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Naghavi M, Ong KL, Aali A, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbasi-Kangevari M, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdollahifar MA, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abebe SS, Abedi A, Abegaz KH, Abhilash ES, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Abolmaali M, Abouzid M, Aboye GB, Abreu LG, Abrha WA, Abtahi D, Abu Rumeileh S, Abualruz H, Abubakar B, Abu-Gharbieh E, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Accrombessi MMK, Adal TG, Adamu AA, Addo IY, Addolorato G, Adebiyi AO, Adekanmbi V, Adepoju AV, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adeyinka DA, Adeyomoye OI, Admass BAA, Adnani QES, Adra S, Afolabi AA, Afzal MS, Afzal S, Agampodi SB, Agasthi P, Aggarwal M, Aghamiri S, Agide FD, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed LA, Ahmed MS, Ahmed MS, Ahmed MB, 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K, Deng X, Denova-Gutiérrez E, Deravi N, Dereje N, Dervenis N, Dervišević E, Des Jarlais DC, Desai HD, Desai R, Devanbu VGC, Dewan SMR, Dhali A, Dhama K, Dhimal M, Dhingra S, Dhulipala VR, Dias da Silva D, Diaz D, Diaz MJ, Dima A, Ding DD, Ding H, Dinis-Oliveira RJ, Dirac MA, Djalalinia S, Do THP, do Prado CB, Doaei S, Dodangeh M, Dodangeh M, Dohare S, Dokova KG, Dolecek C, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorostkar F, Dorsey ER, dos Santos WM, Doshi R, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Du M, Dube J, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dwyer-Lindgren L, Dzianach PA, Dziedzic AM, E'mar AR, Eboreime E, Ebrahimi A, Echieh CP, Edinur HA, Edvardsson D, Edvardsson K, Efendi D, Efendi F, Effendi DE, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, Elbarazi I, Elema TB, Elemam NM, Elgar FJ, Elgendy IY, ElGohary GMT, Elhabashy HR, Elhadi M, El-Huneidi W, Elilo LT, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emeto TI, Engelbert 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Ghahramani S, Ghailan KY, Ghasemi MR, Ghasempour Dabaghi G, Ghasemzadeh A, Ghashghaee A, Ghassemi F, Ghazy RM, Ghimire A, Ghoba S, Gholamalizadeh M, Gholamian A, Gholamrezanezhad A, Gholizadeh N, Ghorbani M, Ghorbani Vajargah P, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Ginindza TG, Girmay A, Glasbey JC, Gnedovskaya EV, Göbölös L, Godinho MA, Goel A, Golchin A, Goldust M, Golechha M, Goleij P, Gomes NGM, Gona PN, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Goulart BNG, Goyal A, Grada A, Graham SM, Grivna M, Grosso G, Guan SY, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Guimarães RA, Gulati S, Gunawardane DA, Gunturu S, Guo C, Gupta AK, Gupta B, Gupta MK, Gupta M, Gupta RD, Gupta R, Gupta S, Gupta VB, Gupta VK, Gupta VK, Gurmessa L, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Haddadi R, Hadei M, Hadi NR, Haep N, Hafezi-Nejad N, Hailu A, Haj-Mirzaian A, Halboub ES, Hall BJ, Haller S, Halwani R, Hamadeh RR, Hameed S, Hamidi S, Hamilton EB, Han C, Han Q, Hanif A, Hanifi N, 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A, Lai DTC, Lal DK, Lalloo R, Lallukka T, Lam H, Lám J, Landrum KR, Lanfranchi F, Lang JJ, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lassi ZS, Latief K, Latifinaibin K, Lauriola P, Le NHH, Le TTT, Le TDT, Ledda C, Ledesma JR, Lee M, Lee PH, Lee SW, Lee SWH, Lee WC, Lee YH, LeGrand KE, Leigh J, Leong E, Lerango TL, Li MC, Li W, Li X, Li Y, Li Z, Ligade VS, Likaka ATM, Lim LL, Lim SS, Lindstrom M, Linehan C, Liu C, Liu G, Liu J, Liu R, Liu S, Liu X, Liu X, Llanaj E, Loftus MJ, López-Bueno R, Lopukhov PD, Loreche AM, Lorkowski S, Lotufo PA, Lozano R, Lubinda J, Lucchetti G, Lugo A, Lunevicius R, Ma ZF, Maass KL, Machairas N, Machoy M, Madadizadeh F, Madsen C, Madureira-Carvalho ÁM, Maghazachi AA, Maharaj SB, Mahjoub S, Mahmoud MA, Mahmoudi A, Mahmoudi E, Mahmoudi R, Majeed A, Makhdoom IF, Malakan Rad E, Maled V, Malekzadeh R, Malhotra AK, Malhotra K, Malik AA, Malik I, Malta DC, Mamun AA, Mansouri P, Mansournia MA, Mantovani LG, Maqsood S, Marasini 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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2100-2132. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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N, Zakzuk J, Zamagni G, Zaman BA, Zaman SB, Zamora N, Zand R, Zandi M, Zandieh GGZ, Zanghì A, Zare I, Zastrozhin MS, Zeariya MGM, Zeng Y, Zhai C, Zhang C, Zhang H, Zhang H, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao Y, Zhao Y, Zheng P, Zhong C, Zhou J, Zhu B, Zhu Z, Ziaeefar P, Zielińska M, Zou Z, Zumla A, Zweck E, Zyoud SH, Lim SS, Murray CJL. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:1989-2056. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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Mahadevan JJ, Psaltis PJ, Thrift AG, Kleinig TJ. Incidence of thrombocytopenia-associated cerebral venous sinus thrombosis: a population-based study. BMJ Neurol Open 2024; 6:e000605. [PMID: 38757112 PMCID: PMC11097850 DOI: 10.1136/bmjno-2023-000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives The identification of SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia (VITT) followed the recognition of a hitherto uncommon clinical syndrome frequently associated with cerebral venous sinus thrombosis (CVST), termed 'thrombosis with thrombocytopenia' syndrome (TTS). While anecdotally recognised as rare, the background incidence of TTS is unknown. We therefore aimed to investigate the background incidence of CVST with TTS in a large, well-defined population-based CVST cohort. Methods We performed an analysis of our previously obtained retrospective population-based cohort of patients with CVST from Adelaide, Australia (2005-2011, comprising an adult population of 953 390) to identify the background incidence of CVST associated with TTS. Results Among 105 people with CVST, the background population-based incidence of TTS-associated CVST was 1.2 per million per year (95% CI 0.5 to 2.4). A single case of a severe CVST VITT-like syndrome with multiorgan thrombosis was identified, occurring 3 weeks postrotavirus infection. Conclusions In our population-based study, the background incidence of CVST with associated TTS was very low, and the sole clinically severe case with multiorgan thrombosis occurred following a rotaviral precipitant. Our study establishes a benchmark against which to measure future potential 'TTS' clusters and suggests that viruses other than adenovirus may trigger this syndrome.
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Affiliation(s)
- Joshua J Mahadevan
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Neurology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter J Psaltis
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Timothy J Kleinig
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Neurology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Birhanu MM, Zengin A, Joshi R, Evans RG, Kalyanram K, Kartik K, Riddell MA, Suresh O, Srikanth VK, Arabshahi S, Thomas N, Thrift AG. Risk factors for incident cardiovascular events and their population attributable fractions in rural India: The Rishi Valley Prospective Cohort Study. Trop Med Int Health 2024; 29:377-389. [PMID: 38403844 DOI: 10.1111/tmi.13981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE We prospectively determined incident cardiovascular events and their association with risk factors in rural India. METHODS We followed up with 7935 adults from the Rishi Valley Prospective Cohort Study to identify incident cardiovascular events. Using Cox proportional hazards regression, we estimated hazard ratios (HRs) with 95% confidence intervals (95% CI) for associations between potential risk factors and cardiovascular events. Population attributable fractions (PAFs) for risk factors were estimated using R ('averisk' package). RESULTS Of the 4809 participants without prior cardiovascular disease, 57.7% were women and baseline mean age was 45.3 years. At follow-up (median of 4.9 years, 23,180 person-years [PYs]), 202 participants developed cardiovascular events, equating to an incidence of 8.7 cardiovascular events/1000 PYs. Incidence was greater in those with hypertension (hazard ratio [HR] [95% CI] 1.73 [1.21-2.49], adjusted PAF 18%), diabetes (1.96 [1.15-3.36], 4%) or central obesity (1.77 [1.23, 2.54], 9%) which together accounted for 31% of the PAF. Non-traditional risk factors such as night sleeping hours and number of children accounted for 16% of the PAF. CONCLUSIONS Both traditional and non-traditional cardiovascular risk factors are important contributors to incident cardiovascular events in rural India. Interventions targeted to these factors could assist in reducing the incidence of cardiovascular events.
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Affiliation(s)
- Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, New Delhi, India
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Michaela A Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Velandai K Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Simin Arabshahi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Birhanu MM, Zengin A, Evans RG, Joshi R, Kalyanram K, Kartik K, Danaei G, Barr E, Riddell MA, Suresh O, Srikanth VK, Arabshahi S, Thomas N, Thrift AG. Comparison of the performance of cardiovascular risk prediction tools in rural India: the Rishi Valley Prospective Cohort Study. Eur J Prev Cardiol 2024; 31:723-731. [PMID: 38149975 DOI: 10.1093/eurjpc/zwad404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/07/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023]
Abstract
AIMS We compared the performance of cardiovascular risk prediction tools in rural India. METHODS AND RESULTS We applied the World Health Organization Risk Score (WHO-RS) tools, Australian Risk Score (ARS), and Global risk (Globorisk) prediction tools to participants aged 40-74 years, without prior cardiovascular disease, in the Rishi Valley Prospective Cohort Study, Andhra Pradesh, India. Cardiovascular events during the 5-year follow-up period were identified by verbal autopsy (fatal events) or self-report (non-fatal events). The predictive performance of each tool was assessed by discrimination and calibration. Sensitivity and specificity of each tool for identifying high-risk individuals were assessed using a risk score cut-off of 10% alone or this 10% cut-off plus clinical risk criteria of diabetes in those aged >60 years, high blood pressure, or high cholesterol. Among 2333 participants (10 731 person-years of follow-up), 102 participants developed a cardiovascular event. The 5-year observed risk was 4.4% (95% confidence interval: 3.6-5.3). The WHO-RS tools underestimated cardiovascular risk but the ARS overestimated risk, particularly in men. Both the laboratory-based (C-statistic: 0.68 and χ2: 26.5, P = 0.003) and non-laboratory-based (C-statistic: 0.69 and χ2: 20.29, P = 0.003) Globorisk tools showed relatively good discrimination and agreement. Addition of clinical criteria to a 10% risk score cut-off improved the diagnostic accuracy of all tools. CONCLUSION Cardiovascular risk prediction tools performed disparately in a setting of disadvantage in rural India, with the Globorisk performing best. Addition of clinical criteria to a 10% risk score cut-off aids assessment of risk of a cardiovascular event in rural India. LAY SUMMARY In a cohort of people without prior cardiovascular disease, tools used to predict the risk of cardiovascular events varied widely in their ability to accurately predict who would develop a cardiovascular event.The Globorisk, and to a lesser extent the ARS, tools could be appropriate for this setting in rural India.Adding clinical criteria, such as sustained high blood pressure, to a cut-off of 10% risk of a cardiovascular event within 5 years could improve identification of individuals who should be monitored closely and provided with appropriate preventive medications.
