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Darshan D, Gange N, Chen D, Bragg A. Stroke epidemiology and incidence in regional Queensland: findings of the Regional Queensland Stroke (REQUEST) study. Intern Med J 2023; 53:1618-1624. [PMID: 36001407 DOI: 10.1111/imj.15917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stroke rates globally have been declining, but a majority of the studies on strokes have been in urban populations. Regional populations have been understudied, bgeographic health differentials can impact stroke presentations and outcomes. AIM To determine the incidence, risk factors for and survivability of stroke in patients presenting to a large rural stroke referral centre. METHODS Data were collected from one major regional stroke referral centre in Queensland, Australia, over 12 months with follow-up at 3.75 years for survival analysis. Patients were retrospectively enrolled based on a diagnosis made by a stroke physician. ICD-10 codes at separation and postcode of residence were applied for case ascertainment. Trial of ORG10172 in Acute Stroke Treatment (TOAST) classification and the World Health Organization standardised definition of stroke were applied. RESULTS There were 105 strokes in a population of 106 760 persons over 12 months, giving a crude rate of 98 per 100 000 and standardised rate of 52/100 000 per year. Cardioembolism (n = 33, 31.4%) was the most common cause out of all ischaemic strokes (n = 87, 82.9%), followed by large vessel atherosclerosis (n = 26, 24.8%). Hypertension was the most prevalent risk factor in all stroke types, and atrial arrhythmia was the most prevalent factor in cardioembolic strokes. Overall survival at 3.75 years was 61%. CONCLUSIONS Incidence of stroke in a regional Queensland population is similar to other regional populations and when compared with larger cities. Despite a global trend in stroke reduction, modifiable risk factors like hypertension and atrial arrhythmias continue to be over-represented in the stroke population. All-cause mortality after stroke is high, especially during the initial period.
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Affiliation(s)
- Deepak Darshan
- Metro North Hospital and Health Service (MNHHS), Internal Medicine Services, Queensland Health, Brisbane, Queensland, Australia
| | - Nisal Gange
- Geriatric Adult Rehabilitation and Stroke Service (GARSS), Darling Downs Health and Hospital Service (DDHHS), Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Daniel Chen
- Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia
| | - Anthony Bragg
- Department of Geriatrics, Northern NSW Local Health District, Lismore, New South Wales, Australia
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2
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Ghelani KP, Chen LY, Norby FL, Soliman EZ, Koton S, Alonso A. Thirty-Year Trends in the Incidence of Atrial Fibrillation: The ARIC Study. J Am Heart Assoc 2022; 11:e023583. [PMID: 35414195 PMCID: PMC9238452 DOI: 10.1161/jaha.121.023583] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
Background Long-term data to study recent trends in the incidence of atrial fibrillation (AF), overall and among sex and race groups, are scarce. We evaluated the 30-year trends in the incidence of AF in the ARIC (Atherosclerosis Risk in Communities) study cohort and explored race and sex differences in these trends. Methods and Results We included 15 343 men and women aged 45 to 64 years in 1987 to 1989 without AF from 4 US communities in the ARIC cohort. Incident AF was identified based on study ECGs, hospital discharge codes, and death certificates through 2017. We calculated age and period-specific incidence rates (IRs) of AF. We used Poisson regression to calculate IR ratios of AF over time adjusting for age, sex, and race. A total of 3241 AF cases were identified during a mean (SD) follow-up of 22 years (8.4 years) (599 in Black participants, 2642 in White participants, 1582 in women, and 1659 in men). Overall, the IR of AF in the ARIC cohort was 9.6 per 1000 person-years (6.9 in Black participants, 10.5 in White participants, 8.1 in women, and 11.6 in men). Age-specific IR by time period did not show significant changes over time. In a model adjusted for sex, race, and age group, the rate of AF did not change significantly from 1987 to 1991 compared with 2012 to 2017 (IR ratio, 1.10 [95% CI, 0.88-1.36] comparing 2012-2017 with 1987-1991). Similarly, no evidence of changes over time in AF rates were identified in men and women or White and Black participants separately. Conclusions Even though IRs of AF increase as age increases, our analysis provided evidence suggesting that the overall IRs of AF have not changed over time in a multicenter cohort of Black and White individuals in the United States from 1987 to 2017.
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Affiliation(s)
- Kunali P. Ghelani
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Lin Yee Chen
- Cardiovascular DivisionDepartment of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Faye L. Norby
- Department of CardiologySmidt Heart Institute, Cedars‐Sinai‐Health SystemLos AngelesCA
| | - Elsayed Z. Soliman
- Department of EpidemiologyDivision of Public Health SciencesWake Forest University School of MedicineWinston‐SalemNC
| | - Silvia Koton
- Stanley Steyer School of Health ProfessionsSackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Department of EpidemiologyJohns Hopkins University School of Public HealthBaltimoreMD
| | - Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
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3
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Maida CD, Daidone M, Pacinella G, Norrito RL, Pinto A, Tuttolomondo A. Diabetes and Ischemic Stroke: An Old and New Relationship an Overview of the Close Interaction between These Diseases. Int J Mol Sci 2022; 23:ijms23042397. [PMID: 35216512 PMCID: PMC8877605 DOI: 10.3390/ijms23042397] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is a comprehensive expression to identify a condition of chronic hyperglycemia whose causes derive from different metabolic disorders characterized by altered insulin secretion or faulty insulin effect on its targets or often both mechanisms. Diabetes and atherosclerosis are, from the point of view of cardio- and cerebrovascular risk, two complementary diseases. Beyond shared aspects such as inflammation and oxidative stress, there are multiple molecular mechanisms by which they feed off each other: chronic hyperglycemia and advanced glycosylation end-products (AGE) promote ‘accelerated atherosclerosis’ through the induction of endothelial damage and cellular dysfunction. These diseases impact the vascular system and, therefore, the risk of developing cardio- and cerebrovascular events is now evident, but the observation of this significant correlation has its roots in past decades. Cerebrovascular complications make diabetic patients 2–6 times more susceptible to a stroke event and this risk is magnified in younger individuals and in patients with hypertension and complications in other vascular beds. In addition, when patients with diabetes and hyperglycemia experience an acute ischemic stroke, they are more likely to die or be severely disabled and less likely to benefit from the one FDA-approved therapy, intravenous tissue plasminogen activator. Experimental stroke models have revealed that chronic hyperglycemia leads to deficits in cerebrovascular structure and function that may explain some of the clinical observations. Increased edema, neovascularization, and protease expression as well as altered vascular reactivity and tone may be involved and point to potential therapeutic targets. Further study is needed to fully understand this complex disease state and the breadth of its manifestation in the cerebrovasculature.
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Affiliation(s)
- Carlo Domenico Maida
- Molecular and Clinical Medicine PhD Programme, University of Palermo, 90127 Palermo, Italy; (C.D.M.); (A.T.)
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Mario Daidone
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
- Correspondence:
| | - Gaetano Pacinella
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Rosario Luca Norrito
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Antonio Pinto
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Antonino Tuttolomondo
- Molecular and Clinical Medicine PhD Programme, University of Palermo, 90127 Palermo, Italy; (C.D.M.); (A.T.)
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
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4
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Huang ZX, Chen LH, Xiong R, He YN, Zhang Z, Zeng J, Cai Q, Liu Z. Essen Stroke Risk Score Predicts Carotid Atherosclerosis in Chinese Community Populations. Healthc Policy 2020; 13:2115-2123. [PMID: 33116991 PMCID: PMC7568636 DOI: 10.2147/rmhp.s274340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/28/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Carotid atherosclerosis (CA) is closely related to stroke, and Framingham Risk Score (FRS) has been used for CA risk evaluation. However, FRS could only be used for subjects of up to 74 years old. The present study was to determine if Essen Stroke Risk Score (ESRS) could be used to estimate CA risk in community populations without age limits. METHODS In the present prospective multi-community screening study, we evaluated the prevalence of CA using high-resolution ultrasound in 521 males and 1039 females (35 to 91 years old). Both FRS and ESRS were calculated for the subjects. Multivariate logistic regression analysis was used to determine the predictive values of FRS and ESRS for CA in these subjects. RESULTS Ultrasound data showed that CA was present in 56.2% of the participants (total of 1560). Multivariate logistic regression analysis showed that ESRS was associated with CA with odds ratio (OR): 1.34 (95% confidence interval (CI), 1.12-1.60, p=0.001). Central obesity (OR: 1.40, CI: 1.07-1.83, p=0.015), female (OR: 0.55, CI: 0.39-0.77, p <0.001) and age (OR: 2.63, CI: 2.27-3.06, p <0.001) were also associated with CA. Based on the estimated area under curve (AUC), FRS (AUC 0.775) was better than ESRS (AUC 0.693) (z statistic 6.774, p <0.001) for CA prediction for individuals of ≤74 years old. However, receiver operating characteristic analysis showed ESRS was a good CA predictor for all subjects (AUC of 0.715). CONCLUSION ESRS could be used as an alternative to FRS to predict CA in community population of all age.
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Affiliation(s)
- Zhi-Xin Huang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China.,Department of Neurology, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Li-Hua Chen
- Department of Neurology, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Ran Xiong
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Yan-Ni He
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Zhu Zhang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China.,Department of Neurology, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jie Zeng
- Department of Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Qiankun Cai
- Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, People's Republic of China
| | - Zhenguo Liu
- Center for Precision Medicine and Division of Cardiovascular Medicine, Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
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5
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Lu H, Guo Z, Liu J, Zhang H, Zhao W, Wu Y, Ni J, Liu W, Tu J, Wang J, Ning X, Zhang J. Trends in stroke incidence among elderly low-income residents of rural China: a population-based study from 1992 to 2016. Aging (Albany NY) 2019; 10:3438-3449. [PMID: 30487317 PMCID: PMC6286840 DOI: 10.18632/aging.101657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 11/15/2018] [Indexed: 11/25/2022]
Abstract
In China, >70% of stroke deaths occur in people aged ≥65 years. However, trends in the stroke incidence among elderly people are unclear. We aimed to determine trends in the stroke incidence among elderly people in rural China. This was a population-based surveillance study conducted in Tianjin, China. Stroke events and all deaths were registered annually. Trends and annual proportion of change in incidence of first-ever stroke were evaluated from 1992 to 2016. The age-standardized incidence of first-ever stroke increased annually by 3.7% overall in elderly people (2.7% for men; 5.0% for women; all P<0.05). However, from 2008 to 2016, there was no significant change in the trends of stroke incidence among elderly people, across gender and subtypes. The proportion of elderly patients with first-ever stroke decreased by 1.1% annually. In contrast to young patients, annual changes in the incidence of stroke tended to be slight in elderly patients (3.7% vs. 9.5%) with greater increase in female patients than those in male patients (2.7% vs. 10.3% for men; 5.0% vs. 8.9% for women). Thus, the control of risk factors for stroke among elderly people is crucial, especially among older women, to reduce the burden of stroke in China.
