as very good or rather good by 62% at 3 months after stroke and by 78% at 12 months after stroke. More than half of the patients suffered from symptoms of depression, with no significant improvement at 12 months. The most common general symptoms at 3 months after stroke were fatigue, sadness, pain in the legs, dizziness and irritability. Fatigue and sadness were still common at 12 months. Twelve months after stroke the prevalences of crying easily, irritability, impaired concentration, nausea and loss of weight were significantly lower. CONCLUSION The majority of patients rated their health as rather good or very good at 3 and 12 months after stroke. However, the majority suffered from fatigue and from symptoms of depression after both 3 and 12 months. In continued care of stroke survivors, it is important to consider the fact that many patients who rate their health as good may nevertheless have symptoms of depression, and some of them may benefit from anti-depressive treatment.
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Affiliation(s)
- Ylva Skånér
- CeFAM (Centre for Family and Community Medicine), Karolinska Institute, Alfred Nobels väg 12, SE-141 83 Huddinge, Sweden
| | - Gunnar H Nilsson
- CeFAM (Centre for Family and Community Medicine), Karolinska Institute, Alfred Nobels väg 12, SE-141 83 Huddinge, Sweden
| | - Kristina Sundquist
- CeFAM (Centre for Family and Community Medicine), Karolinska Institute, Alfred Nobels väg 12, SE-141 83 Huddinge, Sweden
| | - Ejda Hassler
- CeFAM (Centre for Family and Community Medicine), Karolinska Institute, Alfred Nobels väg 12, SE-141 83 Huddinge, Sweden
| | - Ingvar Krakau
- CeFAM (Centre for Family and Community Medicine), Karolinska Institute, Alfred Nobels väg 12, SE-141 83 Huddinge, Sweden
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