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Affiliation(s)
- Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Melbourne, Victoria 3168, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Melbourne, Victoria 3168, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rohina Joshi
- Faculty of Medicine, School of Population Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- George Institute for Global Health, New Delhi, India
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Madanapalle, Chittoor District, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Madanapalle, Chittoor District, Andhra Pradesh, India
| | - Goodarz Danaei
- Department of Global Health and Population and Epidemiology, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | - Elizabeth Barr
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Michaela A Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Melbourne, Victoria 3168, Australia
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Melbourne, Victoria 3168, Australia
- Rishi Valley Rural Health Centre, Madanapalle, Chittoor District, Andhra Pradesh, India
| | - Velandai K Srikanth
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Monash University and Peninsual Health, Melbourne, Victoria, Australia
| | - Simin Arabshahi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Melbourne, Victoria 3168, Australia
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 5, Block E, Monash Medical Centre, 246 Clayton Road, Melbourne, Victoria 3168, Australia
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Steinmetz JD, Seeher KM, Schiess N, Nichols E, Cao B, Servili C, Cavallera V, Cousin E, Hagins H, Moberg ME, Mehlman ML, Abate YH, Abbas J, Abbasi MA, Abbasian M, Abbastabar H, Abdelmasseh M, Abdollahi M, Abdollahi M, Abdollahifar MA, Abd-Rabu R, Abdulah DM, Abdullahi A, Abedi A, Abedi V, Abeldaño Zuñiga RA, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Aboyans V, Abrha WA, Abualhasan A, Abu-Gharbieh E, Aburuz S, Adamu LH, Addo IY, Adebayo OM, Adekanmbi V, Adekiya TA, Adikusuma W, Adnani QES, Adra S, Afework T, Afolabi AA, Afraz A, Afzal S, Aghamiri S, Agodi A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad S, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed JQ, Ahmed LA, Ahmed MB, Ahmed SA, Ajami M, Aji B, Ajumobi O, Akade SE, Akbari M, Akbarialiabad H, Akhlaghi S, Akinosoglou K, Akinyemi RO, Akonde M, Al Hasan SM, Alahdab F, AL-Ahdal TMA, Al-amer RM, Albashtawy M, AlBataineh MT, Aldawsari KA, Alemi H, Alemi S, Algammal AM, Al-Gheethi AAS, Alhalaiqa FAN, Alhassan RK, Ali A, Ali EA, Ali L, Ali MU, Ali MM, Ali R, Ali S, Ali SSS, Ali Z, Alif SM, Alimohamadi Y, Aliyi AA, Aljofan M, Aljunid SM, Alladi S, Almazan JU, Almustanyir S, Al-Omari B, Alqahtani JS, Alqasmi I, Alqutaibi AY, Al-Shahi Salman R, Altaany Z, Al-Tawfiq JA, Altirkawi KA, Alvis-Guzman N, Al-Worafi YM, Aly H, Aly S, Alzoubi KH, Amani R, Amindarolzarbi A, Amiri S, Amirzade-Iranaq MH, Amu H, Amugsi DA, Amusa GA, Amzat J, Ancuceanu R, Anderlini D, Anderson DB, Andrei CL, Androudi S, Angappan D, Angesom TW, Anil A, Ansari-Moghaddam A, Anwer R, Arafat M, Aravkin AY, Areda D, Ariffin H, Arifin H, Arkew M, Ärnlöv J, Arooj M, Artamonov AA, Artanti KD, Aruleba RT, Asadi-Pooya AA, Asena TF, Asghari-Jafarabadi M, Ashraf M, Ashraf T, Atalell KA, Athari SS, Atinafu BTT, Atorkey P, Atout MMW, Atreya A, Aujayeb A, Avan A, Ayala Quintanilla BP, Ayatollahi H, Ayinde OO, Ayyoubzadeh SM, Azadnajafabad S, Azizi Z, Azizian K, Azzam AY, Babaei M, Badar M, Badiye AD, Baghdadi S, Bagherieh S, Bai R, Baig AA, Balakrishnan S, Balalla S, Baltatu OC, Banach M, Bandyopadhyay S, Banerjee I, Baran MF, Barboza MA, Barchitta M, Bardhan M, Barker-Collo SL, Bärnighausen TW, Barrow A, Bashash D, Bashiri H, Bashiru HA, Basiru A, Basso JD, Basu S, Batiha AMM, Batra K, Baune BT, Bedi N, Begde A, Begum T, Behnam B, Behnoush AH, Beiranvand M, Béjot Y, Bekele A, Belete MA, Belgaumi UI, Bemanalizadeh M, Bender RG, Benfor B, Bennett DA, Bensenor IM, Berice B, Bettencourt PJG, Beyene KA, Bhadra A, Bhagat DS, Bhangdia K, Bhardwaj N, Bhardwaj P, Bhargava A, Bhaskar S, Bhat AN, Bhat V, Bhatti GK, Bhatti JS, Bhatti R, Bijani A, Bikbov B, Bilalaga MM, Biswas A, Bitaraf S, Bitra VR, Bjørge T, Bodolica V, Bodunrin AO, Boloor A, Braithwaite D, Brayne C, Brenner H, Briko A, Bringas Vega ML, Brown J, Budke CM, Buonsenso D, Burkart K, Burns RA, Bustanji Y, Butt MH, Butt NS, Butt ZA, Cabral LS, Caetano dos Santos FL, Calina D, Campos-Nonato IR, Cao C, Carabin H, Cárdenas R, Carreras G, Carvalho AF, Castañeda-Orjuela CA, Casulli A, Catalá-López F, Catapano AL, Caye A, Cegolon L, Cenderadewi M, Cerin E, Chacón-Uscamaita PRU, Chan JSK, Chanie GS, Charan J, Chattu VK, Chekol Abebe E, Chen H, Chen J, Chi G, Chichagi F, Chidambaram SB, Chimoriya R, Ching PR, Chitheer A, Chong YY, Chopra H, Choudhari SG, Chowdhury EK, Chowdhury R, Christensen H, Chu DT, Chukwu IS, Chung E, Coberly K, Columbus A, Comachio J, Conde J, Cortesi PA, Costa VM, Couto RAS, Criqui MH, Cruz-Martins N, Dabbagh Ohadi MA, Dadana S, Dadras O, Dai X, Dai Z, D'Amico E, Danawi HA, Dandona L, Dandona R, Darwish AH, Das S, Das S, Dascalu AM, Dash NR, Dashti M, De la Hoz FP, de la Torre-Luque A, De Leo D, Dean FE, Dehghan A, Dehghan A, Dejene H, Demant D, Demetriades AK, Demissie S, Deng X, Desai HD, Devanbu VGC, Dhama K, Dharmaratne SD, Dhimal M, Dias da Silva D, Diaz D, Dibas M, Ding DD, Dinu M, Dirac MA, Diress M, Do TC, Do THP, Doan KDK, Dodangeh M, Doheim MF, Dokova KG, Dongarwar D, Dsouza HL, Dube J, Duraisamy S, Durojaiye OC, Dutta S, Dziedzic AM, Edinur HA, Eissazade N, Ekholuenetale M, Ekundayo TC, El Nahas N, El Sayed I, Elahi Najafi MA, Elbarazi I, Elemam NM, Elgar FJ, Elgendy IY, Elhabashy HR, Elhadi M, Elilo LT, Ellenbogen RG, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emamverdi M, Emeto TI, Endres M, Esezobor CI, Eskandarieh S, Fadaei A, Fagbamigbe AF, Fahim A, Faramarzi A, Fares J, Farjoud Kouhanjani M, Faro A, Farzadfar F, Fatehizadeh A, Fathi M, Fathi S, Fatima SAF, Feizkhah A, Fereshtehnejad SM, Ferrari AJ, Ferreira N, Fetensa G, Firouraghi N, Fischer F, Fonseca AC, Force LM, Fornari A, Foroutan B, Fukumoto T, Gadanya MA, Gaidhane AM, Galali Y, Galehdar N, Gan Q, Gandhi AP, Ganesan B, Gardner WM, Garg N, Gau SY, Gautam RK, Gebre T, Gebrehiwot M, Gebremeskel GG, Gebreslassie HG, Getacher L, Ghaderi Yazdi B, Ghadirian F, Ghaffarpasand F, Ghanbari R, Ghasemi M, Ghazy RM, Ghimire S, Gholami A, Gholamrezanezhad A, Ghotbi E, Ghozy S, Gialluisi A, Gill PS, Glasstetter LM, Gnedovskaya EV, Golchin A, Golechha M, Goleij P, Golinelli D, Gomes-Neto M, Goulart AC, Goyal A, Gray RJ, Grivna M, Guadie HA, Guan B, Guarducci G, Guicciardi S, Gunawardane DA, Guo H, Gupta B, Gupta R, Gupta S, Gupta VB, Gupta VK, Gutiérrez RA, Habibzadeh F, Hachinski V, Haddadi R, Hadei M, Hadi NR, Haep N, Haile TG, Haj-Mirzaian A, Hall BJ, Halwani R, Hameed S, Hamiduzzaman M, Hammoud A, Han H, Hanifi N, Hankey GJ, Hannan MA, Hao J, Harapan H, Hareru HE, Hargono A, Harlianto NI, Haro JM, Hartman NN, Hasaballah AI, Hasan F, Hasani H, Hasanian M, Hassan A, Hassan S, Hassanipour S, Hassankhani H, Hassen MB, Haubold J, Hay SI, Hayat K, Hegazy MI, Heidari G, Heidari M, Heidari-Soureshjani R, Hesami H, Hezam K, Hiraike Y, Hoffman HJ, Holla R, Hopf KP, Horita N, Hossain MM, Hossain MB, Hossain S, Hosseinzadeh H, Hosseinzadeh M, Hostiuc S, Hu C, Huang J, Huda MN, Hussain J, Hussein NR, Huynh HH, Hwang BF, Ibitoye SE, Ilaghi M, Ilesanmi OS, Ilic IM, Ilic MD, Immurana M, Iravanpour F, Islam SMS, Ismail F, Iso H, Isola G, Iwagami M, Iwu CCD, Iyer M, Jaan A, Jacob L, Jadidi-Niaragh F, Jafari M, Jafarinia M, Jafarzadeh A, Jahankhani K, Jahanmehr N, Jahrami H, Jaiswal A, Jakovljevic M, Jamora RDG, Jana S, Javadi N, Javed S, Javeed S, Jayapal SK, Jayaram S, Jiang H, Johnson CO, Johnson WD, Jokar M, Jonas JB, Joseph A, Joseph N, Joshua CE, Jürisson M, Kabir A, Kabir Z, Kabito GG, Kadashetti V, Kafi F, Kalani R, Kalantar F, Kaliyadan F, Kamath A, Kamath S, Kanchan T, Kandel A, Kandel H, Kanmodi KK, Karajizadeh M, Karami J, Karanth SD, Karaye IM, Karch A, Karimi A, Karimi H, Karimi Behnagh A, Kasraei H, Kassebaum NJ, Kauppila JH, Kaur H, Kaur N, Kayode GA, Kazemi F, Keikavoosi-Arani L, Keller C, Keykhaei M, Khadembashiri MA, Khader YS, Khafaie MA, Khajuria H, Khalaji A, Khamesipour F, Khammarnia M, Khan M, Khan MAB, Khan YH, Khan Suheb MZ, Khanmohammadi S, Khanna T, Khatab K, Khatatbeh H, Khatatbeh MM, Khateri S, Khatib MN, Khayat Kashani HR, Khonji MS, khorashadizadeh F, Khormali M, Khubchandani J, Kian S, Kim G, Kim J, Kim MS, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kivimäki M, Kochhar S, Kolahi AA, Koly KN, Kompani F, Koroshetz WJ, Kosen S, Kourosh Arami M, Koyanagi A, Kravchenko MA, Krishan K, Krishnamoorthy V, Kuate Defo B, Kuddus MA, Kumar A, Kumar GA, Kumar M, Kumar N, Kumsa NB, Kundu S, Kurniasari MD, Kusuma D, Kuttikkattu A, Kyu HH, La Vecchia C, Ladan MA, Lahariya C, Laksono T, Lal DK, Lallukka T, Lám J, Lami FH, Landires I, Langguth B, Lasrado S, Latief K, Latifinaibin K, Lau KMM, Laurens MB, Lawal BK, Le LKD, Le TTT, Ledda C, Lee M, Lee SW, Lee SW, Lee WC, Lee YH, Leonardi M, Lerango TL, Li MC, Li W, Ligade VS, Lim SS, Linehan C, Liu C, Liu J, Liu W, Lo CH, Lo WD, Lobo SW, Logroscino G, Lopes G, Lopukhov PD, Lorenzovici L, Lorkowski S, Loureiro JA, Lubinda J, Lucchetti G, Lutzky Saute R, Ma ZF, Mabrok M, Machoy M, Madadizadeh F, Magdy Abd El Razek M, Maghazachi AA, Maghbouli N, Mahjoub S, Mahmoudi M, Majeed A, Malagón-Rojas JN, Malakan Rad E, Malhotra K, Malik AA, Malik I, Mallhi TH, Malta DC, Manilal A, Mansouri V, Mansournia MA, Marasini BP, Marateb HR, Maroufi SF, Martinez-Raga J, Martini S, Martins-Melo FR, Martorell M, März W, Marzo RR, Massano J, Mathangasinghe Y, Mathews E, Maude RJ, Maugeri A, Maulik PK, Mayeli M, Mazaheri M, McAlinden C, McGrath JJ, Meena JK, Mehndiratta MM, Mendez-Lopez MAM, Mendoza W, Mendoza-Cano O, Menezes RG, Merati M, Meretoja A, Merkin A, Mersha AM, Mestrovic T, Mi T, Miazgowski T, Michalek IM, Mihretie ET, Minh LHN, Mirfakhraie R, Mirica A, Mirrakhimov EM, Mirzaei M, Misganaw A, Misra S, Mithra P, Mizana BA, Mohamadkhani A, Mohamed NS, Mohammadi E, Mohammadi H, Mohammadi S, Mohammadi S, Mohammadshahi M, Mohammed M, Mohammed S, Mohammed S, Mohan S, Mojiri-forushani H, Moka N, Mokdad AH, Molinaro S, Möller H, Monasta L, Moniruzzaman M, Montazeri F, Moradi M, Moradi Y, Moradi-Lakeh M, Moraga P, Morovatdar N, Morrison SD, Mosapour A, Mosser JF, Mossialos E, Motaghinejad M, Mousavi P, Mousavi SE, Mubarik S, Muccioli L, Mughal F, Mukoro GD, Mulita 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Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol 2024; 23:344-381. [PMID: 38493795 PMCID: PMC10949203 DOI: 10.1016/s1474-4422(24)00038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. FUNDING Bill & Melinda Gates Foundation.