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Affiliation(s)
- Hongyan Lu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - Zaiyu Guo
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, 300457, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Heliang Zhang
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, 300457, China
| | - Wei Zhao
- Department of Neurology, Tianjin TEDA Hospital, Tianjin, 300457, China
| | - Yanan Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Jingxian Ni
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Wei Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, China
| | - Jianning Zhang
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.,Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
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6
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Conner SC, Pase MP, Carneiro H, Raman MR, McKee AC, Alvarez VE, Walker JM, Satizabal CL, Himali JJ, Stein TD, Beiser A, Seshadri S. Mid-life and late-life vascular risk factor burden and neuropathology in old age. Ann Clin Transl Neurol 2019; 6:2403-2412. [PMID: 31691546 PMCID: PMC6917310 DOI: 10.1002/acn3.50936] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To determine whether vascular risk factor burden in mid- or late-life associates with postmortem vascular and neurodegenerative pathologies in a community-based sample. METHODS We studied participants from the Framingham Heart Study who participated in our voluntary brain bank program. Overall vascular risk factor burden was calculated using the Framingham Stroke Risk Profile (FSRP). Mid-life FSRP was measured at 50 to 60 years of age. Following death, brains were autopsied and semi-quantitatively assessed by board-certified neuropathologists for cerebrovascular outcomes (cortical infarcts, subcortical infarcts, atherosclerosis, arteriosclerosis) and Alzheimer's disease pathology (Braak stage, cerebral amyloid angiopathy, and neuritic plaque score). We estimated adjusted odds ratios between vascular risk burden (at mid-life and before death) and neuropathological outcomes using logistic and proportional-odds logistic models. RESULTS The median time interval between FSRP and death was 33.4 years for mid-life FSRP and 4.4 years for final FSRP measurement before death. Higher mid-life vascular risk burden was associated with increased odds of all cerebrovascular pathology, even with adjustment for vascular risk burden before death. Late-life vascular risk burden was associated with increased odds of cortical infarcts (OR [95% CI]: 1.04 [1.00, 1.08]) and arteriosclerosis stage (OR [95% CI]: 1.03 [1.00, 1.05]). Mid-life vascular risk burden was not associated with Alzheimer's disease pathology, though late-life vascular risk burden was associated with increased odds of higher Braak stage (OR [95% CI]: 1.03 [1.01, 1.05]). INTERPRETATION Mid-life vascular risk burden was predictive of cerebrovascular but not Alzheimer's disease neuropathology, even after adjustment for vascular risk factors before death.
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Affiliation(s)
- Sarah C. Conner
- Framingham Heart StudyFraminghamMassachusetts
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusetts
| | - Matthew P. Pase
- Framingham Heart StudyFraminghamMassachusetts
- Melbourne Dementia Research CentreThe Florey Institute for Neuroscience and Mental HealthMelbourneAustralia
- Centre for Human PsychopharmacologySwinburne University of TechnologyMelbourneAustralia
- Faculty of MedicineDentistry and Health SciencesThe University of MelbourneMelbourneAustralia
| | - Herman Carneiro
- Framingham Heart StudyFraminghamMassachusetts
- Department of MedicineBoston University School of MedicineBostonMassachusetts
| | - Mekala R. Raman
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
| | - Ann C. McKee
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
- Boston UniversityAlzheimer's Disease and CTE CenterBoston University School of MedicineBostonMassachusetts
- Department of Veterans Affairs Medical CenterBedfordMassachusetts
- VA Boston Healthcare SystemBostonMassachusetts
- Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMassachusetts
| | - Victor E. Alvarez
- Boston UniversityAlzheimer's Disease and CTE CenterBoston University School of MedicineBostonMassachusetts
- Department of Veterans Affairs Medical CenterBedfordMassachusetts
- VA Boston Healthcare SystemBostonMassachusetts
- Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMassachusetts
| | - Jamie M. Walker
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative DiseasesUT Health San AntonioSan AntonioTexas
| | - Claudia L. Satizabal
- Framingham Heart StudyFraminghamMassachusetts
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative DiseasesUT Health San AntonioSan AntonioTexas
| | - Jayandra J. Himali
- Framingham Heart StudyFraminghamMassachusetts
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusetts
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative DiseasesUT Health San AntonioSan AntonioTexas
| | - Thor D. Stein
- Boston UniversityAlzheimer's Disease and CTE CenterBoston University School of MedicineBostonMassachusetts
- Department of Veterans Affairs Medical CenterBedfordMassachusetts
- VA Boston Healthcare SystemBostonMassachusetts
- Department of Pathology and Laboratory MedicineBoston University School of MedicineBostonMassachusetts
| | - Alexa Beiser
- Framingham Heart StudyFraminghamMassachusetts
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusetts
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
| | - Sudha Seshadri
- Framingham Heart StudyFraminghamMassachusetts
- Department of NeurologyBoston University School of MedicineBostonMassachusetts
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative DiseasesUT Health San AntonioSan AntonioTexas
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7
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Feigin VL, Krishnamurthi R, Barker-Collo S, Barber PA, Rathnasabapathy Y, Te Ao B, Parmar P, Mahon S, Tunnage B, Swain A, Arroll B, Elder H, Tautolo ES, Parag V, Anderson C, Bennett D, Thrift AG, Cadilhac DA, Brown P, Ranta A, Douwes J. Measuring stroke and transient ischemic attack burden in New Zealand: Protocol for the fifth Auckland Regional Community Stroke Study (ARCOS V). Int J Stroke 2019; 15:573-583. [PMID: 31648621 DOI: 10.1177/1747493019884528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: The goal of this paper is to provide a protocol for conducting a fifth population-based Auckland Regional Community Stroke study (ARCOS V) in New Zealand. Methods and Discussion: In this study, for the first time globally, (1) stroke and TIA burden will be determined using the currently used clinical and tissue-based definition of stroke, in addition to the WHO clinical classifications of stroke used in all previous ARCOS studies, as well as more advanced criteria recently suggested for an "ideal" population-based stroke incidence and outcomes study; and (2) age, sex, and ethnic-specific trends in stroke incidence and outcomes will be determined over the last four decades, including changes in the incidence of acute cerebrovascular events over the last decade. Furthermore, information at four time points over a 40-year period will allow the assessment of effects of recent changes such as implementation of the FAST campaign, ambulance pre-notification, and endovascular treatment. This will enable more accurate projections for health service planning and delivery. Conclusion: The methods of this study will provide a foundation for future similar population-based studies in other countries and populations.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | | | - P Alan Barber
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Braden Te Ao
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Susan Mahon
- Department of Paramedicine, University of Auckland, Auckland, New Zealand
| | - Bronwyn Tunnage
- Department of Paramedicine, University of Auckland, Auckland, New Zealand
| | - Andrew Swain
- Department of Paramedicine, University of Auckland, Auckland, New Zealand
| | - Bruce Arroll
- School of Public Health, University of Auckland, Auckland, New Zealand
| | - Hinemoa Elder
- Brain Research New Zealand Centre of Research Excellence, Auckland, New Zealand
| | - El-Shadan Tautolo
- Centre for Pacific Health & Development Research and Pacific Islands Families, Auckland University of Technology, Auckland, New Zealand
| | - Varsha Parag
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Craig Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Derrick Bennett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia
| | - Paul Brown
- University of California Merced, Merced, CA, USA
| | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
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8
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Béjot Y. Targeting blood pressure for stroke prevention: current evidence and unanswered questions. J Neurol 2019; 268:785-795. [PMID: 31243539 DOI: 10.1007/s00415-019-09443-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 12/22/2022]
Abstract
High blood pressure (BP) is the leading modifiable risk factor of stroke worldwide. Although randomized clinical trials have demonstrated the beneficial effect of BP reduction on stroke risk, there are still insufficiently explored issues concerning the optimal personalized management of BP in stroke patients in terms of thresholds to be achieved and drug classes to be prescribed. Few data are available about BP control in specific clinical contexts such as in older patients, in various stroke subtypes, or in association with co-morbidities such as diabetes. In addition, although drug trials based their conclusions on achieved mean BP values, recent findings indicate that aspects such as circadian variations of BP and BP variability should be taken into account as well. This article aims to highlight current knowledge about BP control in stroke prevention and to provide new perspectives to be addressed in future studies so as to guide clinicians in their day-to-day practice.
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Affiliation(s)
- Yannick Béjot
- Dijon Stroke Registry, E7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France.
- Department of Neurology, University Hospital of Dijon, Hôpital François Mitterrand, 14 rue Paul Gaffarel, BP 77908, 21079, Dijon cedex, France.
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Du X, Wang C, Ni J, Gu H, Liu J, Pan J, Tu J, Wang J, Yang Q, Ning X. Association of Blood Pressure With Stroke Risk, Stratified by Age and Stroke Type, in a Low-Income Population in China: A 27-Year Prospective Cohort Study. Front Neurol 2019; 10:564. [PMID: 31191445 PMCID: PMC6548813 DOI: 10.3389/fneur.2019.00564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/10/2019] [Indexed: 01/05/2023] Open
Abstract
Association of stroke risk with new blood pressure criterion 2017 is unknown in China. We assessed the association between blood pressure (BP) values and stroke risk in a low-income population in Tianjin, China. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were categorized into five strata and strokes were recorded as stroke, ischemic stroke, and hemorrhagic stroke. Stroke risk was analyzed according to blood pressure stratum using Cox regression analysis. Overall, 4,017 residents (age, ≥18 years) were included in this prospective cohort study. Over a 27-year follow-up period (total, 86,515.78 person-years), 638 participants experienced first-ever strokes. The stroke risk was higher among individuals with SBPs ≥140 mmHg or DBPs ≥90 mmHg than among those with SBPs < 130 mmHg or DBPs < 80 mmHg (reference group), after adjusting for covariates. However, hemorrhagic stroke risk increased only in participants with SBPs ≥160 mmHg. The stroke risk increased for individuals < 65-years-old having BP values ≥130/80 mmHg and for individuals ≥65-years-old with BP values ≥160/90 mmHg. To reduce the stroke burden in China, target BP goals must be established for adults, with different targets for the middle-aged and the elderly segments of the population. These results are very important for guiding clinical practice and may be generalized to other developing countries experiencing rapid economic development and where transitions in the spectrum of prevalent diseases have occurred.
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Affiliation(s)
- Xin Du
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Conglin Wang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingxian Ni
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Hongfei Gu
- Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Jing Pan
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Ministry of Education, Tianjin, China
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10
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Lee SU, Kim T, Kwon OK, Bang JS, Ban SP, Byoun HS, Oh CW. Trends in the Incidence and Treatment of Cerebrovascular Diseases in Korea : Part II. Cerebral Infarction, Cerebral Arterial Stenosis, and Moyamoya Disease. J Korean Neurosurg Soc 2019; 63:69-79. [PMID: 31064040 PMCID: PMC6952727 DOI: 10.3340/jkns.2018.0182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/26/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To analyze trends in the incidence and treatment of diseases associated with ischemic stroke, namely, cerebral infarction (CI), cerebral arterial stenosis (CASTN), and moyamoya disease (MMD), based on Korean National Health Insurance Service (NHIS) data from 2008 to 2016. METHODS Data was extracted from the national health-claim database provided by the NHIS for 2008-2016 using International Classification of Diseases codes. The crude and age-standardized incidences of each disease (CI, CASTN without a history of CI, and MMD) were calculated; additional analyses were conducted according to age and sex. Trends in the number of patients undergoing treatment according to treatment method were analyzed for each disease using the Korean Classification of Diseases procedure codes. RESULTS In 2016, the total number of adults with newly diagnosed CI was 83939, reflecting a 9.4% decrease from that in 2008. The agestandardized incidence of CI in adults was 153.2 per 100000 person-years in 2016, reflecting a 37.2% decrease from that in 2008, while that of CASTN was 167.3 per 100000 person-years in 2016, reflecting a 73.3% increase from that in 2008. Among treated cases, the number of patients who underwent intra-arterial (IA) treatment, including IA fibrinolysis and mechanical thrombectomy, showed the most prominent increase, increasing at an annual rate of 25.8%. For CASTN, the number of cases treated with carotid artery stenting or balloon angioplasty (CAS) showed the most prominent increase, increasing at a rate of 69.8% over the 9-year period. For MMD, the total number of patients with newly diagnosed MMD and that with adult MMD demonstrated significantly increasing trends, while the number of pediatric patients with newly diagnosed MMD declined by 18.0% over the 9-year period. The age-standardized incidences of pediatric and adult MMD in 2016 were 2.4 and 3.4 per 100000 person-years, respectively. CONCLUSION Although the incidence of CI showed a declining trend over a 9-year period, the number and proportion of patients treated for CI increased. Meanwhile, the incidence of CASTN and the number of patients treated for CASTN have demonstrated increasing trends since 2008. On the other hand, the number of patients diagnosed with pediatric MMD decreased, despite no significant change in the incidence. In contrast, the number of patients and the incidence of adult MMD increased. These trends reflect changes in the population structure, gains in the accessibility of imaging examinations, and the development of endovascular techniques.
