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Madsen TE, Ding L, Khoury JC, Haverbusch M, Woo D, Ferioli S, De Los Rios La Rosa F, Martini SR, Adeoye O, Khatri P, Flaherty ML, Mackey J, Mistry EA, Demel S, Coleman E, Jasne A, Slavin S, Walsh KB, Star M, Broderick JP, Kissela B, Kleindorfer DO. Trends Over Time in Stroke Incidence by Race in the Greater Cincinnati Northern Kentucky Stroke Study. Neurology 2024; 102:e208077. [PMID: 38546235 PMCID: PMC11097768 DOI: 10.1212/wnl.0000000000208077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/07/2023] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Understanding the current status of and temporal trends of stroke epidemiology by age, race, and stroke subtype is critical to evaluate past prevention efforts and to plan future interventions to eliminate existing inequities. We investigated trends in stroke incidence and case fatality over a 22-year time period. METHODS In this population-based stroke surveillance study, all cases of stroke in acute care hospitals within a 5-county population of southern Ohio/northern Kentucky in adults aged ≥20 years were ascertained during a full year every 5 years from 1993 to 2015. Temporal trends in stroke epidemiology were evaluated by age, race (Black or White), and subtype (ischemic stroke [IS], intracranial hemorrhage [ICH], or subarachnoid hemorrhage [SAH]). Stroke incidence rates per 100,000 individuals from 1993 to 2015 were calculated using US Census data and age-standardized, race-standardized, and sex-standardized as appropriate. Thirty-day case fatality rates were also reported. RESULTS Incidence rates for stroke of any type and IS decreased in the combined population and among White individuals (any type, per 100,000, 215 [95% CI 204-226] in 1993/4 to 170 [95% CI 161-179] in 2015, p = 0.015). Among Black individuals, incidence rates for stroke of any type decreased over the study period (per 100,000, 349 [95% CI 311-386] in 1993/4 to 311 [95% CI 282-340] in 2015, p = 0.015). Incidence of ICH was stable over time in the combined population and in race-specific subgroups, and SAH decreased in the combined groups and in White adults. Incidence rates among Black adults were higher than those of White adults in all time periods, and Black:White risk ratios were highest in adults in young and middle age groups. Case fatality rates were similar by race and by time period with the exception of SAH in which 30-day case fatality rates decreased in the combined population and White adults over time. DISCUSSION Stroke incidence is decreasing over time in both Black and White adults, an encouraging trend in the burden of cerebrovascular disease in the US population. Unfortunately, however, Black:White disparities have not decreased over a 22-year period, especially among younger and middle-aged adults, suggesting the need for more effective interventions to eliminate inequities by race.
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Affiliation(s)
- Tracy E Madsen
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Lili Ding
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Jane C Khoury
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Mary Haverbusch
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Daniel Woo
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Simona Ferioli
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Felipe De Los Rios La Rosa
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Sharyl R Martini
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Opeolu Adeoye
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Pooja Khatri
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Matthew L Flaherty
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Jason Mackey
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Eva A Mistry
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Stacie Demel
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Elisheva Coleman
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Adam Jasne
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Sabreena Slavin
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Kyle B Walsh
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Michael Star
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Joseph P Broderick
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Brett Kissela
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
| | - Dawn O Kleindorfer
- From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor
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9