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Michels N, Mikkel K, Miłkowska K, Miller JC, Milushkina O, Minderico CS, Mini GK, Miquel JF, Mirjalili MR, Mirkopoulou D, Mirrakhimov E, Mišigoj-Duraković M, Mistretta A, Mocanu V, Modesti PA, Moghaddam SS, Mohamed SF, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohanna S, Mohd Yusoff MF, Mohebbi I, Moitry M, Møllehave LT, Møller NC, Molnár D, Momenan A, Mondo CK, Monroy-Valle M, Montenegro Mendoza RA, Monterrubio-Flores E, Monyeki KDK, Moon JS, Moosazadeh M, Mopa HT, Moradpour F, Moreira LB, Morejon A, Moreno LA, Morey F, Morgan K, Morin SN, Mortensen EL, Moschonis G, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Mota-Pinto A, Mota J, Motlagh ME, Motta J, Moura-dos-Santos MA, Movsesyan Y, Mridha MK, Msyamboza KP, Mu TT, Muc M, Muca F, Mugoša B, Muiesan ML, Müller-Nurasyid M, Münzel T, Mursu J, Murtagh EM, Musa KI, Musić Milanović S, Musil V, Musinguzi G, Muyer MT, Nabipour I, Nagel G, Najafi F, Nakamura H, Nalecz H, Námešná J, Nang EEK, Nangia VB, Nankap M, Narake S, Narayan KMV, Nardone P, Naseri T, Nathalie M, Neal WA, Neelapaichit N, Nejatizadeh A, Nekkantti C, Nelis K, Nenko I, Neovius M, Nervi F, Ng TP, Nguyen CT, Nguyen ND, Nguyen QN, Ni MY, Nicolescu R, Nie P, Nieto-Martínez RE, Nikitin YP, Ning G, Ninomiya T, Nishi N, Nishtar S, Noale M, Noboa OA, Nogueira H, Nordendahl M, Nordestgaard BG, Norton KI, Noto D, Nowak-Szczepanska N, Nsour MA, Nuhoğlu I, Nunes B, Nurk E, Nuwaha F, Nyirenda M, O'Neill TW, O'Reilly D, Obreja G, Ochimana C, Ochoa-Avilés AM, Oda E, Odili AN, Oh K, Ohara K, Ohlsson C, Ohtsuka R, Olafsson Ö, Oldenburg B, Olinto MTA, Oliveira IO, Omar MA, Omar SM, Onat A, Ong SK, Onland-Moret NC, Ono LM, Onodugo O, Ordunez P, Ornelas R, Ortiz AP, Ortiz PJ, Osler M, Osmond C, Ostojic SM, Ostovar A, Otero JA, Ottendahl CB, Otu A, Overvad K, Owusu-Dabo E, Oyeyemi AY, Oyeyemi AL, Paccaud FM, Padez CP, Pagkalos I, Pahomova E, de Paiva KM, Pająk A, Pajula N, Palloni A, Palmieri L, Pan WH, Panda-Jonas S, Pandey A, Pang Z, Panza F, Paoli M, Papadopoulou SK, Papandreou D, Pareja RG, Park SW, Park S, Parnell WR, Parsaeian M, Pascanu IM, Pasquet P, Patel ND, Pattussi M, Pavlyshyn H, Pechlaner R, Pećin I, Pednekar MS, Pedro JM, Peer N, Peixoto SV, Peltonen M, Pereira AC, Peres MA, Perez-Londoño A, Pérez CM, Peterkova V, Peters A, Petkeviciene J, Petrauskiene A, Petrovna Kovtun O, Pettenuzzo E, Peykari N, Pfeiffer N, Phall MC, Pham ST, Phiri FP, Pichardo RN, Pierannunzio D, Pierre-Marie P, Pigeot I, Pikhart H, Pilav A, Piler P, Pilotto L, Pistelli F, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Platonova AG, Poh BK, Pohlabeln H, Polka NS, Pop RM, Popkin BM, Popovic SR, Porta M, Posch G, Poudyal A, Poulimeneas D, Pouraram H, Pourfarzi F, Pourshams A, Poustchi H, Price AJ, Price JF, Prista A, Providencia R, Puder JJ, Pudule I, Puhakka S, Puiu M, Punab M, Qadir MS, Qasrawi RF, Qiao Q, Qorbani M, Quintana HK, Quiroga-Padilla PJ, Quoc Bao T, Rach S, Radic I, Radisauskas R, Rahimikazerooni S, Rahman M, Rahman M, Raitakari O, Raj M, Rajabov T, Rakhmatulloev S, Rakovac I, Ramachandra Rao S, Ramachandran A, Ramadan OPC, Ramires VV, Ramirez-Zea M, Ramke J, Ramos E, Ramos R, Rampal L, Rampal S, Ramsay SE, Rangelova LS, Rarra V, Rascon-Pacheco RA, Rashidi MM, Rech CR, Redon J, Reganit PFM, Regecová V, Renner JDP, Repasy JA, Reuter CP, Revilla L, Reynolds A, Rezaei N, Rezaianzadeh A, Rho Y, Ribas-Barba L, Ribeiro R, Riboli E, Rigo F, Rigotti A, Rinaldo N, Rinke de Wit TF, Risérus U, Rito AI, Ritti-Dias RM, Rivera JA, Roa RG, Robinson L, Roccaldo R, Rodrigues D, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Rohner F, Rojas-Martinez R, Rojroongwasinkul N, Romaguera D, Romeo EL, Rosario RV, Rosengren A, Rouse I, Rouzier V, Roy JGR, Ruano MH, Rubinstein A, Rühli FJ, Ruidavets JB, Ruiz-Betancourt BS, Ruiz-Castell M, Ruiz Moreno E, Rusakova IA, Rusek W, Russell Jonsson K, Russo P, Rust P, Rutkowski M, Saamel M, Saar CG, 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Sharman A, Shaw JE, Shayanrad A, Shayesteh AA, Shengelia L, Shi Z, Shibuya K, Shimizu-Furusawa H, Shimony T, Shiri R, Shrestha N, Si-Ramlee K, Siani A, Siantar R, Sibai AM, Sidossis LS, Silitrari N, Silva AM, Silva CRDM, Silva DAS, Silva KS, Sim X, Simon M, Simons J, Simons LA, Sjöberg A, Sjöström M, Skoblina EV, Skoblina NA, Slazhnyova T, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, So HK, Soares FC, Sobek G, Sobngwi E, Sodemann M, Söderberg S, Soekatri MYE, Soemantri A, Sofat R, Solfrizzi V, Solovieva YV, Somi MH, Sonestedt E, Song Y, Soofi S, Sørensen TIA, Sørgjerd EP, Sossa Jérome C, Soto-Rojas VE, Soumaré A, Sousa-Poza A, Sovic S, Sparboe-Nilsen B, Sparrenberger K, Spencer PR, Spinelli A, Spiroski I, Staessen JA, Stamm H, Stang A, Starc G, Staub K, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Steinsbekk S, Stergiou GS, Stessman J, Stevanović R, Stieber J, Stöckl D, Stokwiszewski J, Stoyanova E, Stratton G, Stronks K, Strufaldi MW, Sturua L, Suárez-Medina R, 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Weghuber D, Wei W, Weres A, Werner B, Westbury LD, Whincup PH, Wichstrøm L, Wickramasinghe K, Widhalm K, Widyahening IS, Więcek A, Wild PS, Wilks RJ, Willeit J, Willeit P, Williams J, Wilsgaard T, Wirth JP, Wojtyniak B, Woldeyohannes M, Wolf K, Wong-McClure RA, Wong A, Wong EB, Wong JE, Wong TY, Woo J, Woodward M, Wu FC, Wu HY, Wu J, Wu LJ, Wu S, Wyszyńska J, Xu H, Xu L, Yaacob NA, Yamborisut U, Yan L, Yan W, Yang L, Yang X, Yang Y, Yardim N, Yasuharu T, Yépez García M, Yiallouros PK, Yngve A, Yoosefi M, Yoshihara A, Yotov Y, You QS, You SL, Younger-Coleman NO, Yu YL, Yu Y, Yusof SM, Yusoff AF, Zaccagni L, Zafiropulos V, Zainuddin AA, Zakavi SR, Zamani F, Zambon S, Zampelas A, Zamrazilová H, Zapata ME, Zargar AH, Zaw KK, Zayed AA, Zdrojewski T, Żegleń M, Zejglicova K, Zeljkovic Vrkic T, Zeng Y, Zentai A, Zhang B, Zhang L, Zhang ZY, Zhao D, Zhao MH, Zhao W, Zhecheva YV, Zhen S, Zheng W, Zheng Y, Zholdin B, Zhou M, Zhu D, Zimmet P, Zins M, Zitt E, Zocalo Y, Zoghlami N, Zuñiga Cisneros J, Zuziak M, Ezzati M. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet 2024; 403:1027-1050. [PMID: 38432237 PMCID: PMC7615769 DOI: 10.1016/s0140-6736(23)02750-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. METHODS We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). FINDINGS From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. INTERPRETATION The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. FUNDING UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.
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Balabanski AH, Dos Santos A, Woods JA, Mutimer CA, Thrift AG, Kleinig TJ, Suchy-Dicey AM, Siri SRA, Boden-Albala B, Krishnamurthi RV, Feigin VL, Buchwald D, Ranta A, Mienna CS, Zavaleta-Cortijo C, Churilov L, Burchill L, Zion D, Longstreth WT, Tirschwell DL, Anand SS, Parsons MW, Brown A, Warne DK, Harwood M, Barber PA, Katzenellenbogen JM. Incidence of Stroke in Indigenous Populations of Countries With a Very High Human Development Index: A Systematic Review. Neurology 2024; 102:e209138. [PMID: 38354325 DOI: 10.1212/wnl.0000000000209138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/01/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular disease contributes significantly to disease burden among many Indigenous populations. However, data on stroke incidence in Indigenous populations are sparse. We aimed to investigate what is known of stroke incidence in Indigenous populations of countries with a very high Human Development Index (HDI), locating the research in the broader context of Indigenous health. METHODS We identified population-based stroke incidence studies published between 1990 and 2022 among Indigenous adult populations of developed countries using PubMed, Embase, and Global Health databases, without language restriction. We excluded non-peer-reviewed sources, studies with fewer than 10 Indigenous people, or not covering a 35- to 64-year minimum age range. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. We assessed quality using "gold standard" criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and CONSIDER criteria for reporting of Indigenous health research. An Indigenous Advisory Board provided oversight for the study. RESULTS From 13,041 publications screened, 24 studies (19 full-text articles, 5 abstracts) from 7 countries met the inclusion criteria. Age-standardized stroke incidence rate ratios were greater in Aboriginal and Torres Strait Islander Australians (1.7-3.2), American Indians (1.2), Sámi of Sweden/Norway (1.08-2.14), and Singaporean Malay (1.7-1.9), compared with respective non-Indigenous populations. Studies had substantial heterogeneity in design and risk of bias. Attack rates, male-female rate ratios, and time trends are reported where available. Few investigators reported Indigenous stakeholder involvement, with few studies meeting any of the CONSIDER criteria for research among Indigenous populations. DISCUSSION In countries with a very high HDI, there are notable, albeit varying, disparities in stroke incidence between Indigenous and non-Indigenous populations, although there are gaps in data availability and quality. A greater understanding of stroke incidence is imperative for informing effective societal responses to socioeconomic and health disparities in these populations. Future studies into stroke incidence in Indigenous populations should be designed and conducted with Indigenous oversight and governance to facilitate improved outcomes and capacity building. REGISTRATION INFORMATION PROSPERO registration: CRD42021242367.
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Affiliation(s)
- Anna H Balabanski
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Angela Dos Santos
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - John A Woods
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Chloe A Mutimer
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Amanda G Thrift
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Timothy J Kleinig
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Astrid M Suchy-Dicey
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Susanna Ragnhild A Siri
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Bernadette Boden-Albala
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Rita V Krishnamurthi
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Valery L Feigin
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Dedra Buchwald
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Annemarei Ranta
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Christina S Mienna
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Carol Zavaleta-Cortijo
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Leonid Churilov
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Luke Burchill
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Deborah Zion
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - W T Longstreth
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - David L Tirschwell
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Sonia S Anand
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Mark W Parsons
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Alex Brown
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Donald K Warne
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Matire Harwood
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - P Alan Barber
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
| | - Judith M Katzenellenbogen
- From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth
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Balabanski AH, Nedkoff L, Thrift AG, Kleinig TJ, Brown A, Pearson O, Guthridge S, Dos Santos A, Katzenellenbogen JM. Determining the Optimal Methodology for Identifying Incident Stroke Deaths Using Administrative Datasets Within Australia. Heart Lung Circ 2024:S1443-9506(24)00050-7. [PMID: 38458934 DOI: 10.1016/j.hlc.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND AND AIM Quantifying stroke incidence and mortality is crucial for disease surveillance and health system planning. Administrative data offer a cost-effective alternative to "gold standard" population-based studies. However, the optimal methodology for establishing stroke deaths from administrative data remains unclear. We aimed to determine the optimal method for identifying stroke-related deaths in administrative datasets as the fatal component of stroke incidence, comparing counts derived using underlying and all causes of death (CoD). METHOD Using whole-population multijurisdictional person-level linked data from hospital and death datasets from South Australia, the Northern Territory, and Western Australia, we identified first-ever stroke events between 2012 and 2015, using underlying CoD and all CoD to identify fatal stroke counts. We determined the 28-day case fatality for both counts and compared results with gold standard Australian population-based stroke incidence studies. RESULTS The total number of incident stroke events was 16,150 using underlying CoD and 18,074 using all CoD. Case fatality was 24.7% and 32.7% using underlying and all CoD, respectively. Case fatality using underlying CoD was similar to that observed in four Australian "gold standard" population-based studies (20%-24%). CONCLUSIONS Underlying CoD generates fatal incident stroke estimates more consistent with population-based studies than estimates based on stroke deaths identified from all-cause fields in death registers.
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Affiliation(s)
- Anna H Balabanski
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic, Australia; Department of Neuroscience, The Central Clinical School, Monash University & Alfred Health, Melbourne, Vic, Australia.
| | - Lee Nedkoff
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic, Australia
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia; Faculty of Health and Medical Science, University of Adelaide, SA, Australia
| | - Alex Brown
- Faculty of Health and Medical Science, University of Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Odette Pearson
- Faculty of Health and Medical Science, University of Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Angela Dos Santos
- Department of Neuroscience, The Central Clinical School, Monash University & Alfred Health, Melbourne, Vic, Australia; South West Sydney Clinical School, University of New South Wales, Liverpool, Sydney, NSW, Australia
| | - Judith M Katzenellenbogen
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
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10
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Bam K, Kilkenny MF, Kim J, Cadilhac DA, Pearce C, Andrew NE, Sanders L, Thrift AG, Nelson MR, Gall S, Daraganova G, Olaiya MT. Age and sex disparities in cardiovascular risk factor management prior to stroke: Linked registry and general practice data. Neuroepidemiology 2024:000538067. [PMID: 38447549 DOI: 10.1159/000538067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/25/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION There is limited evidence about the management of cardiovascular risk factors within 12 months before stroke/transient ischaemic attack (TIA) in Australian general practices. We evaluated whether age and sex disparities in cardiovascular risk factor management for primary prevention exist in general practice. METHODS A retrospective cohort study using data from the Australian Stroke Clinical Registry (2014-2018) linked with general practice data from three primary health networks in Victoria, Australia. We included adults who had ≥2 encounters with a general practitioner within 12 months immediately before the first stroke/TIA. Cardiovascular risk factor management within 12 months before stroke/TIA was evaluated in terms of: assessment of risk factors (blood pressure [BP], serum lipids, blood glucose, body weight); prescription of prevention medications (BP, lipid-, glucose-lowering, antithrombotic agents); and attainment of risk factor targets. RESULTS Of 2,880 patients included (median age 76.5 years, 48.4% women), 80.9% were assessed for BP, 49.9% serum lipids, 46.8% blood glucose, and 39.3% body weight. Compared to patients aged 65-84 years, those aged <65 or ≥85 years were less often assessed for risk factors, with women aged ≥85 years assessed for significantly fewer risk factors than their male counterparts. The most prescribed prevention medications were BP-lowering (64.9%) and lipid-lowering agents (42.0%). There were significant sex differences among those aged <65 years (34.7% women vs. 40.2% men) and ≥85 years (34.0% women vs. 44.3% men) for lipid-lowering agents. Risk factor target attainment was generally poorer in men than women, especially among those aged <65 years. CONCLUSION Age-sex disparity exists in risk factor management for primary prevention in general practice, and this was more pronounced among younger patients and older women.