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Affiliation(s)
- Si Un Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Pil Ban
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoung Soo Byoun
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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11
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Wang Y, Dai Y, Zheng J, Xie Y, Guo R, Guo X, Sun G, Sun Z, Sun Y, Zheng L. Sex difference in the incidence of stroke and its corresponding influence factors: results from a follow-up 8.4 years of rural China hypertensive prospective cohort study. Lipids Health Dis 2019; 18:72. [PMID: 30909919 PMCID: PMC6434616 DOI: 10.1186/s12944-019-1010-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/08/2019] [Indexed: 02/08/2023] Open
Abstract
Background Few studies investigate sex difference in stroke incidence in rural China hypertensive population. Methods A total of 5097 hypertensive patients aged ≥35 years (mean age, 56.3 ± 11.2 years; 43.8% men) were included in our analysis with a median follow-up 8.4 years in Fuxin county of Liaoning province in China. Cox proportional hazard models were used to analyze the association between the potential factors and incident stroke. Results We observed 501 new strokes (310 ischemic, 186 hemorrhagic, and 5 unclassified stroke) during the follow-up. The overall incidence of stroke was 1235.21 per 100,000 person-years; for men, the rates were 1652.51 and 920.80 for women. This sex difference in all stroke can be explained by approximately 25% through age, systolic blood pressure, body mass index, low-density lipoprotein-cholesterol, current smoking, current drinking, antihypertensive drugs, education and physical activity. Subgroup analysis indicated that in hemorrhagic stroke this sex difference was more remarkable (63.89% can be explained). Conclusions The incidence of stroke was higher in men than that in women and this difference was partly explained by several traditional cardiovascular risk factors.
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Affiliation(s)
- Yali Wang
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Yue Dai
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Jia Zheng
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Yanxia Xie
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Rongrong Guo
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Xiaofan Guo
- Department of Cardiology, the First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Guozhe Sun
- Department of Cardiology, the First Affiliated Hospital of China Medical University, Shenyang, 110001, People's Republic of China
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, People's Republic of China
| | - Yingxian Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, People's Republic of China.
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Department of Health Policy and Hospital Management, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China.
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12
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Levi CR, Lasserson D, Quain D, Valderas J, Dewey HM, Alan Barber P, Spratt N, Cadilhac DA, Feigin V, Zareie H, Garcia Esperon C, Davey A, Najib N, Magin P. The International comparison of Systems of care and patient outcomes In minor Stroke and Tia (InSIST) study: A community-based cohort study. Int J Stroke 2019; 14:186-190. [PMID: 30608031 DOI: 10.1177/1747493018799983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
RATIONALE Rapid response by health-care systems for transient ischemic attack and minor stroke (TIA/mS) is recommended to maximize the impact of secondary prevention strategies. The applicability of this evidence to Australian non-hospital-based TIA/mS management is uncertain. AIMS Within an Australian community setting we seek to document processes of care, establish determinants of access to care, establish attack rates and determinants of recurrent vascular events and other clinical outcomes, establish the performance of ABC2-risk stratification, and compare the processes of care and outcomes to those in the UK and New Zealand for TIA/mS. SAMPLE SIZE ESTIMATES Recruiting practices containing approximately 51 full-time-equivalent general practitioners to recruit 100 TIA/mS per year over a four-year study period will provide sufficient power for each of our outcomes. METHODS AND DESIGN An inception cohort study of patients with possible TIA/mS recruited from 16 general practices in the Newcastle-Hunter Valley-Manning Valley region of Australia. Potential TIA/mS will be ascertained by multiple overlapping methods at general practices, after-hours collaborative, and hospital in-patient and outpatient services. Participants' index and subsequent clinical events will be adjudicated as TIA/mS or mimics by an expert panel. STUDY OUTCOMES Process outcomes-whether the patient was referred for secondary care; time from event to first patient presentation to a health professional; time from event to specialist acute-access clinic appointment; time from event to brain and vascular imaging and relevant prescriptions. Clinical outcomes-recurrent stroke and major vascular events; and health-related quality of life. DISCUSSION Community management of TIA/mS will be informed by this study.
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Affiliation(s)
- Christopher R Levi
- 1 John Hunter Hospital, Hunter Medical Research Institute, Newcastle, Australia.,2 Department of Neurology, The University of Newcastle, Newcastle, Australia.,3 The Ingham Institute, SPHERE, Sydney, Australia
| | - Daniel Lasserson
- 4 Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,5 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Debbie Quain
- 6 Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | - Jose Valderas
- 7 Health Services & Policy Research, Academic Collaboration for Primary Care (APEx), NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Exeter, UK
| | - Helen M Dewey
- 8 Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia
| | - P Alan Barber
- 9 Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Neil Spratt
- 1 John Hunter Hospital, Hunter Medical Research Institute, Newcastle, Australia.,2 Department of Neurology, The University of Newcastle, Newcastle, Australia
| | - Dominique A Cadilhac
- 10 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Parkville, Australia.,11 Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Valery Feigin
- 12 National Institute for Stroke & Applied Neurosciences, AUT University, Auckland, New Zealand
| | - Hossein Zareie
- 6 Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | | | - Andrew Davey
- 13 Discipline of General Practice, University of Newcastle, Newcastle, Australia
| | - Nashwa Najib
- 13 Discipline of General Practice, University of Newcastle, Newcastle, Australia
| | - Parker Magin
- 13 Discipline of General Practice, University of Newcastle, Newcastle, Australia
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13
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Giménez-Muñoz A, Ara J, Abad Díez J, Campello Morer I, Pérez Trullén J. Trends in stroke hospitalisation rates and in-hospital mortality in Aragon, 1998-2010. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Giménez-Muñoz A, Ara J, Abad Díez J, Campello Morer I, Pérez Trullén J. Tendencia de las tasas de hospitalización y de letalidad hospitalaria de la enfermedad cerebrovascular aguda en Aragón en el periodo 1998-2010. Neurologia 2018; 33:224-232. [DOI: 10.1016/j.nrl.2016.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/14/2016] [Accepted: 06/30/2016] [Indexed: 11/26/2022] Open
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15
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Gierlotka M, Labuz-Roszak B, Wojtyniak B, Lasek-Bal A, Zdrojewski T, Adamczyk-Sowa M, Chwojnicki K, Skrzypek M, Ciesla D, Gasior M. Early and One-Year Outcomes of Acute Stroke in the Industrial Region of Poland During the Decade 2006-2015: The Silesian Stroke Registry. Neuroepidemiology 2018; 50:183-194. [PMID: 29587253 DOI: 10.1159/000487324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Poland, classified as a high-income country, is still considered to have a high cardiovascular risk population. During the last decade, the standards of care in acute stroke (AS) had markedly improved; thus, we aimed to assess whether and how it translated into early and late outcomes. METHODS Silesian Stroke Registry was created from the administrative database of the public, obligatory, health -insurer in Poland. The AS cases were selected based on primary diagnosis coded in ICD-10 as I60-I64 for years 2006-2015 (n = 120,844). Index hospitalization together with data on re-hospitalizations, procedures, ambulatory visits, rehabilitation and all-cause deaths in a 1-year follow-up were analyzed. RESULTS The rates of admissions per 100,000 adult population varied between 41-47 for haemorrhagic and 257-275 for ischaemic stroke with substantial decrease in almost all age groups except for the oldest patients. In ischaemic stroke, thrombolytic therapy raised from 0 to 8.8% in 2015, along with significant trends of decreasing 30-day (from 20 to 16%) and 12-month (from 35 to 31%) case fatality. In haemorrhagic stroke, case fatality had not changed. After ischaemic stroke, 12-month readmissions due to AS declined from 11-12% in 2006-2009 to 9% in 2010-2014. The percentage of patients benefiting from rehabilitation increased from 24 to 32%. CONCLUSIONS In a large population of industrial province, we showed recent, positive trends in AS admissions, treatment and 1-year outcomes. Development of stroke unit networks and increase in thrombolytic treatment were at least in part responsible for survival improvement and reduction of recurrence of AS. However, case-fatality and stroke recurrence remain high compared to those of other developed countries.
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Affiliation(s)
- Marek Gierlotka
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Beata Labuz-Roszak
- Department of Basic Medical Sciences, Faculty of Public Health, Medical University of Silesia, Katowice, Poland
| | - Bogdan Wojtyniak
- Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, Medical Centre of Upper Silesia, Katowice, Poland
| | - Tomasz Zdrojewski
- Department of Arterial Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Monika Adamczyk-Sowa
- Department of Neurology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Kamil Chwojnicki
- Department of Neurology, Medical University of Gdansk, Gdansk, Poland
| | - Michal Skrzypek
- Department of Biostatistics, Faculty of Public Health, Medical University of Silesia, Katowice, Poland
| | - Daniel Ciesla
- Department of Science, Training and New Medical Technologies, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Mariusz Gasior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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16
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Mahon S, Krishnamurthi R, Vandal A, Witt E, Barker-Collo S, Parmar P, Theadom A, Barber A, Arroll B, Rush E, Elder H, Dyer J, Feigin V. Primary prevention of stroke and cardiovascular disease in the community (PREVENTS): Methodology of a health wellness coaching intervention to reduce stroke and cardiovascular disease risk, a randomized clinical trial. Int J Stroke 2018; 13:223-232. [PMID: 28901219 DOI: 10.1177/1747493017730759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Rationale Stroke is a major cause of death and disability worldwide, yet 80% of strokes can be prevented through modifications of risk factors and lifestyle and by medication. While management strategies for primary stroke prevention in high cardiovascular disease risk individuals are well established, they are underutilized and existing practice of primary stroke prevention are inadequate. Behavioral interventions are emerging as highly promising strategies to improve cardiovascular disease risk factor management. Health Wellness Coaching is an innovative, patient-focused and cost-effective, multidimensional psychological intervention designed to motivate participants to adhere to recommended medication and lifestyle changes and has been shown to improve health and enhance well-being. Aims and/or hypothesis To determine the effectiveness of Health Wellness Coaching for primary stroke prevention in an ethnically diverse sample including Māori, Pacific Island, New Zealand European and Asian participants. Design A parallel, prospective, randomized, open-treatment, single-blinded end-point trial. Participants include 320 adults with absolute five-year cardiovascular disease risk ≥ 10%, calculated using the PREDICT web-based clinical tool. Randomization will be to Health Wellness Coaching or usual care groups. Participants randomized to Health Wellness Coaching will receive 15 coaching sessions over nine months. Study outcomes A substantial relative risk reduction of five-year cardiovascular disease risk at nine months post-randomization, which is defined as 10% relative risk reduction among those at moderate five-year cardiovascular disease risk (10-15%) and 25% among those at high risk (>15%). Discussion This clinical trial will determine whether Health Wellness Coaching is an effective intervention for reducing modifiable risk factors, and hence decrease the risk of stroke and cardiovascular disease.
