Increasing incidence of stroke among Swedish women

Stroke incidence in Copenhagen, 1976-1988

BACKGROUND AND PURPOSE

Temporal trends in stroke incidence in Denmark have not been previously reported. The Copenhagen City Heart Study is a prospective study based on a randomly selected sample of an urban population of, initially, 19,698 participants followed since 1976. Over a period of 12 years, we studied three important aspects of stroke incidence in 848 identified cases: temporal trends, dependence on age and sex, and comparison of responders and nonresponders.

METHODS

The participants were invited to two health examinations at 5-year intervals. The participants who attended at least one of the two examinations are termed responders and those who attended none nonresponders. The cases of first-ever stroke were collected from responders, the National Patient Register, and the National Register of Deaths and were verified by study of hospital records and death certificates.

RESULTS

For responders aged 35-64 years and greater than or equal to 65 years, there were no significant changes in the weighted rates in four consecutive 3-year periods. There was a tendency toward decreasing rates among younger women, but not in older women or men. The age- and sex-adjusted rates per 1,000 (based on the Danish population in 1982) in responders in the entire 12-year follow-up period were 1.61 in women, 2.67 in men, and 2.14 in both sexes combined. Stroke incidence rates increased exponentially with age in both sexes, with rates in men generally twice those in women, even in the greater than or equal to 75 years of age group. Age-adjusted rates were higher in nonresponders than in responders. For women, this ratio was 1.7; for men, 1.1.

CONCLUSIONS

The stroke incidence in Copenhagen is relatively high and has shown no decreasing tendency over the period 1976-1988.

The prevalence of vascular dementia in Europe: facts and fragments from 1980-1990 studies. EURODEM-Prevalence Research Group

We selected, reanalyzed, and compared data from current prevalence studies of vascular dementia in Europe. Inclusion criteria were: dementia defined by the Diagnostic and Statistical Manual for Mental Disorders, edition 3, or equivalent criteria; case finding through direct individual examination; appropriate sample size; and inclusion of institutionalized persons. Mixed dementia was combined with vascular dementia. Of the 23 surveys of dementia considered, five fulfilled the inclusion criteria. Age-specific prevalence varied more widely for men than for women; differences were greater in older ages. The prevalence increased steeply with advancing age in all countries, and was generally higher in men; it declined over 15 years in the age class of 80 to 89 years in one Swedish population. Within populations, Alzheimer's disease was generally more common than vascular dementia. Unfortunately, prevalence studies of vascular dementia are limited in Europe and worldwide, and their comparison is impeded by the lack of common diagnostic criteria.

Event, incidence, and fatality rates of cerebrovascular diseases in Enköping-Håbo, Sweden, 1986-1988

In order to study the need for medical care among elderly stroke patients, a prospective registration of cerebrovascular diseases started on January 1, 1986 in Enköping-Håbo health service district, Sweden. This article reports the design of the stroke register and the registration procedures, the annual events of stroke, both first-ever and recurrent, during 1986-1988 and the fatality rate with special regard to the very old population. The annual incidence of first-ever stroke was 0.33/1,000 among persons younger than 65 years of age, 10.6/1,000 among persons aged 65-84 years, and 34.5/1,000 among persons aged 85 years and older. The fatality rate of first-ever strokes was 7.5% within one month for persons younger than 65 years of age, 20.3% in the age-group 65-84 years, and 41% for the population 85 years and older. These results are compared with a similar Swedish study from Söderhamn and four comparable international studies. The results from this study gave a basis for designing special care programs in hospital and in home-care also for old stroke patients.

Changing rates of stroke in the province of Quebec, Canada: 1981-1988

Using more than 37,000 hospital discharges attributed to hemorrhagic or occlusive stroke in the province of Quebec, Canada, we analyzed trends in stroke incidence during the period 1981-1988. There were large and statistically significant (p less than 0.05) increases in the rates of hemorrhagic stroke over this period. Dramatic increases occurred among men in the rates of both intracerebral (International Classification of Diseases--Ninth Revision [ICD9] code 431) and intracranial (ICD9 code 432) hemorrhagic strokes (40-204% depending on age). In contrast, the rates of occlusion of the precerebral arteries (ICD9 code 433) declined in younger men and women but increased substantially (107%) in older men. Rates of occlusion of the cerebral arteries (ICD9 code 434) declined in men over the age of 50 years and in women aged 50-79 years. Despite the decline in the rate of occlusion of the cerebral arteries, the rate of hemorrhagic stroke appears to have increased. Changes in the hospitalization rates for hemorrhagic stroke were not accompanied by consistent decreases in the case-fatality rate. This finding tends to support the hypothesis of an actual increase in the hospitalization rate fo hemorrhagic stroke rather than an artifactually elevated rate due to enhanced diagnosis by computed tomography.