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11
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Orman Z, Olaiya MT, Thrift AG, Cadilhac DA, Phan T, Nelson MR, Ung D, Srikanth VK, Bladin CF, Gerraty RP, Phillipos J, Kim J. Cost-effectiveness of an individualised management program after stroke: a trial-based economic evaluation. Neuroepidemiology 2024:000535638. [PMID: 38359812 DOI: 10.1159/000535638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/20/2023] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Evidence on the cost-effectiveness of comprehensive post-stroke programs is limited. We assessed the cost-effectiveness of an individualised management program (IMP) for stroke or transient ischaemic attack (TIA). METHODS A cost-utility analysis alongside a randomised controlled trial with a 2-year follow-up, from both societal and health system perspectives, was conducted. Adults with stroke/TIA discharged from hospitals were randomised by primary care practice to receive either usual care (UC) or an IMP in addition to UC. An IMP included at-home stroke-specific nurse-led education and a specialist review of care plans at baseline, 3, and 12 months, and telephone reviews by nurses at 6 and 18 months. Costs in 2021 Australian dollars (AUD) and quality-adjusted life years (QALYs) were discounted by 5%. The probability of cost-effectiveness of the intervention was determined by quantifying 10,000 bootstrapped iterations of incremental costs and QALYs below the threshold of AUD50,000/QALY. RESULTS Among the 502 participants (65% male, median age 69 years), 251 (50%) were in the intervention group. From a health system perspective, the incremental cost per QALY gained was AUD53,175 with an IMP compared to UC alone. At a willingness-to-pay threshold of AUD50,000/QALY, an IMP was preferred in 46.7% of iterations. From a societal perspective, the intervention was dominant in 52.7% of iterations with mean per-patient costs of AUD49,045 and 1.352 QALYs compared to mean per-patient costs of AUD51,394 and 1.324 QALYs in the UC group. The probability of cost-effectiveness of an IMP, from a societal perspective, was 60.5%. CONCLUSIONS Care for people with stroke/TIA using an IMP was cost-effective from a societal perspective over two years. Economic evaluations of prevention programs need sufficient time horizons and consideration of costs beyond direct health care utilisation to demonstrate their value to society.
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12
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Orman Z, Cadilhac DA, Andrew NE, Kilkenny MF, Olaiya MT, Thrift AG, Ung D, Dalli LL, Churilov L, Sundararajan V, Lannin NA, Nelson MR, Srikanth V, Kim J. Cost-effectiveness of a government policy to incentivise chronic disease management following stroke: a modelling study. Neuroepidemiology 2024:000536224. [PMID: 38290479 DOI: 10.1159/000536224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Little is known about the cost-effectiveness of government policies that support primary care physicians to provide comprehensive chronic disease management (CDM). AIMS To estimate the potential cost-effectiveness of CDM policies, over a lifetime, in long-time survivors of stroke. METHODS A Markov model, using three health states (stable, hospitalised, dead), was developed to simulate the costs and benefits of CDM policies over 30 years (with 1-year cycles). Transition probabilities and costs from a health system perspective were obtained from the linkage of data between the Australian Stroke Clinical Registry (cohort n=12,368, 42% female, median age 70 years, 45% had a claim) and government-held hospital, Medicare, and pharmaceutical claims datasets. Quality-adjusted life years (QALYs) were obtained from a comparable cohort (n=512, 34% female, median age 69.6 years, 52% had a claim) linked with Medicare claims and death data. A 3% discount rate was applied to costs in Australian dollars (AUD, 2016) and QALYs beyond 12 months. Probabilistic sensitivity analyses were used to understand uncertainty. RESULTS Per-person average total lifetime costs were AUD142,939 and 8.97 QALYs for those with a claim, and AUD103,889 and 8.98 QALYs for those without a claim. This indicates that these CDM policies were costlier without improving QALYs. The probability of cost-effectiveness of CDM was 26.1%, at a willingness-to-pay threshold of AUD50,000/QALY. CONCLUSION CDM policies, designed to encourage comprehensive care, are unlikely to be cost-effective for stroke compared to care without CDM. Further research to understand how to deliver such care in a cost-effective manner is needed.
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13
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Kilkenny MF, Olaiya MT, Cameron J, Lannin NA, Andrew NE, Thrift AG, Hackett M, Kneebone I, Drummond A, Thijs V, Brancatisano O, Kim J, Reyneke M, Hancock S, Allan L, Ellery F, Cloud G, Grimley RS, Middleton S, Cadilhac DA. Statistical analysis plan for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke randomised controlled clinical trial. Trials 2024; 25:78. [PMID: 38263172 PMCID: PMC10804563 DOI: 10.1186/s13063-023-07864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/30/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Unplanned hospital presentations may occur post-stroke due to inadequate preparation for transitioning from hospital to home. The Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial was designed to test the effectiveness of receiving a 12-week, self-management intervention, comprising personalised goal setting with a clinician and aligned educational/motivational electronic messages. Primary outcome is as follows: self-reported unplanned hospital presentations (emergency department/admission) within 90-day post-randomisation. We present the statistical analysis plan for this trial. METHODS/DESIGN Participants are randomised 1:1 in variable block sizes, with stratification balancing by age and level of baseline disability. The sample size was 890 participants, calculated to detect a 10% absolute reduction in the proportion of participants reporting unplanned hospital presentations/admissions, with 80% power and 5% significance level (two sided). Recruitment will end in December 2023 when funding is expended, and the sample size achieved will be used. Logistic regression, adjusted for the stratification variables, will be used to determine the effectiveness of the intervention on the primary outcome. Secondary outcomes will be evaluated using appropriate regression models. The primary outcome analysis will be based on intention to treat. A p-value ≤ 0.05 will indicate statistical significance. An independent Data Safety and Monitoring Committee has routinely reviewed the progress and safety of the trial. CONCLUSIONS This statistical analysis plan ensures transparency in reporting the trial outcomes. ReCAPS trial will provide novel evidence on the effectiveness of a digital health support package post-stroke. TRIAL REGISTRATION ClinicalTrials.gov ACTRN12618001468213. Registered on August 31, 2018. SAP version 1.13 (October 12 2023) Protocol version 1.12 (October 12, 2022) SAP revisions Nil.
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Affiliation(s)
- Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Janette Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Nadine E Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Australia
- National Centre for Healthy Ageing, Monash University, Frankston, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Maree Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ian Kneebone
- Graduate School of Health, Faculty of Health, Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Avril Drummond
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Vincent Thijs
- Department of Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Olivia Brancatisano
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Megan Reyneke
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Shaun Hancock
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Liam Allan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Fiona Ellery
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Geoffrey Cloud
- Department of Neuroscience, Central Clinical School, Monash University, Clayton, Australia
- Stroke Services, Alfred Health, Melbourne, Australia
| | - Rohan S Grimley
- School of Medicine and Dentistry, Griffith University, Birtinya, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney and Australian Catholic University, Sydney, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.
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14
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Dharan AS, Dalli LL, Olaiya MT, Cadilhac DA, Nedkoff L, Kim J, Andrew NE, Sundararajan V, Thrift AG, Faux SG, Grimley R, Kilkenny MF, Kuhn L. Risk Factors Associated with Major Adverse Cardiovascular Events after Ischemic Stroke: A Linked Registry Study. Neuroepidemiology 2023; 58:134-142. [PMID: 38113865 PMCID: PMC10997250 DOI: 10.1159/000535872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Survivors of stroke are at risk of experiencing subsequent major adverse cardiovascular events (MACE). We aimed to determine the incidence of, and risk factors for, MACE after first-ever ischemic stroke, by age group (18-64 years vs. ≥65 years). METHODS Observational cohort study using patient-level data from the Australian Stroke Clinical Registry (2009-2013), linked with hospital administrative data. We included adults with first-ever ischemic stroke who had no previous acute cardiovascular admissions and followed these patients for 2 years post-discharge, or until the first post-stroke MACE event. A Fine-Gray sub-distribution hazard model, accounting for the competing risk of non-cardiovascular death, was used to determine factors for incident post-stroke MACE. RESULTS Among 5,994 patients with a first-ever ischemic stroke (median age 73 years, 45% female), 17% were admitted for MACE within 2 years (129 events per 1,000 person-years). The median time to first post-stroke MACE was 117 days (89 days if aged <65 years vs. 126 days if aged ≥65 years; p = 0.025). Among patients aged 18-64 years, receiving intravenous thrombolysis (sub-distribution hazard ratio [SHR] 0.51 [95% CI, 0.28-0.92]) or being discharged to inpatient rehabilitation (SHR 0.65 [95% CI, 0.46-0.92]) were associated with a reduced incidence of post-stroke MACE. In those aged ≥65 years, being unable to walk on admission (SHR 1.33 [95% CI 1.15-1.54]), and history of smoking (SHR 1.40 [95% CI 1.14-1.71]) or atrial fibrillation (SHR 1.31 [95% CI 1.14-1.51]) were associated with an increased incidence of post-stroke MACE. Acute management in a large hospital (>300 beds) for the initial stroke event was associated with reduced incidence of post-stroke MACE, irrespective of age group. CONCLUSIONS MACE is common within 2 years of stroke, with most events occurring within the first year. We have identified important factors to consider when designing interventions to prevent MACE after stroke, particularly among those aged <65 years.
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Affiliation(s)
- Ajay S Dharan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia,
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Lee Nedkoff
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, Washington, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Victoria, Australia
- National Centre for Healthy Ageing, Frankston, Victoria, Australia
| | - Vijaya Sundararajan
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Steven G Faux
- St Vincent's Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Rohan Grimley
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- School of Medicine and Dentistry, Griffith University, Birtinya, Queensland, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Lisa Kuhn
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
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15
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Zaman SB, Evans RG, Chow CK, Joshi R, Thankappan KR, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Riddell MA, Suresh O, Thomas N, Mini GK, Maulik PK, Srikanth VK, Thrift AG. Morbidity and utilisation of healthcare services among people with cardiometabolic disease in three diverse regions of rural India. Chronic Illn 2023; 19:873-888. [PMID: 36744377 PMCID: PMC10655594 DOI: 10.1177/17423953231153550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 01/11/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the prevalence and determinants of cardiometabolic disease (CMD), and the factors associated with healthcare utilisation, among people with CMD. METHODS Using a cross-sectional design, 11,657 participants were recruited from randomly selected villages in 3 regions located in Kerala and Andhra Pradesh from 2014 to 2016. Multivariable logistic regression was used to identify factors independently associated with CMD and healthcare utilisation (public or private). RESULTS Thirty-four per cent (n = 3629) of participants reported having ≥1 CMD, including hypertension (21.6%), diabetes (11.6%), heart disease (5.0%) or chronic kidney disease (CKD) (1.6%). The prevalence of CMD was progressively greater in regions of greater socio-economic position (SEP), ranging from 19.1% to 40.9%. Among those with CMD 41% had sought any medical advice in the last month, with only 19% utilising public health facilities. Among people with CMD, those with health insurance utilised more healthcare (age-gender adjusted odds ratio (AOR) (95% confidence interval (CI)): 1.31 (1.13, 1.51)) as did those who reported accessing private rather than public health services (1.43 (1.23, 1.66)). DISCUSSION The prevalence of CMD is high in these regions of rural India and is positively associated with indices of SEP. The utilisation of outpatient health services, particularly public services, among those with CMD is low.
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Affiliation(s)
- Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Clara K Chow
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Rohina Joshi
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- George Institute for Global Health, New Delhi, India
| | | | - Brian Oldenburg
- Non-Communicable Diseases and Implementation Science, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Ajay S Mahal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | | | - Michaela A Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Rishi Valley Rural Health Centre, Chittoor District, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | - Gomathyamma K Mini
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Pallab K Maulik
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, New Delhi, India
| | - Velandai K Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Dalli LL, Burns C, Kilkenny MF, Gall SL, Hou WH, Hoffmann TC, Olaiya MT, Cameron J, Purvis T, Thrift AG, Nelson MR, Sanders A, Viney K, Phan HT, Freak-Poli R. In Search of a Gold Standard Tool for Assessing Knowledge of Stroke: A Systematic Review. Neuroepidemiology 2023; 58:75-91. [PMID: 37980894 DOI: 10.1159/000535292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/12/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Knowledge of stroke is essential to empower people to reduce their risk of these events. However, valid tools are required for accurate and reliable measurement of stroke knowledge. We aimed to systematically review contemporary stroke knowledge assessment tools and appraise their content validity, feasibility, and measurement properties. METHODS The protocol was registered in PROSPERO (CRD42023403566). Electronic databases (MEDLINE, PsycInfo, CINAHL, Embase, Scopus, Web of Science) were searched to identify published articles (1 January 2015-1 March 2023), in which stroke knowledge was assessed using a validated tool. Two reviewers independently screened titles and abstracts prior to undertaking full-text review. COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methods guided the appraisal of content validity (relevance, comprehensiveness, comprehensibility), feasibility, and measurement properties. RESULTS After removing duplicates, the titles and abstracts of 718 articles were screened; 323 reviewed in full; with 42 included (N = 23 unique stroke knowledge tools). For content validity, all tools were relevant, two were comprehensive, and seven were comprehensible. Validation metrics were reported for internal consistency (n = 20 tools), construct validity (n = 17 tools), cross-cultural validity (n = 15 tools), responsiveness (n = 9 tools), reliability (n = 7 tools), structural validity (n = 3 tools), and measurement error (n = 1 tool). The Stroke Knowledge Test met all content validity criteria, with validation data for six measurement properties (n = 3 rated "Sufficient"). CONCLUSION Assessment of stroke knowledge is not standardised and many tools lacked validated content or measurement properties. The Stroke Knowledge Test was the most comprehensive but requires updating and further validation for endorsement as a gold standard.