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Affiliation(s)
- Susan Mahon
- 1 Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Emma Witt
- 2 AUT University, Auckland, New Zealand
| | | | | | | | - Alan Barber
- 4 University of Auckland, Auckland City Hospital, Auckland, New Zealand
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17
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Krishnamurthi RV, Barker-Collo S, Parag V, Parmar P, Witt E, Jones A, Mahon S, Anderson CS, Barber PA, Feigin VL. Stroke Incidence by Major Pathological Type and Ischemic Subtypes in the Auckland Regional Community Stroke Studies: Changes Between 2002 and 2011. Stroke 2017; 49:3-10. [PMID: 29212738 DOI: 10.1161/strokeaha.117.019358] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Major pathological stroke types (ischemic stroke [IS], primary intracerebral hemorrhage [ICH], and subarachnoid hemorrhage) and IS subtypes, have differing risk factors, management, and prognosis. We report changes in major stroke types and IS subtypes incidence during 10 years using data from the ARCOS (Auckland Regional Community Stroke Study) III performed during 12 months in 2002 to 2003 and the fourth ARCOS study (ARCOS-IV) performed in 2011 to 2012. METHODS ARCOS-III and ARCOS-IV were population-based registers of all new strokes in the greater Auckland region (population aged >15 years, 1 119 192). Strokes were classified into major pathological types (IS, ICH, subarachnoid hemorrhage, and undetermined type). Crude annual age-, sex-, and ethnic-specific stroke incidence with 95% confidence intervals was calculated. ISs were subclassified using TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria into 5 etiologic groups. Rate ratios with 95% confidence intervals were calculated for differences in age-standardized rates between the 2 studies. RESULTS In ARCOS-IV, there were 1329 (81%) ISs, 211 (13%) ICHs, 79 (5%) subarachnoid hemorrhages, and 24 (1%) undetermined type strokes. The proportional distribution of IS subtypes was 29% cardioembolism, 21% small-vessel occlusion, 15% large-artery atherosclerosis, 5% other determined etiology, and 31% undetermined type. Between 2002 and 2011, age-standardized incidence decreased for subarachnoid hemorrhage (rate ratios, 0.73; 95% confidence intervals, 0.54-0.99) and undetermined type (rate ratios, 0.14; 95% confidence intervals, 0.09-0.22). Rates were stable for IS and ICH. Among IS subtypes, large-artery atherosclerosis and small-vessel occlusion rates increased significantly. The frequency of all risk factors increased in IS. Ethnic differences were observed for both stroke subtype rates and their risk factor frequencies. CONCLUSIONS A lack of change in IS and ICH incidence may reflect a trend toward increased incidence of younger strokes. Increased rates of large-artery atherosclerosis and small-vessel occlusion are associated with increased smoking and high blood pressure. Ethnic differences in the proportional distribution of pathological stroke subtypes suggest differential exposure and susceptibility to risk factors.
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Affiliation(s)
- Rita V Krishnamurthi
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Suzanne Barker-Collo
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Varsha Parag
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Priyakumari Parmar
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Emma Witt
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Amy Jones
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Susan Mahon
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Craig S Anderson
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - P Alan Barber
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.)
| | - Valery L Feigin
- From the National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (R.V.K., P.P., E.W., A.J., S.M., V.L.F.); Department of Psychology (S.B.-C.) and National Institute for Health Innovation (V.P.), University of Auckland, New Zealand; Division of Neurology and Mental Health, George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.); George Institute China at Peking University Health Science Center, Beijing, China (C.S.A.); and Centre for Brain Research University of Auckland, New Zealand (P.A.B.).
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Howard G, Howard VJ. Design and implementation of observational studies to measure disease burden with a focus on stroke. Int J Stroke 2017; 13:157-165. [PMID: 29148962 DOI: 10.1177/1747493017743800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Observational epidemiological studies have the dual goals of measuring disease burden and assessing the association between exposures and outcomes. This report focuses on the first of these goals and provides an overview of design considerations of commonly used approaches, specifically community surveillance studies, cross-sectional studies, and longitudinal cohort studies. Each of these designs has strengths and weaknesses, with no study design being superior in all cases. Rather, these designs are complementary to achieve a better understanding of the burden of stroke.
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Affiliation(s)
- George Howard
- 1 Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- 2 Department of Epidemiology School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Olivier CL, Phillips J, Roy DE. To be or not to be? A caregiver's question: the lived experience of a stroke family during the first 18 months poststroke. Scand J Caring Sci 2017; 32:270-279. [DOI: 10.1111/scs.12458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/14/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Cheryl L Olivier
- Department of Osteopathy; Health Care Practice Pathway; Unitec Institute of Technology; Auckland New Zealand
| | - Jill Phillips
- Department of Nursing; Health Care Practice Pathway; Unitec Institute of Technology; Auckland New Zealand
| | - Dianne E Roy
- Department of Nursing; Health Care Practice Pathway; Unitec Institute of Technology; Auckland New Zealand
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20
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Dufouil C, Beiser A, McLure LA, Wolf PA, Tzourio C, Howard VJ, Westwood AJ, Himali JJ, Sullivan L, Aparicio HJ, Kelly-Hayes M, Ritchie K, Kase CS, Pikula A, Romero JR, D'Agostino RB, Samieri C, Vasan RS, Chêne G, Howard G, Seshadri S. Revised Framingham Stroke Risk Profile to Reflect Temporal Trends. Circulation 2017; 135:1145-1159. [PMID: 28159800 PMCID: PMC5504355 DOI: 10.1161/circulationaha.115.021275] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Age-adjusted stroke incidence has decreased over the past 50 years, likely as a result of changes in the prevalence and impact of various stroke risk factors. An updated version of the Framingham Stroke Risk Profile (FSRP) might better predict current risks in the FHS (Framingham Heart Study) and other cohorts. We compared the accuracy of the standard (old) and of a revised (new) version of the FSRP in predicting the risk of all-stroke and ischemic stroke and validated this new FSRP in 2 external cohorts, the 3C (3 Cities) and REGARDS (Reasons for Geographic and Racial Differences in Stroke) studies. METHODS We computed the old FSRP as originally described and a new model that used the most recent epoch-specific risk factor prevalence and hazard ratios for individuals ≥55 years of age and for the subsample ≥65 years of age (to match the age range in REGARDS and 3C studies, respectively) and compared the efficacy of these models in predicting 5- and 10-year stroke risks. RESULTS The new FSRP was a better predictor of current stroke risks in all 3 samples than the old FSRP (calibration χ2 of new/old FSRP: in men: 64.0/12.1, 59.4/30.6, and 20.7/12.5; in women: 42.5/4.1, 115.4/90.3, and 9.8/6.5 in FHS, REGARDS, and 3C, respectively). In the REGARDS, the new FSRP was a better predictor among whites compared with blacks. CONCLUSIONS A more contemporaneous, new FSRP better predicts current risks in 3 large community samples and could serve as the basis for examining geographic and racial differences in stroke risk and the incremental diagnostic utility of novel stroke risk factors.
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Affiliation(s)
- Carole Dufouil
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Alexa Beiser
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Leslie A McLure
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Philip A Wolf
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Christophe Tzourio
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Virginia J Howard
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Andrew J Westwood
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Jayandra J Himali
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Lisa Sullivan
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Hugo J Aparicio
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Margaret Kelly-Hayes
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Karen Ritchie
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Carlos S Kase
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Aleksandra Pikula
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Jose R Romero
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Ralph B D'Agostino
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Cécilia Samieri
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Ramachandran S Vasan
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Genevieve Chêne
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - George Howard
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.)
| | - Sudha Seshadri
- From Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, France (C.D., C.T., C.S., G.C.); ISPED, Univ. Bordeaux, France (C.D., C.S., G.C.); CHU de Bordeaux, Pole de sante publique, France (C.D., C.T., G.C.); Department of Neurology, School of Medicine (A.B., P.A.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., S.S.), Department of Biostatistics, School of Public Health (A.B., L.S.), and Department of Mathematics (R.B.D.), Boston University, MA; National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (A.B., P.A.W., A.J.W., J.J.H., H.J.A., M.K.-H., C.S.K., A.P., J.R.R., R.B.D., R.S.V., S.S.); Department of Biostatistics, Drexel University School of Public Health, Philadelphia, PA (L.A.M.); Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; and INSERM Unit 1061, Montpellier University, France (K.R.).
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21
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Ning X, Sun J, Jiang R, Lu H, Bai L, Shi M, Tu J, Wu Y, Wang J, Zhang J. Increased Stroke Burdens Among the Low-Income Young and Middle Aged in Rural China. Stroke 2017; 48:77-83. [DOI: 10.1161/strokeaha.116.014897] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/29/2016] [Accepted: 11/08/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although stroke in the young and middle aged accounts for 31% of all strokes in China, the disease burden is unknown. We aimed to determine the secular trends in stroke incidence and the transition of subtypes in rural China over a 24-year period.
Methods—
In 1992, 14 920 residents were recruited to participate in the Tianjin Brain Study. Stroke events and all deaths were registered annually. We assessed the trends in incidence of first-ever stroke, including intracerebral hemorrhage and ischemic stroke, among adults aged 35 to 64 years during 1992 to 1999, 2000 to 2007, and 2008 to 2015. The annual proportion of change in stroke incidence was evaluated from 1992 to 2015.
Results—
The age-standardized incidence of first-ever stroke per 100 000 person-years increased significantly, from 122 in 1992 to 1999, to 215.8 in 2000 to 2007, to 471.8 in 2008 to 2015. The incidence of first-ever stroke increased annually by 11.9% overall (12.4% in men, 9.0% in women, 8.7% for intracerebral hemorrhage, and 10.7% for ischemic stroke;
P
<0.001). The greatest increases were observed in adults aged 55 to 64 years, with an annual increase of 11.6% for ischemic stroke (10.8% in men and 6.9% in women). However, the proportion of intracerebral hemorrhage has not changed over the past 24 years.
Conclusions—
In contrast with that in developed countries, the burden of stroke in China originates primarily from young and middle-aged adults. Thus, control of risk factors in this population is required to reduce the future burden of stroke in China.
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Affiliation(s)
- Xianjia Ning
- From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China
| | - Jian Sun
- From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China
| | - Rongcai Jiang
- From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China
| | - Hongyan Lu
- From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China
| | - Lingling Bai
- From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China
| | - Min Shi
- From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China
| | - Jun Tu
- From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China
| | - Yanan Wu
- From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China
| | - Jinghua Wang
- From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China
| | - Jianning Zhang
- From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China
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22
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Newbury J, Kleinig T, Leyden J, Arima H, Castle S, Cranefield J, Paterson T, Jannes J, Crotty M, Anderson CS. Stroke Epidemiology in an Australian Rural Cohort (SEARCH). Int J Stroke 2016; 12:161-168. [PMID: 27694313 DOI: 10.1177/1747493016670174] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Stroke rates in Australia and New Zealand have been declining since 1990 but all studies have been completed in large urban centers. Aim We report the first Australasian stroke incidence study in a rural population. Methods The authors applied the principle of complete ascertainment, used the WHO standard definition of stroke and classified ischemic stroke by the TOAST criteria. Data were collected from five rural centers defined by postcode of residence, over a 2-year period with 12 months of follow up of all cases. Results There were 217 strokes in 215 individuals in a population of 96,036 people, over 2 years, giving a crude attack rate of 113 per 100,000 per year. The 181 first-ever strokes (83% of total), standardized to the WHO world population, occurred at a rate of 50/100,000 (95% CI: 43-58). The 28-day fatality for first-ever strokes was 24% (95% CI: 18-31) and 77% (95% CI: 71-83) were classified as ischemic (140/181), 15% (95% CI: 10-21) intracerebral hemorrhage, 3% (95% CI: 1-6) due to subarachnoid hemorrhage and 5% (95% CI: 2-9) were unknown. A high proportion of first-ever ischemic strokes (44%) were cardioembolic, mostly (77%) due to atrial arrhythmias. Of the 38 with known atrial arrhythmias prior to stroke, only six (16%) were therapeutically anticoagulated. Conclusions This rural companion study of a recent Australian urban stroke incidence study confirms the downward trend of stroke incidence in Australia, and reiterates that inadequate anticoagulation of atrial arrhythmia remains a preventable cause of ischemic stroke.