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Madsen TE, Khoury JC, Leppert M, Alwell K, Moomaw CJ, Sucharew H, Woo D, Ferioli S, Martini S, Adeoye O, Khatri P, Flaherty M, De Los Rios La Rosa F, Mackey J, Mistry E, Demel SL, Coleman E, Jasne A, Slavin SJ, Walsh K, Star M, Broderick JP, Kissela BM, Kleindorfer DO. Temporal Trends in Stroke Incidence Over Time by Sex and Age in the GCNKSS. Stroke 2020; 51:1070-1076. [PMID: 32078459 DOI: 10.1161/strokeaha.120.028910] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background and Purpose- Sex differences in stroke incidence over time were previously reported from the GCNKSS (Greater Cincinnati/Northern Kentucky Stroke Study). We aimed to determine whether these differences continued through 2015 and whether they were driven by particular age groups. Methods- Within the GCNKSS population of 1.3 million, incident (first ever) strokes among residents ≥20 years of age were ascertained at all local hospitals during 5 periods: July 1993 to June 1994 and calendar years 1999, 2005, 2010, and 2015. Out-of-hospital cases were sampled. Sex-specific incidence rates per 100 000 were adjusted for age and race and standardized to the 2010 US Census. Trends over time by sex were compared (overall and age stratified). Sex-specific case fatality rates were also reported. Bonferroni corrections were applied for multiple comparisons. Results- Over the 5 study periods, there were 9733 incident strokes (56.3% women). For women, there were 229 (95% CI, 215-242) per 100 000 incident strokes in 1993/1994 and 174 (95% CI, 163-185) in 2015 (P<0.05), compared with 282 (95% CI, 263-301) in 1993/1994 to 211 (95% CI, 198-225) in 2015 (P<0.05) in men. Incidence rates decreased between the first and last study periods in both sexes for IS but not for intracerebral hemorrhage or subarachnoid hemorrhage. Significant decreases in stroke incidence occurred between the first and last study periods for both sexes in the 65- to 84-year age group and men only in the ≥85-year age group; stroke incidence increased for men only in the 20- to 44-year age group. Conclusions- Overall stroke incidence decreased from the early 1990s to 2015 for both sexes. Future studies should continue close surveillance of sex differences in the 20- to 44-year and ≥85-year age groups, and future stroke prevention strategies should target strokes in the young- and middle-age groups, as well as intracerebral hemorrhage.
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Affiliation(s)
- Tracy E Madsen
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.)
| | - Jane C Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K., H.S.)
| | - Michelle Leppert
- Department of Neurology, University of Colorado School of Medicine, Aurora (M.L.)
| | - Kathleen Alwell
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH
| | - Charles J Moomaw
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH
| | - Heidi Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K., H.S.)
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH.,UC Gardner Neuroscience Institute (D.W., S.F., O.A., P.K., M.F., S.L.D., J.P.B., B.M.K., D.O.K.)
| | - Simona Ferioli
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH.,UC Gardner Neuroscience Institute (D.W., S.F., O.A., P.K., M.F., S.L.D., J.P.B., B.M.K., D.O.K.)
| | - Sharyl Martini
- Department of Neurology, Baylor College of Medicine, Houston, TX (S.M.).,Veterans Affairs National Telestroke Program (S.M.)
| | - Opeolu Adeoye
- Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine, OH.,UC Gardner Neuroscience Institute (D.W., S.F., O.A., P.K., M.F., S.L.D., J.P.B., B.M.K., D.O.K.)
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH.,UC Gardner Neuroscience Institute (D.W., S.F., O.A., P.K., M.F., S.L.D., J.P.B., B.M.K., D.O.K.)
| | - Matthew Flaherty
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH.,UC Gardner Neuroscience Institute (D.W., S.F., O.A., P.K., M.F., S.L.D., J.P.B., B.M.K., D.O.K.)
| | | | - Jason Mackey
- Department of Neurology, Indiana University School of Medicine, Indianapolis (J.M.)
| | - Eva Mistry
- Department of Neurology, Vanderbilt University, Nashville, TN (E.M.)
| | - Stacie L Demel
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH.,UC Gardner Neuroscience Institute (D.W., S.F., O.A., P.K., M.F., S.L.D., J.P.B., B.M.K., D.O.K.)
| | - Elisheva Coleman
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH
| | - Adam Jasne
- Department of Neurology, Yale School of Medicine, New Haven, CT (A.J.)
| | - Sabreena J Slavin
- Department of Neurology, University of Kansas Medical Center, MO (S.J.S.)
| | - Kyle Walsh
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH
| | - Michael Star
- Department of Neurology, Soroka Medical Center, Beersheva, Israel (M.S.)
| | - Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH.,UC Gardner Neuroscience Institute (D.W., S.F., O.A., P.K., M.F., S.L.D., J.P.B., B.M.K., D.O.K.)
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH.,UC Gardner Neuroscience Institute (D.W., S.F., O.A., P.K., M.F., S.L.D., J.P.B., B.M.K., D.O.K.)
| | - Dawn O Kleindorfer
- Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., D.W., S.F., P.K., M.F., S.L.D., E.C., K.W., J.P.B., B.M.K., D.O.K.), University of Cincinnati College of Medicine, OH.,UC Gardner Neuroscience Institute (D.W., S.F., O.A., P.K., M.F., S.L.D., J.P.B., B.M.K., D.O.K.)
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