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Affiliation(s)
- Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Catherine Burns
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Seana L Gall
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital/Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Kayla Viney
- Stroke Foundation, Melbourne, Victoria, Australia
| | - Hoang T Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Rosanne Freak-Poli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Zhou B, Sheffer KE, Bennett JE, Gregg EW, Danaei G, Singleton RK, Shaw JE, Mishra A, Lhoste VPF, Carrillo-Larco RM, Kengne AP, Phelps NH, Heap RA, Rayner AW, Stevens GA, Paciorek CJ, Riley LM, Cowan MJ, Savin S, Vander Hoorn S, Lu Y, Pavkov ME, Imperatore G, Aguilar-Salinas CA, Ahmad NA, Anjana RM, Davletov K, Farzadfar F, González-Villalpando C, Khang YH, Kim HC, Laatikainen T, Laxmaiah A, Mbanya JCN, Narayan KMV, Ramachandran A, Wade AN, Zdrojewski T, Abbasi-Kangevari M, Rahim HFA, Abu-Rmeileh NM, Adambekov S, Adams RJ, Aekplakorn W, Agdeppa IA, Aghazadeh-Attari J, Agyemang C, Ahmadi A, Ahmadi N, Ahmadi N, Ahmed SH, Ajlouni K, Al-Hinai H, Al-Lahou B, Al-Lawati JA, Asfoor DA, Al Qaoud NM, Alarouj M, AlBuhairan F, AlDhukair S, Aldwairji MA, Ali MM, Alinezhad F, Alkandari A, Alomirah HF, Aly E, Amarapurkar DN, Andersen LB, Anderssen SA, Andrade DS, Ansari-Moghaddam A, Aounallah-Skhiri H, Aris T, Arlappa N, Aryal KK, Assah FK, Assembekov B, Auvinen J, Avdičová M, Azad K, Azimi-Nezhad M, Azizi F, Bacopoulou F, Balakrishna N, Bamoshmoosh M, Banach M, Bandosz P, Banegas JR, Barbagallo CM, Barceló A, Baretić M, Barrera L, Basit A, Batieha AM, Batista AP, Baur LA, Belavendra A, Ben Romdhane H, Benet M, Berkinbayev S, Bernabe-Ortiz A, Berrios Carrasola X, Bettiol H, Beybey AF, Bhargava SK, Bika Lele EC, Bikbov MM, Bista B, Bjerregaard P, Bjertness E, Bjertness MB, Björkelund C, Bloch KV, Blokstra A, Bo S, Bobak M, Boggia JG, Bonaccio M, Bonilla-Vargas A, Borghs H, Bovet P, Brajkovich I, Brenner H, Brewster LM, Brian GR, Briceño Y, Brito M, Bugge A, Buntinx F, Cabrera de León A, Caixeta RB, Can G, Cândido APC, Capanzana MV, Čapková N, Capuano E, Capuano R, Capuano V, Cardoso VC, Carlsson AC, Casanueva FF, Censi L, Cervantes‐Loaiza M, Chamnan P, Chamukuttan S, Chan Q, Charchar FJ, Chaturvedi N, Chen H, Cheraghian B, Chirlaque MD, Chudek J, Cifkova R, Cirillo M, Claessens F, Cohen E, Concin H, Cooper C, Costanzo S, Cowell C, Crujeiras AB, Cruz JJ, Cureau FV, Cuschieri S, D’Arrigo G, d’Orsi E, Dallongeville J, Damasceno A, Dastgiri S, De Curtis A, de Gaetano G, De Henauw S, Deepa M, DeGennaro V, Demarest S, Dennison E, Deschamps V, Dhimal M, Dika Z, Djalalinia S, Donfrancesco C, Dong G, Dorobantu M, Dörr M, Dragano N, Drygas W, Du Y, Duante CA, Duboz P, Dushpanova A, Dziankowska-Zaborszczyk E, Ebrahimi N, Eddie R, Eftekhar E, Efthymiou V, Egbagbe EE, Eghtesad S, El-Khateeb M, El Ati J, Eldemire-Shearer D, Elosua R, Enang O, Erasmus RT, Erbel R, Erem C, Ergor G, Eriksen L, Eriksson JG, Esmaeili A, Evans RG, Fakhradiyev I, Fall CH, Faramarzi E, Farjam M, Farzi Y, Fattahi MR, Fawwad A, Felix-Redondo FJ, Ferguson TS, Fernández-Bergés D, Ferrari M, Ferreccio C, Ferreira HS, Ferrer E, Feskens EJM, Flood D, Forsner M, Fosse S, Fottrell EF, Fouad HM, Francis DK, Frontera G, Furusawa T, Gaciong Z, Garnett SP, Gasull M, Gazzinelli A, Gehring U, Ghaderi E, Ghamari SH, Ghanbari A, Ghasemi E, Gheorghe-Fronea OF, Ghimire A, Gialluisi A, Giampaoli S, Gianfagna F, Gill TK, Gironella G, Giwercman A, Goltzman D, Gomula A, Gonçalves H, Gonçalves M, Gonzalez-Chica DA, Gonzalez-Gross M, González-Rivas JP, González-Villalpando ME, Gonzalez AR, Gottrand F, Grafnetter D, Grodzicki T, Grøntved A, Guerrero R, Gujral UP, Gupta R, Gutierrez L, Gwee X, Haghshenas R, Hakimi H, Hambleton IR, Hamzeh B, Hanekom WA, Hange D, Hantunen S, Hao J, Hari Kumar R, Harooni J, Hashemi-Shahri SM, Hata J, Heidemann C, Henrique RDS, Herrala S, Herzig KH, Heshmat R, Ho SY, Holdsworth M, Homayounfar R, Hopman WM, Horimoto ARVR, Hormiga C, Horta BL, Houti L, Howitt C, Htay TT, Htet AS, Htike MMT, Huerta JM, Huhtaniemi IT, Huisman M, Husseini A, Huybrechts I, Iacoviello L, Iakupova EM, Iannone AG, Ibrahim Wong N, Ijoma C, Irazola VE, Ishida T, Isiguzo GC, Islam SMS, Islek D, Ittermann T, Iwasaki M, Jääskeläinen T, Jacobs JM, Jaddou HY, Jadoul M, Jallow B, James K, Jamil KM, Janus E, Jarvelin MR, Jasienska G, Jelaković A, Jelaković B, Jennings G, Jha AK, Jimenez RO, Jöckel KH, Jokelainen JJ, Jonas JB, Joshi P, Josipović J, Joukar F, Jóźwiak J, Kafatos A, Kajantie EO, Kalmatayeva Z, Karki KB, Katibeh M, Kauhanen J, Kazakbaeva GM, Kaze FF, Ke C, Keinänen-Kiukaanniemi S, Kelishadi R, Keramati M, Kersting M, Khader YS, Khaledifar A, Khalili D, Kheiri B, Kheradmand M, Khosravi A, Kiechl-Kohlendorfer U, Kiechl SJ, Kiechl S, Kingston A, Klakk H, Klanova J, Knoflach M, Kolsteren P, König J, Korpelainen R, Korrovits P, Kos J, Koskinen S, Kowlessur S, Koziel S, Kriemler S, Kristensen PL, Kromhout D, Kubinova R, Kujala UM, Kulimbet M, Kurjata P, Kyobutungi C, La QN, Labadarios D, Lachat C, Laid Y, Lall L, Lankila T, Lanska V, Lappas G, Larijani B, Latt TS, Laurenzi M, Lehmann N, Lehtimäki T, Lemogoum D, Leung GM, Li Y, Lima-Costa MF, Lin HH, Lind L, Lissner L, Liu X, Lopez-Garcia E, Lopez T, Lozano JE, Luksiene D, Lundqvist A, Lunet N, Lustigová M, Machado-Coelho GLL, Machado-Rodrigues AM, Macia E, Macieira LM, Madar AA, Maestre GE, Maggi S, Magliano DJ, Magriplis E, Mahasampath G, Maire B, Makdisse M, Malekpour MR, Malekzadeh F, Malekzadeh R, Mallikharjuna Rao K, Malyutina S, Maniego LV, Manios Y, Mannix MI, Mansour-Ghanaei F, Manzato E, Margozzini P, Mariño J, Marques LP, Martorell R, Mascarenhas LP, Masinaei M, Mathiesen EB, Matsha TE, Mc Donald Posso AJ, McFarlane SR, McGarvey ST, Mediene Benchekor S, Mehlig K, Mehrparvar AH, Melgarejo JD, Méndez F, Menezes AMB, Mereke A, Meshram II, Meto DT, Minderico CS, Mini GK, Miquel JF, Miranda JJ, Mirjalili MR, Modesti PA, Moghaddam SS, Mohamed MK, Mohammad K, Mohammadi MR, Mohammadi Z, Mohammadifard N, Mohammadpourhodki R, Mohan V, Mohd Yusoff MF, Mohebbi I, Møller NC, Molnár D, Momenan A, Mondo CK, Montenegro Mendoza RA, Monterrubio-Flores E, Moosazadeh M, Moradpour F, Morejon A, Moreno LA, Morgan K, Morin SN, Moslem A, Mosquera M, Mossakowska M, Mostafa A, Mostafavi SA, Motlagh ME, Motta J, Msyamboza KP, Mu TT, Muiesan ML, Mursu J, Musa KI, Mustafa N, Muyer MTMC, Nabipour I, Nagel G, Naidu BM, Najafi F, Námešná J, Nangia VB, Naseri T, Neelapaichit N, Nejatizadeh A, Nenko I, Nervi F, Ng TP, Nguyen CT, Nguyen QN, Ni MY, Nie P, Nieto-Martínez RE, Ninomiya T, Noale M, Noboa OA, Noto D, Nsour MA, Nuhoğlu I, O’Neill TW, Odili AN, Oh K, Ohtsuka R, Omar MA, Onat A, Ong SK, Onodugo O, Ordunez P, Ornelas R, Ortiz PJ, Osmond C, Ostovar A, Otero JA, Ottendahl CB, Otu A, Owusu-Dabo E, Palmieri L, Pan WH, Panda-Jonas S, Panza F, Paoli M, Park S, Parsaeian M, Patel ND, Pechlaner R, Pećin I, Pedro JM, Peixoto SV, Peltonen M, Pereira AC, Pessôa dos Prazeres TM, Peykari N, Phall MC, Pham ST, Phan HH, Pichardo RN, Pikhart H, Pilav A, Piler P, Pitakaka F, Piwonska A, Pizarro AN, Plans-Rubió P, Plata S, Porta M, Poudyal A, Pourfarzi F, Pourshams A, Poustchi H, Pradeepa R, Providencia R, Puder JJ, Puhakka S, Punab M, Qorbani M, Quintana HK, Quoc Bao T, Rahimikazerooni S, Raitakari O, Ramirez-Zea M, Ramke J, Ramos R, Rampal L, Rampal S, Rangel Reina DA, Rashidi MM, Redon J, Renner JDP, Reuter CP, Revilla L, Rezaei N, Rezaianzadeh A, Rigo F, Roa RG, Robinson L, Rodríguez-Artalejo F, Rodriguez-Perez MDC, Rodríguez-Villamizar LA, Rodríguez AY, Roggenbuck U, Rohloff P, Romeo EL, Rosengren A, Rubinstein A, Rust P, Rutkowski M, Sabbaghi H, Sachdev HS, Sadjadi A, Safarpour AR, Safi S, Safiri S, Saghi MH, Saidi O, Saki N, Šalaj S, Salanave B, Salonen JT, Salvetti M, Sánchez-Abanto J, Santos DA, Santos LC, Santos MP, Santos TR, Saramies JL, Sardinha LB, Sarrafzadegan N, Saum KU, Sbaraini M, Scazufca M, Schaan BD, Scheidt-Nave C, Schipf S, Schmidt CO, Schöttker B, Schramm S, Sebert S, Sedaghattalab M, Sein AA, Sepanlou SG, Sewpaul R, Shamah-Levy T, Shamshirgaran SM, Sharafkhah M, Sharma SK, Sharman A, Shayanrad A, Shayesteh AA, Shimizu-Furusawa H, Shiri R, Shrestha N, Si-Ramlee K, Silva DAS, Simon M, Simons J, Simons LA, Sjöström M, Slowikowska-Hilczer J, Slusarczyk P, Smeeth L, Sobngwi E, Söderberg S, Soemantri A, Sofat R, Solfrizzi V, Somi MH, Soumaré A, Sousa-Poza A, Sparrenberger K, Staessen JA, Stavreski B, Steene-Johannessen J, Stehle P, Stein AD, Stessman J, Stokwiszewski J, Stronks K, Suarez-Ortegón MF, Suebsamran P, Sundström J, Suriyawongpaisal P, Sylva RC, Szklo M, Tamosiunas A, Tarawneh MR, Tarqui-Mamani CB, Taylor A, Taylor J, Tello T, Thankappan KR, Theobald H, Theodoridis X, Thomas N, Thrift AG, Timmermans EJ, Tjandrarini DH, Tolonen HK, Tolstrup JS, Tomaszewski M, Topbas M, Torres-Collado L, Traissac P, Triantafyllou A, Tuitele J, Tuliakova AM, Tulloch-Reid MK, Tuomainen TP, Tzala E, Tzourio C, Ueda P, Ugel E, Ukoli FAM, Ulmer H, Uusitalo HMT, Valdivia G, van den Born BJ, Van der Heyden J, Van Minh H, van Rossem L, Van Schoor NM, van Valkengoed IGM, van Zutphen EM, Vanderschueren D, Vanuzzo D, Vasan SK, Vega T, Velasquez-Melendez G, Verstraeten R, Viet L, Villalpando S, Vioque J, Virtanen JK, Viswanathan B, Voutilainen A, Wan Bebakar WM, Wan Mohamud WN, Wang C, Wang N, Wang Q, Wang YX, Wang YW, Wannamethee SG, Webster-Kerr K, Wedderkopp N, Wei W, Westbury LD, Whincup PH, Widhalm K, Widyahening IS, Więcek A, Wilks RJ, Willeit J, Willeit P, Wilsgaard T, Wojtyniak B, Wong A, Wong EB, Woodward M, Wu FC, Xu H, Xu L, Yaacob NA, Yan L, Yan W, Yoosefi M, Yoshihara A, Younger-Coleman NO, Yu YL, Yu Y, Yusoff AF, Zainuddin AA, Zamani F, Zambon S, Zampelas A, Zaw KK, Zeljkovic Vrkic T, Zeng Y, Zhang ZY, Zholdin B, Zimmet P, Zitt E, Zoghlami N, Zuñiga Cisneros J, Ezzati M. Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c. Nat Med 2023; 29:2885-2901. [PMID: 37946056 PMCID: PMC10667106 DOI: 10.1038/s41591-023-02610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/25/2023] [Indexed: 11/12/2023]
Abstract
Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance.