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Affiliation(s)
| | - Tim Kleinig
- 1 The University of Adelaide, Adelaide, Australia.,2 Royal Adelaide Hospital, SA Health, Adelaide, Australia.,3 Lyell McEwin Hospital, SA Health, Elizabeth Vale, Australia
| | - James Leyden
- 3 Lyell McEwin Hospital, SA Health, Elizabeth Vale, Australia
| | - Hisatomi Arima
- 4 The George Institute for Global Health, Sydney, Australia.,5 Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Sally Castle
- 6 South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Jennifer Cranefield
- 1 The University of Adelaide, Adelaide, Australia.,2 Royal Adelaide Hospital, SA Health, Adelaide, Australia
| | | | - Jim Jannes
- 1 The University of Adelaide, Adelaide, Australia.,2 Royal Adelaide Hospital, SA Health, Adelaide, Australia
| | - Maria Crotty
- 7 Flinders Medical Centre, Bedford Park, Australia
| | - Craig S Anderson
- 4 The George Institute for Global Health, Sydney, Australia.,5 Sydney Medical School, The University of Sydney, Sydney, Australia.,8 Royal Prince Alfred Hospital, Sydney, Australia
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23
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Yamanashi H, Ngoc MQ, Huy TV, Suzuki M, Tsujino A, Toizumi M, Takahashi K, Thiem VD, Anh DD, Anh NTH, Tho LH, Maeda T, Cox SE, Yoshida LM, Ariyoshi K. Population-Based Incidence Rates of First-Ever Stroke in Central Vietnam. PLoS One 2016; 11:e0160665. [PMID: 27513471 PMCID: PMC4981455 DOI: 10.1371/journal.pone.0160665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/22/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Stroke incidence data with methodologically acceptable design in Southeast Asia countries is limited. This study aimed to determine incidence of age-, sex- and subtype-specific first-ever stroke (FES) in Vietnam. Methods We conducted a hospital-based retrospective study, targeting all stroke cases hospitalized at a solo-provider hospital in our study site of Nha Trang from January 2009 to December 2011 with International Classification of Diseases, 10th revision (ICD-10) codes I60-69. We calculated positive predictive values (PPVs) of each ICD-10-coded stroke by conducting a detailed case review of 190 randomly selected admissions with ICD-10 codes of I60-I69. These PPVs were then used to estimate annual incident stroke cases from the computerized database. National census data in 2009 was used as a denominator. Results 2,693 eligible admissions were recorded during the study period. The crude annual incidence rate of total FES was 90.2 per 100,000 population (95% CI 81.1–100.2). The age-adjusted incidence of FES was 115.7 (95% CI 95.9–139.1) when adjusted to the WHO world populations. Importantly, age-adjusted intracerebral hemorrhage was as much as one third of total FES: 36.9 (95% CI 26.1–51.0). Conclusions We found a considerable proportion of FES in Vietnam to be attributable to intracerebral hemorrhage, which is as high or exceeding levels seen in high-income countries. A high prevalence of improperly treated hypertension in Vietnam may underlie the high prevalence of intracerebral hemorrhagic stroke in this population.
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Affiliation(s)
- Hirotomo Yamanashi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Goto, Nagasaki, Japan
| | - Mai Quang Ngoc
- Department of Geriatrics, Khanh Hoa Gerenral Hospital, Nha Trang, Khanh Hoa, Vietnam
| | - Tran Van Huy
- Department of Geriatrics, Khanh Hoa Gerenral Hospital, Nha Trang, Khanh Hoa, Vietnam
| | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Kensuke Takahashi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Vu Dinh Thiem
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Le Huu Tho
- Khanh Hoa Health Service, Nha Trang, Khanh Hoa, Vietnam
| | - Takahiro Maeda
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Goto, Nagasaki, Japan
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Sharon E. Cox
- Nagasaki University School of Tropical Medicine and Global Health, Sakamoto, Nagasaki, Japan
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
- * E-mail:
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24
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Barber PA, Krishnamurthi R, Parag V, Anderson NE, Ranta A, Kilfoyle D, Wong E, Green G, Arroll B, Bennett DA, Witt E, Rush E, Minsun Suh F, Theadom A, Rathnasabapathy Y, Te Ao B, Parmar P, Feigin VL. Incidence of Transient Ischemic Attack in Auckland, New Zealand, in 2011 to 2012. Stroke 2016; 47:2183-8. [PMID: 27470991 DOI: 10.1161/strokeaha.116.014010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/01/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There have been few recent population-based studies reporting the incidence (first ever) and attack rates (incident and recurrent) of transient ischemic attack (TIA). METHODS The fourth Auckland Regional Community Stroke study (ARCOS IV) used multiple overlapping case ascertainment methods to identify all hospitalized and nonhospitalized cases of TIA that occurred in people ≥16 years of age usually resident in Auckland (population ≥16 years of age is 1.12 million), during the 12 months from March 1, 2011. All first-ever and recurrent new TIAs (any new TIA 28 days after the index event) during the study period were recorded. RESULTS There were 785 people with TIA (402 [51.2%] women, mean [SD] age 71.5 [13.8] years); 614 (78%) of European origin, 84 (11%) Māori/Pacific, and 75 (10%) Asian/Other. The annual incidence of TIA was 40 (95% confidence interval, 36-43), and attack rate was 63 (95% confidence interval, 59-68), per 100 000 people, age standardized to the World Health Organization world population. Approximately two thirds of people were known to be hypertensive or were being treated with blood pressure-lowering agents, half were taking antiplatelet agents and just under half were taking lipid-lowering therapy before the index TIA. Two hundred ten (27%) people were known to have atrial fibrillation at the time of the TIA, of whom only 61 (29%) were taking anticoagulant therapy, suggesting a failure to identify or treat atrial fibrillation. CONCLUSIONS This study describes the burden of TIA in an era of aggressive primary and secondary vascular risk factor management. Education programs for medical practitioners and patients around the identification and management of atrial fibrillation are required.
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Affiliation(s)
- P Alan Barber
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.).
| | - Rita Krishnamurthi
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Varsha Parag
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Neil E Anderson
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Annemarei Ranta
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Dean Kilfoyle
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Edward Wong
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Geoff Green
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Bruce Arroll
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Derrick A Bennett
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Emma Witt
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Elaine Rush
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Flora Minsun Suh
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Alice Theadom
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Yogini Rathnasabapathy
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Braden Te Ao
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Priyakumari Parmar
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
| | - Valery L Feigin
- From the Centre for Brain Research (P.A.B.), National Institute for Health Innovation (V.P.), and Department of General Practice and Primary Health Care (B.A.), University of Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., A.T., B.T.A., P.P., V.L.F.) and School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences (E.R.), Auckland University of Technology, New Zealand; Department of Neurology, Auckland City Hospital, New Zealand (P.A.B., N.E.A., D.K., E.W.); Departments of Medicine, Waitemata (D.K., Y.R., V.L.F.) and Counties Manukau (E.W., G.G.), District Health Boards, Auckland, New Zealand; Department of Neurology, Wellington Hospital, New Zealand (A.R.) and Department of Medicine, University of Otago, Wellington, New Zealand (A.R.); School of Psychology, University of Queensland, Brisbane, Australia (F.M.S.); and Nuffield Department of Population Health, University of Oxford, United Kingdom (D.A.B.)
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Feigin VL, McNaughton H, Dyall L. Burden of Stroke in Maori and Pacific Peoples of New Zealand. Int J Stroke 2016; 2:208-10. [DOI: 10.1111/j.1747-4949.2007.00140.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Studying ethnic particularities of stroke epidemiology may not only provide a clue to the causes of the observed racial/ethnic differences in stroke mortality but is also important for appropriate, culturally specific health care planning, prevention in stroke and improved health outcomes. This overview of published population-based stroke incidence studies and other relevant research in the multi-ethnic New Zealand population demonstrates an obvious ethnic disparity in stroke in New Zealand, with the greatest and increasing burden of stroke being imposed on Maori, who are indigenous, and Pacific people, who have migrated and settled in this country. These data warrant urgent and effective measures to be undertaken by health policy makers and health care providers to reverse the unfavourable trends in stroke and improve Maori and Pacific people's health.
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Affiliation(s)
- Valery L. Feigin
- Clinical Trials Research Unit, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Harry McNaughton
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Lorna Dyall
- Department of Maori and Pacific Health, School of Population Health, The University of Auckland, Auckland, New Zealand
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The use of national administrative data to describe the spatial distribution of in-hospital mortality following stroke in France, 2008-2011. Int J Health Geogr 2016; 15:2. [PMID: 26754188 PMCID: PMC4710001 DOI: 10.1186/s12942-015-0028-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 12/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background In the context of implementing the National Stroke Plan in France, a spatial approach was used to measure inequalities in this disease. Using the national PMSI-MCO databases, we analyzed the in-hospital prevalence of stroke and established a map of in-hospital mortality rates with regard to the socio-demographic structure of the country. Methods The principal characteristics of patients identified according to ICD10 codes relative to stroke (in accordance with earlier validation work) were studied. A map of standardized mortality rates at the level of PMSI geographic codes was established. An exploratory analysis (principal component analysis followed by ascending hierarchical classification) using INSEE socio-economic data and mortality rates was also carried out to identify different area profiles. Results Between 2008 and 2011, the number of stroke patients increased by 3.85 %, notably for ischemic stroke in the 36–55 years age group (60 % of men). Over the same period, in-hospital mortality fell, and the map of standardized rates illustrated the diagonal of high mortality extending from the north-east to the south-west of the country. The most severely affected areas were also those with the least favorable socio-professional indicators. Conclusions The PMSI-MCO database is a major source of data on the health status of the population. It can be used for the area-by-area observation of the performance of certain healthcare indicators, such as in-hospital mortality, or to follow the implementation of the National Stroke Plan. Our study showed the interplay between social and demographic factors and stroke-related in-hospital mortality. The map derived from the results of the exploratory analysis illustrated a variety of areas where social difficulties, aging and high mortality seemed to meet. The study raises questions about access to neuro-vascular care in isolated areas and in those in demographic decline. Telemedicine appears to be the solution favored by decision makers. The aging of the population managed for stroke must not mask the growing incidence in younger people, which raises questions about the development of classical (smoking, hypertension) or new (drug abuse) risk factors.
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Béjot Y, Daubail B, Giroud M. Epidemiology of stroke and transient ischemic attacks: Current knowledge and perspectives. Rev Neurol (Paris) 2015; 172:59-68. [PMID: 26718592 DOI: 10.1016/j.neurol.2015.07.013] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/09/2015] [Accepted: 07/22/2015] [Indexed: 11/26/2022]
Abstract
Because of the growing size and aging of the world's population, the global burden of stroke is increasing dramatically. Current epidemiological data indicate that 16.9 million people suffer a stroke each year, which represents a global incidence of 258/100,000/year, with marked differences between high- and low-income countries, and an age-adjusted incidence 1.5 times higher in men than in women. Although primary prevention has contributed to a decrease in stroke incidence in high-income countries, the so-called 'epidemiological transition' has led to an increase in incidence in middle-to-low-income countries as well. In addition, the incidence of ischemic stroke in young adults is on the rise, suggesting a need for specific preventative interventions in that age group. The number of stroke survivors almost doubled between 1990 and 2010, and has now reached 33 million people. According to epidemiological projections, this number will rise to 77 million by 2030. In France, the number of hospitalizations for an acute cerebrovascular event was about 138,000 in 2009, accounting for 3% of the total national health expenditure. Outcomes after stroke are frequently impaired by complications, including motor handicaps, dementia, depression, fatigue, and a high risk of early rehospitalization and institutionalization, with adverse consequences in terms of socioeconomic costs. In addition, there are 5.9 million stroke-related deaths worldwide every year. Finally, although many analytical epidemiological studies have considerably increased our knowledge of risk factors for stroke, the recent INTERSTROKE study provided evidence that 10 risk factors alone accounted for 88% of all strokes. Many of these risk factors are modifiable, which suggests that efforts should be made to promote interventions that aim to reduce the risk of stroke. A new 'mass approach' aiming to reduce the level of stroke risk factors in all people in a region, regardless of any given individual's level of risk, is currently still being developed. This interesting and innovative way to spread stroke awareness is based on the use of an internationally validated mobile-phone application that can calculate the risk of stroke for any given individual, and also contains a section to educate people on stroke warning symptoms and signs.