Risk factors for transient ischemic attacks in middle-age. A population-based case-control study

A case-control study was based on "unselected" transient ischemic attacks (TIAs) in a middle-aged Italian population. The identified cases included 52 prevalent and 25 incident TIAs. There was an incidence rate ratio (female/male) of 1.8 for definite cases. Comparison with the whole population for medical history of hypertension, diabetes and heart attack showed age/sex-adjusted odds ratios of 4.3, 2.1, 7.9 for incident cases. The results were similar when a more detailed investigation of risk factors was performed with all the cases and a random sample of the controls. Moreover, female sex had an odds ratio for incident cases of 3.3 (95% confidence interval 1.0-11.3) after adjustment for age and presence of all the main risk factors. The presence of at least one cardiopathy showed an odds ratio of 8.3 for incident cases (95% confidence interval 2.4-28.4).

Risk factors and causes of stroke in young women in Israel

OBJECTIVE

to identify risk factors and likely causes for stroke in young women, as a basis for designing a strategy for stroke incidence reduction.

DESIGN

retrospective chart review for comparisons between the sexes.

SETTING

general and rehabilitation hospitals.

PATIENTS

all 263 patients aged 17-45 years with stroke over a 15-year period.

EXCLUSIONS

patients seen at 14 general hospitals who were not referred to the Loewenstein.

ASSESSMENTS

data on sociodemographic, anamnestic, and clinical aspects.

RESULTS

stroke under the age of 30 years was more frequent in women, and in them the risk factors differed from those in an older population. The most frequent cause of stroke in the younger women was embolism, in the majority on the basis of a rheumatic valvular defect, whereas in young men the usual cause was atherosclerosis.

CONCLUSIONS

opportunities for preventive initiatives have not always been grasped, and more attention should be directed to such possibilities.

Survival after stroke and transient ischemic attacks during the 1970s and 1980s

Survival after stroke and transient ischemic attack was studied in Söderhamn, Sweden, during the periods 1975-1979 and 1983-1987; 640 patients with first-ever stroke and 97 with first-ever transient ischemic attack were registered and followed for 1-3 years. Approximately 90% of the patients were treated in the Department of Internal Medicine of Söderhamn Hospital. The protocols for physical rehabilitation and antithrombotic treatment changed between study periods. Between periods, 3-year survival after stroke increased by 16% (p less than 0.003). The 95% confidence intervals of the relative survival rates were 0.524-0.648, 0.435-0.567, and 0.337-0.475 at 1, 2, and 3 years, respectively, during the first period and 0.616-0.728, 0.600-0.732, and 0.576-0.748 during the second period. Fewer patients suffered fatal complications of stroke during the second period. The rate of stroke recurrence was approximately 10%/year during both study periods. Four patients suffered fatal hemorrhage during the first period, but no patient did so during the second period. Observed survival after transient ischemic attack did not differ from that expected in the first 2 years of follow-up during either study period. The risk for stroke after transient ischemic attack was approximately 5%/year during both periods. The higher survival rates after stroke during the second period seems to be the result of fewer fatal complications rather than of a reduced risk for recurrent stroke.

First-year results of a community-based study of stroke incidence in Umbria, Italy

The SEPIVAC study (Italian initials for "epidemiologic study of incidence of acute cerebrovascular disease") is a community-based epidemiologic survey of incidence and outcome of cerebrovascular disease in the territory of the 6th Local Health Unit, Umbria, Italy, where 49,101 people live. All cases were registered with the study either by notification from general practitioners or by check of hospital admission within the study area and in the two hospitals of Perugia. Death certificates were looked at as well. Patients were registered with the study when the clinical picture fulfilled the definition of stroke and transient ischemic attack (TIA) adopted for this study. Patients were followed up at approximately 30 days and 6 months. During the first year of the study (September 1, 1986 to August 31, 1987), 189 cases were registered: 108 suffered a "first ever in a lifetime" stroke, 30 a recurrent stroke, and 51 a "first ever in a lifetime" transient ischemic attack. Sixty-one percent of patients (71% of first strokes) had a computed tomography scan. For our study, the crude annual incidence rate of first stroke was 2.2 per 1,000 (confidence intervals 1.81-2.66); the standardized rate to the European population was 1.36 (confidence intervals 1.06-1.74). At least 83% of first strokes were due to cerebral ischemia; in 26 cases a clinical diagnosis of lacunar ischemia was made. The 30-day case fatality rate was 21%; 25% of our patients had recovered completely or almost completely after 1 month.

Projecting the number of patients with first ever strokes and patients newly handicapped by stroke in England and Wales

The common assumption that future increases in the number of elderly people will result in a parallel increase in the burden of care of long term disabled survivors of stroke was examined. The number of patients with first ever strokes and the net number of people handicapped after these strokes in England and Wales every five years until 2023 have been projected. Between the base year 1983 and the year 2023 an increase in population of about 5% will occur; first ever strokes are projected to increase by about 30% and deaths within six months of first ever strokes by about 40%. The net number of severely handicapped people six months after a first ever stroke is projected to increase by only about 8%, however, and the net number of people who are moderately or severely handicapped by only 4%. This paradox occurs because first ever stroke often kills people who have been handicapped by other causes, particularly if they are elderly. It is concluded that despite the limitations of these data they strongly suggest that the increased burden of health care of patients with first ever strokes in the next 40 years will be primarily that of caring for those in the acute stages of stroke and not with the management of chronic handicap after a stroke.