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Noe KM, Don A, Cochrane AD, Zhu MZL, Ngo JP, Smith JA, Thrift AG, Vogiatjis J, Martin A, Bellomo R, McMillan J, Evans RG. Intraoperative hemodynamics and risk of cardiac surgery-associated acute kidney injury: An observation study and a feasibility clinical trial. Clin Exp Pharmacol Physiol 2023; 50:878-892. [PMID: 37549882 PMCID: PMC10947000 DOI: 10.1111/1440-1681.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
Targeting greater pump flow and mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) could potentially alleviate renal hypoxia and reduce the risk of postoperative acute kidney injury (AKI). Therefore, in an observational study of 93 patients undergoing on-pump cardiac surgery, we tested whether intraoperative hemodynamic management differed between patients who did and did not develop AKI. Then, in 20 patients, we assessed the feasibility of a larger-scale trial in which patients would be randomized to greater than normal target pump flow and MAP, or usual care, during CPB. In the observational cohort, MAP during hypothermic CPB averaged 68.8 ± 8.0 mmHg (mean ± SD) in the 36 patients who developed AKI and 68.9 ± 6.3 mmHg in the 57 patients who did not (p = 0.98). Pump flow averaged 2.4 ± 0.2 L/min/m2 in both groups. In the feasibility clinical trial, compared with usual care, those randomized to increased target pump flow and MAP had greater mean pump flow (2.70 ± 0.23 vs. 2.42 ± 0.09 L/min/m2 during the period before rewarming) and systemic oxygen delivery (363 ± 60 vs. 281 ± 45 mL/min/m2 ). Target MAP ≥80 mmHg was achieved in 66.6% of patients in the intervention group but in only 27.3% of patients in the usual care group. Nevertheless, MAP during CPB did not differ significantly between the two groups. We conclude that little insight was gained from our observational study regarding the impact of variations in pump flow and MAP on the risk of AKI. However, a clinical trial to assess the effects of greater target pump flow and MAP on the risk of AKI appears feasible.
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Affiliation(s)
- Khin M Noe
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Andrea Don
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Andrew D Cochrane
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Michael Z L Zhu
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Jennifer P Ngo
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Johnny Vogiatjis
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Andrew Martin
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - James McMillan
- Perfusion Services Pty Ltd, Melbourne, Victoria, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Sun YA, Kalpakavadi S, Prior S, Thrift AG, Waddingham S, Phan H, Gall SL. Socioeconomic status and health-related quality of life after stroke: a systematic review and meta-analysis. Health Qual Life Outcomes 2023; 21:115. [PMID: 37875951 PMCID: PMC10599023 DOI: 10.1186/s12955-023-02194-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Socioeconomic status (SES) is associated with stroke occurrence and survival following stroke but its association with health-related quality of life (HRQoL) following stroke remains uncertain. We performed a systematic review and meta-analysis to examine the association between SES and HRQoL after stroke. METHODS PubMed, SCOPUS, EMBASE, and Web of Science were searched to identify relevant cohort and case-control studies between January 2000 and May 2022. Two authors screened titles, abstracts and full text articles. One author extracted data from all included studies. Meta-analyses were performed for studies with comparable measurements of SES and HRQoL. Random effects models were used to estimate pooled summary standardised mean differences in HRQoL by SES. RESULTS Out of 1,876 citations, 39 studies incorporated measurement of overall HRQoL following stroke and were included in the systematic review, with 17 studies included in the meta-analyses. Overall, reports including education, income, occupation and work status effects on HRQoL after stroke were inconsistent among all included 39 studies. In the global meta-analysis of 17 studies, HRQoL among survivors of stroke was lower in the low SES group than in the high SES group (standardised mean difference (SMD) -0.36, 95% CI -0.52, -0.20, p < 0.0001). When using education and income indicators separately, summary effects were similar to those of the global analysis (low versus high education SMD -0.38, 95% CI -0.57, -0.18, p < 0.0001; low versus high income SMD -0.39, 95% CI -0.59, -0.19, p < 0.0001). CONCLUSIONS Across all SES indicators, people with stroke who have lower SES have poorer overall HRQoL than those with higher SES. Accessibility and affordability of poststroke support services should be taken into consideration when planning and delivering services to people with low SES.
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Affiliation(s)
- Yichao A Sun
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Serah Kalpakavadi
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
| | - Sarah Prior
- Tasmanian School of Medicine, Rural Clinical School, University of Tasmania, Burnie, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | | | - Hoang Phan
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia
- Menzies School for Health Research, Charles Darwin University, Casuarina, Australia
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
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Youens D, Katzenellenbogen J, Srinivasa Ragavan R, Sodhi-Berry N, Carson J, Zemedikun D, Thrift AG, Feigin V, Nedkoff L. Differing Definitions of First-Ever Stroke Influence Incidence Estimates More than Trends: A Study Using Linked Administrative Data. Neuroepidemiology 2023; 57:423-432. [PMID: 37751719 DOI: 10.1159/000534242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/20/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Researchers apply varying definitions when measuring stroke incidence using administrative data. We aimed to investigate the sensitivity of incidence estimates to varying definitions of stroke and lookback periods and to provide updated incidence rates and trends for Western Australia (WA). METHODS We used linked state-wide hospital and death data from 1985 to 2017 to identify incident strokes from 2005 to 2017. A standard definition was applied which included strokes coded as the principal hospital diagnosis or the underlying cause of death, with a 10-year lookback used to clear prevalent cases. Alternative definitions were compared against the standard definition by percentage difference in case numbers. Age-standardised incidence rates were calculated, and age- and sex-adjusted Poisson regression models were used to estimate incidence trends. RESULTS The standard definition with a 10-year lookback period captured 31,274 incident strokes. Capture increased by 19.3% when including secondary diagnoses, 4.1% when including nontraumatic subdural and extradural haemorrhage, and 8.1% when including associated causes of death. Excluding death records reduced capture by 11.1%. A 20-year lookback reduced over-ascertainment by 2.0%, and a 1-year lookback increased capture by 13.3%. Incidence declined 0.6% annually (95% confidence interval -0.9, -0.3). Annual reductions were similar for most definitions except when death records were excluded (-0.1%, CI: -0.4, 0.2) and with the shortest lookback periods (greatest annual reduction). CONCLUSION Stroke incidence has declined in WA. Differing methods of identifying stroke influence estimates of incidence to a greater extent than estimates of trends. Reductions in stroke incidence over time are primarily driven by declines in fatal strokes.
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Affiliation(s)
- David Youens
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Crawley, Washington, Australia
- School of Population Health, Curtin University, Bentley, Washington, Australia
| | - Judith Katzenellenbogen
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Crawley, Washington, Australia
| | - Rathina Srinivasa Ragavan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Nita Sodhi-Berry
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Crawley, Washington, Australia
| | - Jennie Carson
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Crawley, Washington, Australia
| | - Dawit Zemedikun
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Crawley, Washington, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Valery Feigin
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Lee Nedkoff
- Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Crawley, Washington, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
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Kim J, Grimley R, Kilkenny MF, Cadigan G, Johnston T, Andrew NE, Thrift AG, Lannin NA, Sundararajan V, Cadilhac DA. Costs of acute hospitalisation for stroke and transient ischaemic attack in Australia. HEALTH INF MANAG J 2023; 52:176-184. [PMID: 35667095 DOI: 10.1177/18333583221090277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stroke is a high-cost condition. Detailed patient-level assessments of the costs of care received and outcomes achieved provide useful information for organisation and optimisation of the health system. OBJECTIVES To describe the costs of hospital care for stroke and transient ischaemic attack (TIA) and investigate factors associated with costs. METHODS Retrospective cohort study using data from the Australian Stroke Clinical Registry (AuSCR) collected between 2009 and 2013 linked to hospital administrative data and clinical costing data in Queensland. Clinical costing data include standardised assignment of costs from hospitals that contribute to the National Hospital Costing programme. Patient-level costs for each hospital admission were described according to the demographic, clinical and treatment characteristics of patients. Multivariable median regression with clustering by hospital was used to determine factors associated with greater costs. RESULTS Among 22 hospitals, clinical costing data were available for 3909 of 5522 patient admissions in the AuSCR (71%). Compared to those without clinical costing data, patients with clinical costing data were more often aged <65 years (30% with cost data vs 24% without cost data, p < 0.001) and male (56% with cost data vs 49% without cost data, p < 0.001). Median cost of an acute episode was $7945 (interquartile range $4176 to $14970) and the median length of stay was 5 days (interquartile range 2 to 10 days). The most expensive cost buckets were related to medical (n = 3897, median cost $1577), nursing (n = 3908, median cost $2478) and critical care (n = 434, median cost $3064). Factors associated with greater total costs were a diagnosis of intracerebral haemorrhage, greater socioeconomic position, in-hospital stroke and prior history of stroke. CONCLUSION Medical and nursing costs were incurred by most patients admitted with stroke or TIA, and were relatively more expensive on average than other cost buckets such as imaging and allied health. IMPLICATIONS Scaling this data linkage to national data collections may provide valuable insights into activity-based funding at public hospitals. Regular report of these costs should be encouraged to optimise economic evaluations.
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Affiliation(s)
- Joosup Kim
- Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | | | - Monique F Kilkenny
- Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | | | | | | | | | - Natasha A Lannin
- Monash University, Clayton, VIC, Australia
- Alfred Health, Prahran, VIC, Australia
| | | | - Dominique A Cadilhac
- Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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22
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Sun YA, Phan H, Buscot MJ, Thrift AG, Gall S. Area-level and individual-level socio-economic differences in health-related quality of life trajectories: Results from a 10-year longitudinal stroke study. J Stroke Cerebrovasc Dis 2023; 32:107188. [PMID: 37216749 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND We examined area-level (aSES) and individual-level (iSES) socio-economic status on trajectories of HRQoL to 10 years following stroke. METHODS Participants with strokes between 1/5/1996 and 30/4/1999 completed the Assessment of Quality of Life instrument (AQoL, range: -0.04 [worse than death] to 0 [death] to 1 [full health]) at ≥one of 3month, 6-month, 1-year, 2-year, 3-year, 4-year, 5-year, 7-year and 10-year interviews after stroke. Sociodemographic and health information were collected at baseline. We derived aSES from postcode using the Australian Socio-Economic Indexes For Area (2006) (categories: high, medium, low), and iSES from lifetime occupation (categories: non-manual, manual). Multivariable linear mixed effects modelling was used to estimate trajectories of HRQoL over 10 years, by aSES and iSES, adjusting for age, sex, cardiovascular disease, smoking, diabetes, stroke severity, stroke type, and the time influence on age and health conditions. RESULTS Of 1,686 participants enrolled, we excluded 239 with 'possible' stroke and 284 with missing iSES. Among the remaining 1,163 participants, 1,123 (96.6%) had AQoL assessed at ≥3 timepoints. In multivariable analysis, over time, people in the medium aSES group had mean 0.02 (95% CI -0.06, 0.02) greater reduction in AQoL score, and people in the low aSES group had mean 0.04 (95% CI, -0.07, -0.001) greater reduction, than those in the high aSES group. Manual workers had an average 0.04 (95% CI, -0.07, -0.01) greater reduction in AQoL score over time than non-manual workers. CONCLUSIONS Over time, HRQoL declines in all people with stroke, declining most rapidly in lower SES groups.
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Affiliation(s)
- Yichao A Sun
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas., Australia
| | - Hoang Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas., Australia
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas., Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic., Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas., Australia; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic., Australia.
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23
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Thapa R, Zengin A, Neupane D, Mishra SR, Koirala S, Kallestrup P, Thrift AG. Sustainability of a 12-month lifestyle intervention delivered by community health workers in reducing blood pressure in Nepal: 5-year follow-up of the COBIN open-label, cluster randomised trial. Lancet Glob Health 2023; 11:e1086-e1095. [PMID: 37349035 DOI: 10.1016/s2214-109x(23)00214-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The sustainability and scalability of limited-duration interventions in low-income and middle-income countries remain unclear. We aimed to investigate the sustainability in reduction of blood pressure through a 12-month lifestyle intervention led by community health workers to reduce blood pressure in Nepal, 4 years after the intervention ceased. METHODS The Community-Based Intervention for Control of Hypertension in Nepal (COBIN) trial was a non-blinded, cluster-randomised trial done in Kaski, Nepal. Adults aged 25-65 years were eligible. People were excluded if they declined consent, were severely ill, unlikely to be in the community throughout the intervention, or pregnant. During the 12-month intervention, female community health volunteers (FCHVs) visited participants in the intervention groups and provided lifestyle counselling and blood pressure measurement every 4 months. At the end of the 12-month intervention, systolic blood pressure was significantly lower in the intervention group than in the usual care group in all cohorts, ranging from -2·3 mm Hg (95% CI -3·8 to -0·8) lower in those with normal blood pressure to -4·9 mm Hg (-7·8 to -2·0) in the hypertensive cohort. The primary outcome for this follow-up study was a mean change in systolic blood pressure from baseline to follow-up at 60 months. We did an intention-to-treat analysis. FINDINGS Between April 1, 2015, and Dec 31, 2015, 1638 participants were recruited in COBIN (939 [57·3%] assigned to intervention and 699 [42·7%] assigned to usual care). Of the 1468 (89·6%) who completed the 12-month assessments, we followed up 1352 (92·1%) participants at 60 months, between Oct 11, 2020, and May 5, 2022. 964 (71·3%) participants were women and 388 (28·7%) were men. From baseline to 60 months, the mean systolic blood pressure increased by 10·4 mm Hg (95% CI 9·1-11·6) in the intervention group and 6·0 mm Hg (4·6-7·5) in the usual care group (adjusted mean difference 4·1 mm Hg [2·2 to 5·8]). INTERPRETATION Lifestyle counselling and blood pressure monitoring by community health workers is effective in substantially reducing blood pressure while adults are being monitored in a trial but, following cessation of the intervention, this benefit is not maintained in the long term, with potential for harm. This finding could have important implications for funders and research communities to regularly target participants for education and follow-up at an optimal timepoint to reduce any likelihood of harm. FUNDING Monash University (Melbourne, VIC, Australia) and the Jayanti Memorial Trust (Kathmandu, Nepal). TRANSLATION For the Nepali translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Rajshree Thapa
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia; Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia; Nepal Development Society, Chitwan, Bagmati Province, Nepal
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Dinesh Neupane
- Nepal Development Society, Chitwan, Bagmati Province, Nepal; Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Shiva Raj Mishra
- Nepal Development Society, Chitwan, Bagmati Province, Nepal; Epidemiology and Simulation Modelling, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sweta Koirala
- Nepal Development Society, Chitwan, Bagmati Province, Nepal
| | - Per Kallestrup
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Midtjylland, Denmark
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
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24
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Balabanski AH, Nedkoff L, Brown A, Thrift AG, Pearson O, Guthridge S, Dos Santos A, Kleinig TJ, Katzenellenbogen JM. Incidence of Stroke in the Aboriginal and Non-Aboriginal Populations of Australia: A Data Linkage Study. Stroke 2023. [PMID: 37325922 DOI: 10.1161/strokeaha.122.041975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/21/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Most estimates of stroke incidence among Aboriginal and Torres Strait Islander (hereinafter Aboriginal) Australians are confined to single regions and include small sample sizes. We aimed to measure and compare stroke incidence in Aboriginal and non-Aboriginal residents across central and western Australia. METHODS Whole-population multijurisdictional person-linked data from hospital and death datasets were used to identify stroke admissions and stroke-related deaths (2001-2015) in Western Australia, South Australia, and the Northern Territory. Fatal (including out-of-hospital deaths) and nonfatal incident (first-ever) strokes in patients aged 20-84 years were identified during the 4-year study period (2012-2015), using a 10-year lookback period to exclude people with prior stroke. Incidence rates per 100 000 population/year were estimated for Aboriginal and non-Aboriginal populations, age-standardized to the World Health Organization World Standard population. RESULTS In a population of 3 223 711 people (3.7% Aboriginal), 11 740 incident (first-ever) strokes (20.6% regional/remote location of residence; 15.6% fatal) were identified from 2012 to 2015, 675 (5.7%) in Aboriginal people (73.6% regional/remote; 17.0% fatal). Median age of Aboriginal cases (54.5 years; 50.1% female) was 16 years younger than non-Aboriginal cases (70.3 years; 44.1% female; P<0.001), with significantly greater prevalence of comorbidities. Age-standardized stroke incidence in Aboriginal people (192/100 000 [95% CI, 177-208]) was 2.9-fold greater than in non-Aboriginal people (66/100 000 [95% CI, 65-68]) aged 20-84 years; fatal incidence was 4.2-fold greater (38/100 000 [95% CI, 31-46] versus 9/100 000 [95% CI, 9-10]). Disparities were particularly apparent at younger ages (20-54 years), where age-standardized stroke incidence was 4.3-fold greater in Aboriginal people (90/100 000 [95% CI, 81-100]) than non-Aboriginal people (21/100 000 [95% CI, 20-22]). CONCLUSIONS Stroke occurred more commonly, and at younger ages, in Aboriginal than non-Aboriginal populations. Greater prevalence of baseline comorbidities was present in the younger Aboriginal population. Improved primary prevention is required. To optimize stroke prevention, interventions should include culturally appropriate community-based health promotion and integrated support for nonmetropolitan health services.