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Affiliation(s)
- Y Béjot
- Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, 21079 Dijon cedex, France.
| | - B Daubail
- Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, 21079 Dijon cedex, France
| | - M Giroud
- Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, 21079 Dijon cedex, France
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Barker-Collo S, Krishnamurthi R, Witt E, Feigin V, Jones A, McPherson K, Starkey N, Parag V, Jiang Y, Barber PA, Rush E, Bennett D, Aroll B. Improving Adherence to Secondary Stroke Prevention Strategies Through Motivational Interviewing: Randomized Controlled Trial. Stroke 2015; 46:3451-8. [PMID: 26508749 DOI: 10.1161/strokeaha.115.011003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/18/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Stroke recurrence rates are high (20%-25%) and have not declined over past 3 decades. This study tested effectiveness of motivational interviewing (MI) for reducing stroke recurrence, measured by improving adherence to recommended medication and lifestyle changes compared with usual care. METHODS Single-blind, prospective phase III randomized controlled trial of 386 people with stroke assigned to either MI treatment (4 sessions at 28 days, 3, 6, and 9 months post stroke) or usual care; with outcomes assessed at 28 days, 3, 6, 9, and 12 months post stroke. Primary outcomes were change in systolic blood pressure and low-density lipoprotein cholesterol levels as indicators of adherence at 12 months. Secondary outcomes included self-reported adherence, new stroke, or coronary heart disease events (both fatal and nonfatal); quality of life (Short Form-36); and mood (Hospital Anxiety and Depression Scale). RESULTS MI did not significantly change measures of blood pressure (mean difference in change, -0.2.35 [95% confidence interval, -6.16 to 1.47]) or cholesterol (mean difference in change, -0.0.12 [95% confidence interval, -0.30 to 0.06]). However, it had positive effects on self-reported medication adherence at 6 months (1.979; 95% confidence interval, 0.98-3.98; P=0.0557) and 9 months (4.295; 95% confidence interval, 1.56-11.84; P=0.0049) post stroke. Improvement across other measures was also observed, but the differences between MI and usual care groups were not statistically significant. CONCLUSIONS MI improved self-reported medication adherence. All other effects were nonsignificant, though in the direction of a treatment effect. Further study is required to determine whether MI leads to improvement in other important areas of functioning (eg, caregiver burden). CLINICAL TRIAL REGISTRATION URL: http://www.anzctr.org.au. Unique identifier: ACTRN-12610000715077.
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Affiliation(s)
- Suzanne Barker-Collo
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.).
| | - Rita Krishnamurthi
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
| | - Emma Witt
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
| | - Valery Feigin
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
| | - Amy Jones
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
| | - Kathryn McPherson
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
| | - Nicola Starkey
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
| | - Varsha Parag
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
| | - Yannan Jiang
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
| | - P Alan Barber
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
| | - Elaine Rush
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
| | - Derrick Bennett
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
| | - Bruce Aroll
- From the School of Psychology (S.B.-C.), National Institute for Health innovation, School of Population Health (V.P., Y.J.), Department of Neurology, Centre for Brain Research (P.A.B.), and General Practice and Primary Healthcare, School of Population Health (B.A.), University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (R.K., E.W., V.F., A.J.) and Centre for Physical Activity and Nutrition (E.R.), AUT University, Auckland, New Zealand; Health Research Council New Zealand, Auckland, New Zealand (K.M.); Department of Psychology, Waikato University, Hamilton, New Zealand (N.S.); and Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom (D.B.)
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30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies. PLoS One 2015; 10:e0134609. [PMID: 26291829 PMCID: PMC4546383 DOI: 10.1371/journal.pone.0134609] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/12/2015] [Indexed: 11/29/2022] Open
Abstract
Background Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years. Methods Four stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years) of Auckland NZ in 1981–1982, 1991–1992, 2002–2003 and 2011–2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution. Results 5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in frequency of current smoking among stroke patients. Conclusions In this unique temporal series of studies spanning 30 years, stroke incidence, early case-fatality and 1-year mortality have declined, but ethnic disparities in risk and outcome for stroke persisted suggesting that primary stroke prevention remains crucial to reducing the burden of this disease.
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Abstract
AbstractBackgroundWe analyzed a 10-year stroke administrative dataset to examine trends in admissions, mortality, and discharge destination in Canada.MethodsWe conducted an analysis of hospital administrative data from April 1st 2003 to March 31st 2013 from the Canadian Institute of Health Information’s Discharge Abstract Database. Ten-year trends for population-based age- and sex-standardized admission rates were calculated. We reviewed 10-year trends in absolute stroke admissions for differences between provinces and age groups. Stroke 30-day in-hospital mortality rates were calculated and adjusted for sex, age, stroke type and comorbidities. We documented changes in discharge location for ischemic and hemorrhagic stroke patients discharged from acute care.ResultsThe rate of hospital admissions has declined from 140.2 to 117.5 (per 100,000 people). The number of absolute stroke admissions within provinces increased in Alberta and British Columbia (21.7% and 16.2% respectively). The proportion of stroke patients aged 40-69 years old increased by 4.8% (p<0.0001) over the 10 years, whereas the proportion aged over 70 decreased by 4.9% (p<0.0001). Risk-adjusted 30-day in-hospital mortality decreased from: 18.5% to 14.9% for all strokes; 15.2% to 12.1% for ischemic strokes; 35.6% to 29.7% for intracerebral hemorrhage; and 25.1% to 18.0% for subarachnoid hemorrhage. The absolute increase in patients requiring inpatient and outpatient support increased by 4% (p<0.0001).ConclusionThe rate of admissions for stroke is decreasing but there is an increase in stroke admissions for younger patients. In-hospital mortality is decreasing; fewer patients are going directly home without services and more are requiring support services.
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Han MH, Yi HJ, Kim YS, Kim YS. Effect of seasonal and monthly variation in weather and air pollution factors on stroke incidence in Seoul, Korea. Stroke 2015; 46:927-35. [PMID: 25669311 DOI: 10.1161/strokeaha.114.007950] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of the present study was to determine whether seasonal and monthly variations in stroke incidence exist and whether they are related to meteorologic and air pollution parameters under similar weather and environmental conditions in selected areas of Seongdong district, Seoul, South Korea. METHODS From January 1, 2004, to December 31, 2013, 3001 consecutive stroke events were registered in residents of selected areas of Seongdong district, Seoul, South Korea. The authors calculated the stroke attack rate per 100,000 people per month and the relative risk of stroke incidence associated with meteorologic and air pollution parameters. We also analyzed odds ratios with a 95% confidence interval for seasonal and monthly stroke incidence. RESULTS The incidence of stroke in September was significantly higher (odds ratio, 1.233; 95% confidence interval, 1.042-1.468) compared with January. The seasonal ischemic stroke incidence in summer (odds ratio, 1.183; 95% confidence interval, 1.056-1.345) was significantly higher than in winter, whereas the seasonal incidence of intracerebral hemorrhage relative to winter was not significant. The mean temperature was positively correlated with ischemic stroke (relative risk, 1.006; P=0.003), and nitrogen dioxide (relative risk, 1.262; P=0.001) showed a strong positive correlation with intracerebral hemorrhage incidence among the older age group. CONCLUSIONS We demonstrated distinct patterns of seasonal and monthly variation in the incidence of stroke and its subtypes through consideration of the meteorologic and air pollution parameters. We therefore expect that these findings may enhance our understanding of the relationships between stroke and weather and pollutants.
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Affiliation(s)
- Myung-Hoon Han
- From the Department of Neurosurgery (M.-H.H., H.-J.Y., Young-Soo Kim), and Department of Neurology (Young-Seo Kim), Hanyang University Medical Center, Seoul, Korea
| | - Hyeong-Joong Yi
- From the Department of Neurosurgery (M.-H.H., H.-J.Y., Young-Soo Kim), and Department of Neurology (Young-Seo Kim), Hanyang University Medical Center, Seoul, Korea.
| | - Young-Soo Kim
- From the Department of Neurosurgery (M.-H.H., H.-J.Y., Young-Soo Kim), and Department of Neurology (Young-Seo Kim), Hanyang University Medical Center, Seoul, Korea
| | - Young-Seo Kim
- From the Department of Neurosurgery (M.-H.H., H.-J.Y., Young-Soo Kim), and Department of Neurology (Young-Seo Kim), Hanyang University Medical Center, Seoul, Korea
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Olindo S, Chausson N, Mejdoubi M, Jeannin S, Rosillette K, Saint-Vil M, Signate A, Edimonana-Kaptue M, Larraillet V, Cabre P, Smadja D, Joux J. Trends in Incidence and Early Outcomes in a Black Afro-Caribbean Population From 1999 to 2012. Stroke 2014; 45:3367-73. [DOI: 10.1161/strokeaha.114.005930] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephane Olindo
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Nicolas Chausson
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Mehdi Mejdoubi
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Severine Jeannin
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Karine Rosillette
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Martine Saint-Vil
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Aissatou Signate
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Mireille Edimonana-Kaptue
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Veronique Larraillet
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Philippe Cabre
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Didier Smadja
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Julien Joux
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
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Cadilhac DA, Vos T, Thrift AG. Estimating the annual number of strokes and the issue of imperfect data: an example from Australia. Int J Stroke 2014; 9:19-22. [PMID: 24350871 DOI: 10.1111/ijs.12246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Estimates of strokes in Australia are typically obtained using 1996-1997 age-specific attack rates from the pilot North East Melbourne Stroke Incidence (NEMESIS) Study (eight postcode regions). Declining hospitalizations for stroke indicate the potential to overestimate cases. AIMS To illustrate how current methods may potentially overestimate the number of strokes in Australia. METHODS Hospital separations data (primary discharge ICD10 codes I60 to I64) and three stroke projection models were compared. Each model had age- and gender-specific attack rates from the NEMESIS study applied to the 2003 population. One model used the 2003 Burden of Disease approach where the ratio of the 1996-1997 NEMESIS study incidence to hospital separation rate in the same year was adjusted by the 2002/2003 hospital separation rate within the same geographic region using relevant ICD-primary diagnosis codes. Hospital separations data were inflated by 12·1% to account for nonhospitalized stroke, while the Burden of Disease model was inflated by 27·6% to account for recurrent stroke events in that year. The third model used 1997-1999 attack rates from the larger 22-postcode NEMESIS study region. RESULTS In 2003, Australian hospitalizations for stroke (I60 to I64) were 33,022, and extrapolation to all stroke (hospitalized and nonhospitalized) was 37,568. Applying NEMESIS study attack rates to the 2003 Australian population, 50,731 strokes were projected. Fewer cases for 2003 were estimated with the Burden of Disease model (28,364) and 22-postcode NEMESIS study rates (41,332). CONCLUSIONS Estimating the number of strokes in a country can be highly variable depending on the recency of data, the type of data available, and the methods used.