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Affiliation(s)
- Anna H Balabanski
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (A.H.B., A.G.T.)
- Alfred Brain, Alfred Health, Victoria, Australia (A.H.B., A.D.S.)
- Melbourne Brain Centre, Royal Melbourne Hospital, Victoria, Australia (A.H.B., A.D.S.)
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia (L.N., J.M.K.)
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia (L.N.)
| | - Alex Brown
- National Centre for Indigenous Genomics, Telethon Kids Institute and The Australian National University, Australian Capital Territory (A.B.)
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (A.H.B., A.G.T.)
| | - Odette Pearson
- South Australian Health and Medical Research Institute, South Australia (O.P.)
- Faculty of Health and Medical Science, University of Adelaide, South Australia (O.P., T.J.K.)
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Australia (S.G.)
| | - Angela Dos Santos
- Alfred Brain, Alfred Health, Victoria, Australia (A.H.B., A.D.S.)
- Melbourne Brain Centre, Royal Melbourne Hospital, Victoria, Australia (A.H.B., A.D.S.)
| | - Timothy J Kleinig
- Faculty of Health and Medical Science, University of Adelaide, South Australia (O.P., T.J.K.)
- Department of Neurology, Royal Adelaide Hospital, South Australia (T.J.K.)
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Towfighi A, Boden-Albala B, Cruz-Flores S, El Husseini N, Odonkor CA, Ovbiagele B, Sacco RL, Skolarus LE, Thrift AG. Strategies to Reduce Racial and Ethnic Inequities in Stroke Preparedness, Care, Recovery, and Risk Factor Control: A Scientific Statement From the American Heart Association. Stroke 2023. [PMID: 37183687 DOI: 10.1161/str.0000000000000437] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Stroke is a disease of disparities, with tremendous racial and ethnic inequities in incidence, prevalence, treatment, and outcomes. The accumulating literature on the relationship between stroke and social determinants of health (ie, the structural conditions of the places where people live, learn, work, and play) contributes to our understanding of stroke inequities. Several interventions have been tested concurrently to reduce racial and ethnic inequities in stroke preparedness, care, recovery, and risk factor control. It is regrettable that no common theoretical framework has been used to facilitate comparison of interventions. In this scientific statement, we summarize, across the stroke continuum of care, trials of interventions addressing racial and ethnic inequities in stroke care and outcomes. We reviewed the literature on interventions to address racial and ethnic inequities to identify gaps and areas for future research. Although numerous trials tested interventions aimed at reducing inequities in prehospital, acute care, transitions in care, and poststroke risk factor control, few addressed inequities in rehabilitation, recovery, and social reintegration. Most studies addressed proximate determinants (eg, medication adherence, health literacy, and health behaviors), but upstream determinants (eg, structural racism, housing, income, food security, access to care) were not addressed. A common theoretical model of social determinants can help researchers understand the heterogeneity of social determinants, inform future directions in stroke inequities research, support research in understudied areas within the continuum of care, catalyze implementation of successful interventions in additional settings, allow for comparison across studies, and provide insight into whether addressing upstream or downstream social determinants has the strongest effect on reducing inequities in stroke care and outcomes.
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Ragavan RS, Ismail J, Evans RG, Srikanth VK, Kaye M, Joshi R, Thankappan KR, Chow CK, Riddell MA, Oldenburg B, Mahal A, Kalyanram K, Kartik K, Suresh O, Thomas N, Mini GK, Maulik PK, Arabshahi S, Thrift AG. Combining general and central measures of adiposity to identify risk of hypertension: a cross-sectional survey in rural India. Obes Res Clin Pract 2023; 17:249-256. [PMID: 37142499 DOI: 10.1016/j.orcp.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/28/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023]
Abstract
AIM In three socioeconomically diverse regions of rural India, we determined the optimal cut-offs for definition of overweight, the prevalence of overweight, and the relationships between measures of overweight and risk of hypertension. SUBJECTS AND METHODS Villages were randomly sampled within rural Trivandrum, West Godavari, and Rishi Valley. Sampling of individuals was stratified by age group and sex. Cut-offs for measures of adiposity were compared using area under the receiver operating characteristic curve. Associations between hypertension and definitions of overweight were assessed by logistic regression. RESULTS Of 11 657 participants (50 % male; median age 45 years), 29.8 % had hypertension. Large proportions were overweight as defined by body mass index (BMI) ≥ 23 kg/m2 (47.7 %), waist circumference (WC) ≥ 90 cm for men or ≥ 80 cm for women (39.6 %), waist-hip ratio (WHR) ≥ 0.9 for men or ≥ 0.8 for women (65.6 %), waist-height ratio (WHtR) ≥ 0.5 (62.5 %), or by BMI plus either WHR, WC or WHtR (45.0 %). All definitions of overweight were associated with hypertension, with optimal cut-offs being at, or close to, the World Health Organization (WHO) Asia-Pacific standards. Having overweight according to both BMI and a measure of central adiposity was associated with approximately twice the risk of hypertension than overweight defined by only one measure. CONCLUSIONS Overweight, as assessed by both general and central measures, is prevalent in rural southern India. WHO standard cut-offs are appropriate in this setting for assessing risk of hypertension. However, combining BMI with a measure of central adiposity identifies risk of hypertension better than any single measure. The risk of hypertension is significantly greater in those centrally and generally overweight than those overweight by a single measure.
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Affiliation(s)
- Rathina Srinivasa Ragavan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Jordan Ismail
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia; Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Velandai K Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Matthew Kaye
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Rohina Joshi
- School of Population Health, UNSW, Sydney, Australia
| | - Kavumpurathu R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India; Central University of Kerala, Kasaragod, India
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney and Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Michaela A Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Ajay Mahal
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia; Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gomathyamma K Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India; Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India; University of New South Wales, Sydney, Australia
| | - Simin Arabshahi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
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27
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Gall SL, Feigin V, Thrift AG, Kleinig TJ, Cadilhac DA, Bennett DA, Nelson MR, Purvis T, Jalili-Moghaddam S, Kitsos G, Krishnamurthi R. Personalized knowledge to reduce the risk of stroke (PERKS-International): Protocol for a randomized controlled trial. Int J Stroke 2023; 18:477-483. [PMID: 35770887 DOI: 10.1177/17474930221113430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Theoretically, most strokes could be prevented through the management of modifiable risk factors. The Stroke Riskometer™ mobile phone application (hereon "The App") uses an individual's data to provide personalized information and advice to reduce their risk of stroke. AIMS To determine the effect of The App on a combined cardiovascular risk score (Life's Simple 7®, LS7) of modifiable risk factors at 6 months post-randomization. METHODS AND DESIGN PERKS-International is a Phase III, multicentre, prospective, pragmatic, open-label, single-blinded endpoint, two-arm randomized controlled trial (RCT). Inclusion criteria are as follows: age ⩾ 35 and ⩽75 years; ⩾2 LS7 risk factors; smartphone ownership; no history of stroke/myocardial infarction/cognitive impairment/terminal illness. The intervention group (IG) will be provided with The App, and the usual care group (UCG) is provided with generic online information about risk factors, but not be informed about The App. Face-to-face assessments will be conducted at baseline and 6 months, and online at 3 and 12 months. The RCT includes a process and economic evaluation. STUDY OUTCOMES AND SAMPLE SIZE The primary outcome is a difference in the mean change in LS7 (seven individual items: blood pressure, cholesterol, glucose, body mass index (BMI), smoking, physical activity, and diet) from baseline to 6 months post-randomization with intention-to-treat analysis. Secondary outcomes include: change in individual LS7 items, quality of life; stroke awareness, adverse events; health service use; and costs. Based on pilot data, 790 participants (395 IG, 395 UCG) will be required to provide 80% power (two-sided α = 0.05) to detect a mean difference in the LS7 of ⩾0.40 (SD 1.61) in IG compared to 0.01 (SD 1.44) in the UCG at 6 months post-randomization. DISCUSSION Stroke is largely preventable. This study will provide evidence of the effectiveness of a mobile app to reduce stroke risk. TRIAL REGISTRATION ACTRN12621000211864.
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Affiliation(s)
- Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- National Institute of Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Valery Feigin
- Epidemiology and Prevention Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Amanda G Thrift
- National Institute of Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Timothy J Kleinig
- Department of Medicine, The University of Adelaide, Adelaide, SA, Australia
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dominique A Cadilhac
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Derrick A Bennett
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Tara Purvis
- Translational Public Health and Evaluation Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Shabnam Jalili-Moghaddam
- Epidemiology and Prevention Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Gemma Kitsos
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Rita Krishnamurthi
- Epidemiology and Prevention Division, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Meharg DP, Naanyu V, Rambaldini B, Clarke MJ, Lacey C, Jebasingh F, Lopez-Jaramillo P, Gould GS, Aceves B, Alison JA, Chaiton M, Chen J, Gonzalez-Salazar F, Goodyear-Smith F, Gwynne KG, Lee KS, MacKay D, Maple-Brown L, Mishara BL, Nigenda G, Ramani-Chander A, Sherwood SG, Thomas N, Thrift AG, Anderson M. The Global Alliance for Chronic Diseases researchers' statement on non-communicable disease research with Indigenous peoples. Lancet Glob Health 2023; 11:e324-e326. [PMID: 36796972 DOI: 10.1016/s2214-109x(23)00039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/09/2023] [Indexed: 02/16/2023]
Affiliation(s)
- David P Meharg
- Sydney School of Health Sciences, University of Sydney, Sydney 2006, NSW, Australia; Faculty of Medicine and Health, and Poche Centre for Indigenous Health, University of Sydney, Sydney 2006, NSW, Australia.
| | - Violet Naanyu
- School of Arts and Social Sciences, Moi University, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Boe Rambaldini
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Marilyn J Clarke
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Cameron Lacey
- Māori Indigenous Health Innovation, University of Otago, Christchurch, New Zealand
| | - Felix Jebasingh
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Gillian S Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Benjamin Aceves
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jennifer A Alison
- Sydney School of Health Sciences, University of Sydney, Sydney 2006, NSW, Australia; Allied Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Michael Chaiton
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Jun Chen
- Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Francisco Gonzalez-Salazar
- Cytogenetics Department, Northeast Biomedical Research Center, Mexican Institute of Social Security, Monterrey, Mexico
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Kylie G Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Kylie S Lee
- The Edith Collins Centre, Sydney Local Health District, Sydney, NSW, Australia; National Drug Research Institute and enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Burnet Institute, Melbourne, VIC, Australia; Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney 2006, NSW, Australia
| | - Diana MacKay
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia; Department of Endocrinology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia; Department of Endocrinology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Brian L Mishara
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Anusha Ramani-Chander
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Stephen G Sherwood
- Fundación EkoRural, Quito, Ecuador and Wageningen University, Wageningen, Netherlands
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Michael Anderson
- Waakebiness Institute for Indigenous Health, University of Toronto, Toronto, ON, Canada
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Andrew NE, Ung D, Olaiya MT, Dalli LL, Kim J, Churilov L, Sundararajan V, Thrift AG, Cadilhac DA, Nelson MR, Lannin NA, Barnden R, Srikanth V, Kilkenny MF. The population effect of a national policy to incentivize chronic disease management in primary care in stroke: a population-based cohort study using an emulated target trial approach. The Lancet Regional Health - Western Pacific 2023. [DOI: 10.1016/j.lanwpc.2023.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Robinson K, Katzenellenbogen JM, Kleinig TJ, Kim J, Budgeon CA, Thrift AG, Nedkoff L. Large Burden of Stroke Incidence in People with Cardiac Disease: A Linked Data Cohort Study. Clin Epidemiol 2023; 15:203-211. [PMID: 36846512 PMCID: PMC9945299 DOI: 10.2147/clep.s390146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/28/2023] [Indexed: 02/19/2023] Open
Abstract
Purpose People with cardiac disease have 2-4 times greater risk of stroke than the general population. We measured stroke incidence in people with coronary heart disease (CHD), atrial fibrillation (AF) or valvular heart disease (VHD). Methods We used a person-linked hospitalization/mortality dataset to identify all people hospitalized with CHD, AF or VHD (1985-2017), and stratified them as pre-existing (hospitalized 1985-2012 and alive at October 31, 2012) or new (first-ever cardiac hospitalization in the five-year study period, 2012-2017). We identified first-ever strokes occurring from 2012 to 2017 in patients aged 20-94 years and calculated age-specific and age-standardized rates (ASR) for each cardiac cohort. Results Of the 175,560 people in the cohort, most had CHD (69.9%); 16.3% had multiple cardiac conditions. From 2012-17, 5871 first-ever strokes occurred. ASRs were greater in females than males in single and multiple condition cardiac groups, largely driven by rates in females aged ≥75 years, with stroke incidence in this age group being at least 20% greater in females than males in each cardiac subgroup. In females aged 20-54 years, stroke incidence was 4.9-fold greater in those with multiple versus single cardiac conditions. This differential declined with increasing age. Non-fatal stroke incidence was greater than fatal stroke in all age groups except in the 85-94 age group. Incidence rate ratios were up to 2-fold larger in new versus pre-existing cardiac disease. Conclusion Stroke incidence in people with cardiac disease is substantial, with older females, and younger patients with multiple cardiac conditions, at elevated risk. These patients should be specifically targeted for evidence-based management to minimize the burden of stroke.