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Affiliation(s)
- Dominique A Cadilhac
- Stroke & Ageing Research Centre, Monash Medical Centre, Southern Clinical School, Monash University, Clayton, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
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Béjot Y, Daubail B, Jacquin A, Durier J, Osseby GV, Rouaud O, Giroud M. Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry. J Neurol Neurosurg Psychiatry 2014; 85:509-13. [PMID: 24249786 DOI: 10.1136/jnnp-2013-306203] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recent data have suggested that stroke incidence in young people may be rising. In this population-based study, we aimed to determine whether the incidence of stroke in people aged <55 years old had changed over the last three decades. METHODS All cases of first-ever stroke (ischaemic stroke, spontaneous intracerebral haemorrhage, and undetermined stroke) occurring in Dijon, France, from 1985 to 2011 were prospectively collected from a population-based registry. Incidence rates were calculated and temporal trends were analysed by age groups and stroke subtypes using a Poisson regression to estimate incidence rate ratios (IRR). Risk factors and premorbid treatments were analysed. RESULTS Over the 27-year study period, 4506 patients were recorded (53% women, mean age 74.6±14.4, 10.1% aged <55 years). An increase in overall stroke incidence was noted, as was a rise in ischaemic stroke in individuals aged <55 years (IRR 1.308; 95% CI 0.982 to 1.741, p=0.066 for period 1994-2002 vs period 1985-1993, and IRR 1.697; 95% CI 1.340 to 2.150, p<0.001 for period 2003-2011 vs period 1994-2002), which was consistent for men and women. In these young patients, smoking was the most frequent risk factor (43%). CONCLUSIONS Multiple factors may account for the increased incidence of ischaemic stroke in people aged <55 years including changes in vascular risk factors, better awareness of the disease and treatment options in the population and among practitioners leading to more frequent referrals for specialised care, and improvements in stroke diagnosis. Stroke prevention must be encouraged even in young adults.
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Affiliation(s)
- Yannick Béjot
- Department of Neurology, Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, , Dijon, France
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Feigin VL, Parmar PG, Barker-Collo S, Bennett DA, Anderson CS, Thrift AG, Stegmayr B, Rothwell PM, Giroud M, Bejot Y, Carvil P, Krishnamurthi R, Kasabov N. Geomagnetic storms can trigger stroke: evidence from 6 large population-based studies in Europe and Australasia. Stroke 2014; 45:1639-45. [PMID: 24757102 DOI: 10.1161/strokeaha.113.004577] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although the research linking cardiovascular disorders to geomagnetic activity is accumulating, robust evidence for the impact of geomagnetic activity on stroke occurrence is limited and controversial. METHODS We used a time-stratified case-crossover study design to analyze individual participant and daily geomagnetic activity (as measured by Ap Index) data from several large population-based stroke incidence studies (with information on 11 453 patients with stroke collected during 16 031 764 person-years of observation) in New Zealand, Australia, United Kingdom, France, and Sweden conducted between 1981 and 2004. Hazard ratios and corresponding 95% confidence intervals (CIs) were calculated. RESULTS Overall, geomagnetic storms (Ap Index 60+) were associated with 19% increase in the risk of stroke occurrence (95% CI, 11%-27%). The triggering effect of geomagnetic storms was most evident across the combined group of all strokes in those aged <65 years, increasing stroke risk by >50%: moderate geomagnetic storms (60-99 Ap Index) were associated with a 27% (95% CI, 8%-48%) increased risk of stroke occurrence, strong geomagnetic storms (100-149 Ap Index) with a 52% (95% CI, 19%-92%) increased risk, and severe/extreme geomagnetic storms (Ap Index 150+) with a 52% (95% CI, 19%-94%) increased risk (test for trend, P<2×10(-16)). CONCLUSIONS Geomagnetic storms are associated with increased risk of stroke and should be considered along with other established risk factors. Our findings provide a framework to advance stroke prevention through future investigation of the contribution of geomagnetic factors to the risk of stroke occurrence and pathogenesis.
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Affiliation(s)
- Valery L Feigin
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.).
| | - Priya G Parmar
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
| | - Suzanne Barker-Collo
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
| | - Derrick A Bennett
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
| | - Craig S Anderson
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
| | - Amanda G Thrift
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
| | - Birgitta Stegmayr
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
| | - Peter M Rothwell
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
| | - Maurice Giroud
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
| | - Yannick Bejot
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
| | - Phillip Carvil
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
| | - Rita Krishnamurthi
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
| | - Nikola Kasabov
- From the National Institute for Stroke and Applied Neurosciences (V.L.F., P.G.P., R.K.) and Knowledge Engineering and Discovery Research Institute (N.K.), Auckland University of Technology, Auckland, New Zealand; School of Psychology, The University of Auckland, Auckland, New Zealand (S.B.-C.); Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health (D.A.B.) and University Department of Clinical Neurology (P.M.R.), University of Oxford, Oxford, United Kingdom; Neurological and Mental Health Division at the George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia (C.S.A.); Department of Medicine, Southern Clinical School, Monash University Melbourne, Melbourne, Australia (A.G.T.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (B.S.); Service de Neurologie, Centre Hospitalo-Universitaire, Dijon, France (M.G.); University Hospital and Faculty of Medicine of Dijon, EA 4183, University of Burgundy, Stroke Registry of Dijon (Inserm and Invs), Dijon, France (Y.B.); and Centre of Human Aerospace and Physiological Science, King's College London, London, United Kingdom (P.C.)
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Plakht Y, Pertzov B, Gez H, Hellerman M, Ifergane G. Stroke Hospitalizations Over Three Decades: Lower for Men, Unchanged for Women. A Population-Based Study. J Womens Health (Larchmt) 2014; 23:296-301. [DOI: 10.1089/jwh.2013.4591] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ygal Plakht
- Unit of Nursing Research, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Barak Pertzov
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hadar Gez
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moran Hellerman
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Ifergane
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel
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Te Ao B, Brown P, Fink J, Vivian M, Feigin V. Potential gains and costs from increasing access to thrombolysis for acute ischemic stroke patients in New Zealand hospitals. Int J Stroke 2013; 10:903-10. [PMID: 24206567 DOI: 10.1111/ijs.12152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM Treatment of ischemic stroke patients with tissue-type plasminogen activator (tPA) is known to be effective and cost-effective, yet the percentage of patients treated with thrombolysis in hospitals remains low. The purpose of this study is to examine whether providing thrombolysis in New Zealand hospitals is currently cost-effective and to estimate the amount that might be spent on campaigns aimed at increasing thrombolysis receipt rates. METHODS A decision-analytic model was developed and populated using health services data from the literature and the Auckland Regional Community Stroke Outcome Study. The cost-utilities of providing thrombolysis over one-year and patient lifetime were estimated. Using a threshold of NZ$20 000 (US$15 337) per quality-adjusted life year, the analysis identified the maximum amount that might be spent on campaigns aiming to increase rates of receipt of thrombolysis above their current levels. Monte Carlo simulations and probabilistic sensitivity analysis explored the robustness of the findings. RESULTS Providing thrombolysis was cost-effective, especially when long-term costs and effects were considered (NZ$6641 or US$5093 per quality-adjusted life year). The results suggest that better management within hospitals would be more effective in increasing thrombolysis receipt rates (up to 17%) than campaigns aiming at higher awareness of stroke symptoms in the community. The amount that might be spent on a national campaign to increase rate of receipt of thrombolysis from its current level (3% of eligible patients) depended upon the effectiveness of the campaign, ranging from under NZ$6 million for New Zealand for an increase in rate to 30% to over $9 million for an increase in rate to 50%. CONCLUSION While thrombolysis is a cost-effective treatment in New Zealand, resources should be devoted to campaigns, both within hospitals and in the community, to increase coverage.
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Affiliation(s)
- Braden Te Ao
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Paul Brown
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,School of Social Science, Humanities and Arts, University of California, Merced, CA, USA
| | - John Fink
- Department of Neurology, Canterbury District Health Board, Christchurch, New Zealand
| | - Mark Vivian
- New Zealand Stroke Foundation, Wellington, New Zealand
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Feigin VL, McPherson K, Barker-Collo S, Krishnamurthi R. Measuring and reducing the stroke burden in New Zealand. Int J Stroke 2013; 9:5. [PMID: 24165358 DOI: 10.1111/ijs.12122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Valery L Feigin
- Epidemiology and Neurology, National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand
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Krishnamurthi R, Jones A, Barber PA, Barker-Collo S, McPherson K, Bennett D, Rush E, Suh F, Starkey N, Theadom A, Parag V, Rathnasabapathy Y, Feigin VL. Methodology of a population-based stroke and TIA incidence and outcomes study: the Auckland Regional Community Stroke Study (ARCOS IV) 2011-2012. Int J Stroke 2013; 9:140-7. [PMID: 24165287 DOI: 10.1111/ijs.12108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stroke is a leading cause of death and disability worldwide. Stroke burden is immense as it leads to premature deaths, leaves survivors with ongoing disabilities, and has a major financial impact on the individual, their families, and the community. Reliable, high-quality evidence is needed on stroke risk factors, incidence, and outcomes to provide information on how best to reduce this burden. Population-based studies are regarded as the 'gold-standard' of measuring disease burden but are not common due to the logistical and financial challenges they present. The Auckland Regional Community Stroke Studies are among a few in the world that have been carried out at a population level and at regular intervals. AIM The aim of the fourth Auckland Regional Community Stroke Studies IV is to examine the current measures of stroke incidence, prevalence, and outcomes as well the trends over four decades. This article describes the methodology of the Auckland Regional Community Stroke Studies IV with stroke and transient ischemic attacks cases registered over a 12-month period from March 1, 2011 to February 29, 2012. CONCLUSIONS The methodology described may be used as a guide in order to design similar population-based stroke incidence and outcome studies in other countries and populations, thus facilitating the collection of most consistent and accurate stroke epidemiological data.
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Affiliation(s)
- Rita Krishnamurthi
- Faculty of Health and Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
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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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Stroke Incidence and Usage Rate of Thrombolysis in A Japanese Urban City: The Kurashiki Stroke Registry. J Stroke Cerebrovasc Dis 2013; 22:349-57. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/14/2011] [Accepted: 09/19/2011] [Indexed: 11/20/2022] Open
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Kleindorfer DO, Khatri P. Understanding the Remarkable Decline in Stroke Mortality in Recent Decades. Stroke 2013; 44:949-50. [DOI: 10.1161/strokeaha.111.000560] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Pooja Khatri
- From the Department of Neurology, University of Cincinnati, Cincinnati, OH
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Béjot Y, Jacquin A, Troisgros O, Rouaud O, Aboa-Eboulé C, Hervieu M, Osseby GV, Giroud M. Diagnostic procedures in ischaemic stroke patients with dementia. a population-based study. Int J Stroke 2012; 10:95-8. [PMID: 23227877 DOI: 10.1111/j.1747-4949.2012.00948.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/16/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dementia is a frequent condition in stroke patients. AIMS To investigate the effect of dementia on access to diagnostic procedures in ischaemic stroke patients. METHODS All cases of ischaemic stroke from 2006 to 2010 were identified from the population-based Stroke Registry of Dijon, France. Patients' characteristics were recorded, as was the use of brain computed tomography scans, brain magnetic resonance imaging, electrocardiogram, echocardiography, and Doppler ultrasonography of the cervical arteries. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Logistic regression models were used to evaluate the associations between dementia and the use of the diagnostic procedures. RESULTS Of the 907 patients recorded, 104 were excluded because of death and inability to test cognition. Among the remaining 803 patients, 149 (18·5%) had dementia. Almost all of the patients underwent a brain computed tomography scan and an electrocardiogram during their stay. In contrast, the use of both Doppler ultrasonography of the cervical arteries (79·2% versus 90·2%, P < 0·001), echocardiography (32·9% versus 43·6%, P = 0·02), and brain magnetic resonance imaging (21·5% versus 34·4%, P < 0·001) were significantly lower in stroke patients with dementia than in those without. In multivariate logistic regression, dementia was associated with a lower use of both Doppler ultrasonography (odds ratio = 0·49; 95% confidence interval: 0·29-0·81, P = 0·005), echocardiography (odds ratio = 0·57; 95% confidence interval: 0·37-0·89, P = 0·012), brain magnetic resonance imaging (odds ratio = 0·55; 95% confidence interval: 0·34-0·89, P = 0·015), and a comprehensive assessment (odds ratio = 0·62; 95% confidence interval: 0·40-0·96, P = 0·033). CONCLUSION Demented patients were less likely to undergo diagnostic procedures after ischaemic stroke. Further studies are needed to determine whether this lower utilization could account for the reported excess in recurrent events in these patients.
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Affiliation(s)
- Yannick Béjot
- Dijon Stroke Registry, EA4184, Department of Neurology, Medical School, University Hospital of Dijon, University of Burgundy, Dijon, France; Centre Mémoire, Ressources et Recherche, Memory Clinic, University Hospital of Dijon, Dijon, France
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Ranta A, Dovey S, Weatherall M, O’Dea D. Efficacy and safety of a TIA/stroke electronic support tool (FASTEST) trial: study protocol. Implement Sci 2012; 7:107. [PMID: 23114224 PMCID: PMC3545837 DOI: 10.1186/1748-5908-7-107] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 09/25/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Strokes are a common cause of adult disability and mortality worldwide. Transient ischaemic attacks (TIA) are associated with a high risk of subsequent stroke, and rapid intervention has the potential to reduce stroke burden. This study will assess a novel electronic decision support (EDS) tool to allow general practitioners (GPs) to implement evidence-based care rapidly without full reliance on specialists. METHODS/DESIGN This is a cluster randomized controlled trial comparing TIA/stroke management of GPs with access to the EDS tool versus usual care. The intervention period is 12 months with a 3-month follow-up period for individual patients. Primary outcomes consist of stroke within 90 days of presenting event and adherence to the New Zealand national TIA guideline. DISCUSSION A positive study will provide strong evidence for widespread implementation of this tool in practice and has the potential to improve key outcomes for patients and reduce the burden of stroke. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12611000792921.
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Affiliation(s)
- Annemarei Ranta
- Department of Neurology, MidCentral Health, Private Bag 11036, Palmerston North, 4442, New Zealand
- University of Otago-Wellington, Wellington, New Zealand
| | - Susan Dovey
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Dea O’Dea
- University of Otago-Wellington, Wellington, New Zealand
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Feigin VL, Barker-Collo S, Parag V, Hackett ML, Kerse N, Barber PA, Theadom A, Krishnamurthi R. Prevalence and predictors of 6-month fatigue in patients with ischemic stroke: a population-based stroke incidence study in Auckland, New Zealand, 2002-2003. Stroke 2012; 43:2604-9. [PMID: 22851549 DOI: 10.1161/strokeaha.112.660886] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Although persistent and significant fatigue affects the daily life of stroke survivors, there are no population-based studies examining the prevalence of fatigue in 6-month survivors of ischemic stroke and few studies of predictors of poststroke fatigue. METHODS This article examined data from the Auckland Regional Community Stroke study conducted in Auckland, New Zealand, in 2002 to 2003. Presence of fatigue was evaluated at 6 months in 613 patients with ischemic stroke using a Short Form 36 Vitality Score (energy and fatigue) of ≤ 47. Multivariate logistic regression analysis was used to determine predictors of fatigue development 6 months poststroke. RESULTS The prevalence of fatigue was 30% (28% in men and 33% in women). There was a clear association between increased prevalence of fatigue and advancing age. The only baseline variables independently associated with an increased risk of developing fatigue at 6 months poststroke were prestroke incontinence and being of New Zealand European ethnicity. Being independent and living alone at baseline were associated with significant reduction in the risk of being fatigued at 6 months poststroke. Severe depression at 6 months was significantly and independently associated with being fatigued. CONCLUSIONS The prevalence of fatigue found in our study is at the lower level of range reported in other studies. The prevalence of fatigue increased with advancing age, as found in most previous studies. Because fatigue can have a negative impact on stroke recovery, particular attention needs to be paid to those who are older, incontinent before stroke, and those who report severe symptoms of depression at 6 months after stroke.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, AUT University, Private Bag 92006, Auckland 1142, New Zealand.
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Gill RS, Hambridge HL, Schneider EB, Hanff T, Tamargo RJ, Nyquist P. Falling temperature and colder weather are associated with an increased risk of aneurysmal subarachnoid hemorrhage. World Neurosurg 2012; 79:136-42. [PMID: 22732514 DOI: 10.1016/j.wneu.2012.06.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 04/07/2012] [Accepted: 06/13/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To use weather data to predict increased incidence of aneurysmal subarachnoid hemorrhage (aSAH) at a large institution with an extensive referral network in response to falling temperatures. METHODS In a retrospective study, 1175 prospectively collected aSAH cases accrued over 18 years from one hospital were reviewed to determine if season, maximum ambient temperature (MAT), average relative humidity, and atmospheric pressure were related to incidence of aSAH at that institution on a given day. A Poisson regression model was used to assess daily risk of incident aSAH based on daily MAT and 1-day change in MAT. RESULTS A MAT decrease of 1°F from one day to the next was associated with a 0.6% increase in risk of aSAH (relative risk [RR]=1.006, P=0.016). The increased risk associated with MAT decrease from the previous day was especially strong for female patients (RR=1.008/°F, P=0.007) and drove the overall model, representing 72% of cases. In addition, warmer temperatures were associated with a decreased risk of aSAH; each 1°F increase in temperature compared with the previous day was associated with a 0.3% decrease in risk of aSAH (RR=0.997; P<0.001). CONCLUSIONS A 1-day decrease in temperature and colder daily temperatures were associated with an increased risk of incident aSAH at a single institution with a large referral network. These variables appeared to act synergistically and independently of season. These relationships were particularly predominant in the fall when the transition from warmer to colder temperatures occurred.
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Affiliation(s)
- Randeep S Gill
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Wieberdink RG, Ikram MA, Hofman A, Koudstaal PJ, Breteler MMB. Trends in stroke incidence rates and stroke risk factors in Rotterdam, the Netherlands from 1990 to 2008. Eur J Epidemiol 2012; 27:287-95. [PMID: 22426770 PMCID: PMC3370158 DOI: 10.1007/s10654-012-9673-y] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/23/2012] [Indexed: 11/28/2022]
Abstract
Stroke incidence rates have decreased in developed countries over the past 40 years, but trends vary across populations. We investigated whether age-and-sex-specific stroke incidence rates and associated risk factors as well as preventive medication use have changed in Rotterdam in the Netherlands during the last two decades. The study was part of the Rotterdam Study, a large population-based cohort study among elderly people. Participants were 10,994 men and women aged 55-94 years who were stroke-free at baseline. Trends were calculated by comparing the 1990 subcohort (n=7516; baseline 1990-1993) with the 2000 subcohort (n=2883; baseline 2000-2001). Poisson regression was used to calculate incidence rates and incidence rate ratios in age-and-sex-specific strata. We further compared the prevalence of stroke risk factors and preventive medication use in the two subcohorts. In the 1990 subcohort 467 strokes occurred during 45,428 person years; in the 2000 subcohort 115 strokes occurred in 18,356 person years. Comparing the subcohorts, incidence rates decreased by 34% in men, but remained unchanged in women. Blood pressure levels increased between 1990 and 2000, whereas the proportion of current cigarette smokers decreased in men, but not in women. There was a strong increase in medication use for treatment of stroke risk factors across all age categories in both sexes. Our findings suggest that in Rotterdam between 1990 and 2008 stroke incidence rates have decreased in men but not in women.
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Affiliation(s)
- Renske G Wieberdink
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Sposato LA, Saposnik G. Gross Domestic Product and Health Expenditure Associated With Incidence, 30-Day Fatality, and Age at Stroke Onset. Stroke 2012; 43:170-7. [DOI: 10.1161/strokeaha.111.632158] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Luciano A. Sposato
- From the Vascular Research Institute at INECO Foundation (L.A.S.), Department of Neurology at INECO, Stroke Center at the Institute of Neurosciences, University Hospital, Favaloro Foundation, Buenos Aires, Argentina; and the Stroke Outcomes Research Center (G.S.), Li Ka Shing Knowledge Institute, Departments of Medicine and Health Policy Management and Evaluation (HPME) and the Institute for Clinical Evaluative Sciences (ICES), St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Gustavo Saposnik
- From the Vascular Research Institute at INECO Foundation (L.A.S.), Department of Neurology at INECO, Stroke Center at the Institute of Neurosciences, University Hospital, Favaloro Foundation, Buenos Aires, Argentina; and the Stroke Outcomes Research Center (G.S.), Li Ka Shing Knowledge Institute, Departments of Medicine and Health Policy Management and Evaluation (HPME) and the Institute for Clinical Evaluative Sciences (ICES), St Michael's Hospital, University of Toronto, Ontario, Canada
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Barker-Collo S, Starkey N, Lawes CM, Feigin V, Senior H, Parag V. Neuropsychological Profiles of 5-Year Ischemic Stroke Survivors by Oxfordshire Stroke Classification and Hemisphere of Lesion. Stroke 2012; 43:50-5. [DOI: 10.1161/strokeaha.111.627182] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although the neuropsychological literature typically examines stroke outcomes by hemisphere of lesion, the medical literature provides classifications more closely linked to circulatory distribution impacted by stroke. This article examined profiles of cognitive function by hemisphere and by Oxfordshire Community Stroke Project stroke classification.
Methods—
This study included a sample of 315 5-year ischemic stroke survivors. Assessment included tests of verbal memory, visual memory, word finding/verbal fluency, abstract visual reasoning, executive functioning, and speed of processing.
Results—
The sample produced scores within 1 standard deviation of the normative mean on tests of abstract visual reasoning, verbal memory, and visual recall. Impaired performances were observed for executive function and processing speed. Profile analysis revealed no significant differences in overall cognitive performance or in the profile of performance across measures by hemisphere of lesion. However, groups defined by Oxfordshire Community Stroke Project categories produced significantly different cognitive profiles. Post hoc analyses indicate those with posterior stroke performed best overall on all tests except the Stroop Dots trial, whereas those with total anterior stroke produced significantly worse scores on tasks requiring visual abstract reasoning (Block Design, Rey Figure Copy), word finding (Boston Naming Test), and processing speed (Stroop Dots, Trails A).
Conclusions—
Oxfordshire Community Stroke Project stroke subtypes identified significant differences between groups, suggesting this classification system is of greater use than hemisphere of lesion in predicting poststroke cognitive outcomes.
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Affiliation(s)
- Suzanne Barker-Collo
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
| | - Nicola Starkey
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
| | - Carlene M.M. Lawes
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
| | - Valery Feigin
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
| | - Hugh Senior
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
| | - Varsha Parag
- From the Department of Psychology (S.B.C.), Faculty of Sciences, University of Auckland, Auckland, New Zealand; School of Psychology (N.S.), Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand; Clinical Trials Research Unit (C.M.M.L.), Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; National Institute for Stroke and Applied Neurosciences (V.F.), School of Rehabilitation and Occupation Studies, AUT University, Auckland, New
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