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Affiliation(s)
- Keira Robinson
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia,Correspondence: Keira Robinson, School of Population and Global Health, The University of Western Australia, M431, 35 Stirling Hwy, Crawley, WA, 6009, Australia, Email
| | - Judith M Katzenellenbogen
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joosup Kim
- Department of Medicine, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Charley A Budgeon
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia,Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
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Balabanski AH, Dos Santos A, Woods JA, Mutimer CA, Thrift AG, Kleinig TJ, Suchy-Dicey AM, Ragnhild Siri S, Boden-Albala B, Krishnamurthi RV, Feigin VL, Buchwald D, Ranta A, Mienna CS, Zavaleta C, Churilov L, Burchill LJ, Zion D, Longstreth WT, Tirschwell DL, Anand SS, Parsons MW, Brown A, Warne DK, Harwood M, Barber A, Katzenellenbogen JM. Abstract 140: The Incidence Of Stroke In Indigenous Populations Of Countries With A Very High Human Development Index: A Systematic Review. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Despite known socioeconomic and health disparities affecting Indigenous populations in developed countries, stroke incidence data are sparse. With Indigenous Advisory Board oversight, we undertook a systematic review to compare Indigenous with non-Indigenous stroke incidence rates in countries with a very high Human Development Index (HDI).
Methods:
We identified population-based stroke incidence studies published from 1990-2022 in Indigenous adult populations of developed countries using PubMed, EMBASE and Global Health databases, without language restriction. We excluded non-peer-reviewed sources, studies with <10 Indigenous people, or studies not covering a 35-64 year minimum age range. Two reviewers independently screened titles, abstracts, and full texts, and extracted data. We assessed quality using "ideal" criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and CONSIDER criteria for Indigenous research.
Results:
Among 13,041 publications, 24 studies (19 full text, 5 abstracts) from 7 countries met inclusion criteria. Compared with respective non-Indigenous populations (Fig 1), age-standardised incidence rates were greater in Aboriginal and Torres Strait Islander Australians (ratios ranging from 1.7-3.2), American Indians (1.2), Sámi of Sweden/Norway (1.08-2.14), and Singaporean Malay (1.7-1.9), with higher rate ratios at younger ages. Studies had substantial heterogeneity in design and risk of bias. Few investigators reported Indigenous stakeholder involvement.
Conclusions:
In countries with a very high HDI, available data suggest marked disparities in stroke incidence in Indigenous populations, although there are gaps in data availability and quality. Indigenous stakeholder involvement in studies is infrequently reported. A greater understanding of stroke incidence in these populations is imperative for informing effective societal responses.
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Affiliation(s)
| | - Angela Dos Santos
- Dept of Medicine and Neurology, Royal Melbourne Hosp, Melbourne, Australia
| | - John A Woods
- Sch of Population and Global Health, Univ of Western Australia, Perth, Australia
| | | | | | | | | | - Susanna Ragnhild Siri
- Dept of Community Medicine, Cntr for Sami Health Rsch, UiT the Arctic Univ of Norway, Tromso, Norway
| | - Bernadette Boden-Albala
- Dept of Population Health and Disease Prevention and Dept of Epidemiology, Univ of California, Irvine, CA
| | | | | | - Dedra Buchwald
- Elson S. Floyd College of Medicine, Washington State Univ, Spokane, WA
| | | | | | - Carol Zavaleta
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Deborah Zion
- Human Rsch Ethics Committee, Victoria Univ, Melbourne, Australia
| | | | | | | | | | - Alex Brown
- South Australian Health and Med Rsch Institute, Adelaide, Australia
| | - Donald K Warne
- Sch of Medicine and Health Sciences, Univ of North Dakota, Grand Forks, ND
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Vogiatjis J, Noe KM, Don A, Cochrane AD, Zhu MZL, Smith JA, Ngo JP, Martin A, Thrift AG, Bellomo R, Evans RG. Association Between Changes in Norepinephrine Infusion Rate and Urinary Oxygen Tension After Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:237-245. [PMID: 36435720 DOI: 10.1053/j.jvca.2022.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine if the administration of norepinephrine to patients recovering from on-pump cardiac surgery is associated with changes in urinary oxygen tension (PO2), an indirect index of renal medullary oxygenation. DESIGN Single center, prospective observational study. SETTING Surgical intensive care unit (ICU). PARTICIPANTS A nonconsecutive sample of 93 patients recovering from on-pump cardiac surgery. MEASUREMENTS AND MAIN RESULTS In the ICU, norepinephrine was the most commonly used vasopressor agent (90% of patients, 84/93), with fewer patients receiving epinephrine (48%, 45/93) or vasopressin (4%, 4/93). During the 30-to-60-minute period after increasing the infused dose of norepinephrine (n = 89 instances), urinary PO2 decreased by (least squares mean ± SEM) 1.8 ± 0.5 mmHg from its baseline level of 25.1 ± 1.1 mmHg. Conversely, during the 30-to-60-minute period after the dose of norepinephrine was decreased (n = 134 instances), urinary PO2 increased by 2.6 ± 0.5 mmHg from its baseline level of 22.7 ± 1.2 mmHg. No significant change in urinary PO2 was detected when the dose of epinephrine was decreased (n = 21). There were insufficient observations to assess the effects of increasing the dose of epinephrine (n = 11) or of changing the dose of vasopressin (n <4). CONCLUSIONS In patients recovering from on-pump cardiac surgery, changes in norepinephrine dose are associated with reciprocal changes in urinary PO2, potentially reflecting an effect of norepinephrine on renal medullary oxygenation.
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Affiliation(s)
- Johnny Vogiatjis
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - Khin M Noe
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Andrea Don
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - Andrew D Cochrane
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
| | - Michael Z L Zhu
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
| | - Jennifer P Ngo
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia; Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Andrew Martin
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.
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Phan TG, Beare R, Bath PM, Ievlieva S, Ho S, Ly J, Thrift AG, Srikanth VK, Ma H. Effect of alteplase, benzodiazepines and beta-blocker on post-stroke pneumonia: Exploration of VISTA-Acute. PLoS One 2023; 18:e0281617. [PMID: 37126535 PMCID: PMC10150972 DOI: 10.1371/journal.pone.0281617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 01/27/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Post-stroke pneumonia is a frequent complication of stroke and is associated with high mortality. Investigators have described its associations with beta-blocker. However, there has been no evaluation of the role of recombinant tissue plasminogen activator (RTPA). We postulate that RTPA may modify the effect of stroke on pneumonia by reducing stroke disability. We explore this using data from neuroprotection trials in Virtual International Stroke Trials Archive (VISTA)-Acute. METHOD We evaluated the impact of RTPA and other medications in random forest model. Random forest is a type of supervised ensemble tree-based machine learning method. We used the standard approach for performing random forest and partitioned the data into training (70%) and validation (30%) sets. This action enabled to the model developed on training data to be evaluated in the validation data. We borrowed idea from Coalition Game Theory on fair distribution of marginal profit (Shapley value) to determine proportional contribution of a covariate to the model. Consistent with other analysis using the VISTA-Acute data, the diagnosis of post-stroke pneumonia was based on reports of serious adverse events. RESULTS The overall frequency of pneumonia was 10.9% (614/5652). It was present in 11.5% of the RTPA (270/2358) and 10.4% (344/3295) of the no RTPA groups. There was significant (p<0.05) imbalance in covariates (age, baseline National Institutes of Health Stroke Scale (NIHSS), diabetes, and sex). The AUC for training data was 0.70 (95% CI 0.65-0.76), validation data was 0.67 (95% CI 0.62-0.73). The Shapley value shows that baseline NIHSS (≥10) and age (≥80) made the largest contribution to the model of pneumonia while absence of benzodiazepine may protect against pneumonia. RTPA and beta-blocker had very low effect on frequency of pneumonia. CONCLUSION In this cohort pneumonia was strongly associated with stroke severity and age whereas RTPA had a much lower effect. An intriguing finding is a possible association between benzodiazepine and pneumonia but this requires further evaluation.
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Affiliation(s)
- Thanh G Phan
- Department of Neurology, Monash Medical Centre, Clayton, Australia
- Stroke and Aging Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Richard Beare
- Department of Medicine, Peninsula Health and Central Clinical School, Monash University and National Centre for Healthy Ageing, Melbourne, Australia
- Murdoch Children Institute of Research, Melbourne, Australia
| | - Philip M Bath
- Division of Clinical Neuroscience, Stroke Trials Unit, University of Nottingham, Nottingham, United Kingdom
| | - Svitlana Ievlieva
- Department of Neurology, Monash Medical Centre, Clayton, Australia
- Stroke and Aging Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Stella Ho
- Department of Pharmacy, Monash Health, Clayton, Australia
| | - John Ly
- Department of Neurology, Monash Medical Centre, Clayton, Australia
- Stroke and Aging Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Amanda G Thrift
- Stroke and Aging Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Velandai K Srikanth
- Department of Medicine, Peninsula Health and Central Clinical School, Monash University and National Centre for Healthy Ageing, Melbourne, Australia
| | - Henry Ma
- Department of Neurology, Monash Medical Centre, Clayton, Australia
- Stroke and Aging Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Dalli LL, Olaiya MT, Kim J, Andrew NE, Cadilhac DA, Ung D, Lindley RI, Sanfilippo FM, Thrift AG, Nelson MR, Gall SL, Kilkenny MF. Antihypertensive Medication Adherence and the Risk of Vascular Events and Falls After Stroke: A Real-World Effectiveness Study Using Linked Registry Data. Hypertension 2023; 80:182-191. [PMID: 36330805 DOI: 10.1161/hypertensionaha.122.19883] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Real-world evidence is limited on whether antihypertensive medications help avert major adverse cardiovascular events (MACE) after stroke without increasing the risk of falls. We investigated the association of adherence to antihypertensive medications on the incidence of MACE and falls requiring hospitalization after stroke. METHODS A retrospective cohort study of adults who were newly dispensed antihypertensive medications after an acute stroke (Australian Stroke Clinical Registry 2012-2016; Queensland and Victoria). Pharmaceutical dispensing records were used to determine medication adherence according to the proportion of days covered in the first 6 months poststroke. Outcomes between 6 and 18 months postdischarge included: (i) MACE, a composite outcome of all-cause death, recurrent stroke or acute coronary syndrome; and (ii) falls requiring hospitalization. Estimates were derived using Cox models, adjusted for >30 confounders using inverse probability treatment weights. RESULTS Among 4076 eligible participants (median age 68 years; 37% women), 55% had a proportion of days covered ≥80% within 6 months postdischarge. In the subsequent 12 months, 360 (9%) participants experienced a MACE and 337 (8%) experienced a fall requiring hospitalization. After achieving balance between groups, participants with a proportion of days covered ≥80% had a reduced risk of MACE (hazard ratio: 0.68; 95% CI: 0.54-0.84) and falls requiring hospitalization (subdistribution hazard ratio: 0.78; 95% CI: 0.62-0.98) than those with a proportion of days covered <80%. CONCLUSIONS High adherence to antihypertensive medications within 6 months poststroke was associated with reduced risks of both MACE and falls requiring hospitalization. Patients should be encouraged to adhere to their antihypertensive medications to maximize poststroke outcomes.
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Affiliation(s)
- Lachlan L Dalli
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.)
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.)
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC, Australia (J.K., D.A.C., M.F.K.)
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, VIC, Australia (N.E.A., D.U.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC, Australia (J.K., D.A.C., M.F.K.)
| | - David Ung
- Peninsula Clinical School, Central Clinical School, Monash University, VIC, Australia (N.E.A., D.U.)
| | - Richard I Lindley
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia (R.I.L.)
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia (F.M.S.)
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.)
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (M.R.N., S.L.G.)
| | - Seana L Gall
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.).,Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia (M.R.N., S.L.G.)
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (L.L.D., M.T.O., J.K., D.A.C., A.G.T., S.L.G., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, VIC, Australia (J.K., D.A.C., M.F.K.)
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Zaman SB, Evans RG, Singh R, Singh R, Singh A, Goh TY, Singh P, De Silva N, Thrift AG. Usability and acceptability of the software ‘Arogya Sahyog’ to assess non-communicable diseases in rural India. Health Policy and Technology 2022. [DOI: 10.1016/j.hlpt.2022.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cameron J, Lannin NA, Harris D, Andrew NE, Kilkenny MF, Purvis T, Thrift AG, Thayabaranathan T, Ellery F, Sookram G, Hackett M, Kneebone I, Drummond A, Cadilhac DA. A mixed-methods feasibility study of a new digital health support package for people after stroke: the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention. Pilot Feasibility Stud 2022; 8:241. [PMCID: PMC9675218 DOI: 10.1186/s40814-022-01197-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial. Methods We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0–4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7–14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. Results Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. Conclusion The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018); Universal Trial Number: U1111-1206-7237
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Affiliation(s)
- Janette Cameron
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Natasha A. Lannin
- grid.1002.30000 0004 1936 7857Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia ,grid.267362.40000 0004 0432 5259Alfred Health, Melbourne, Australia
| | - Dawn Harris
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Nadine E. Andrew
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia ,grid.1002.30000 0004 1936 7857Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Australia
| | - Monique F. Kilkenny
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia ,grid.418025.a0000 0004 0606 5526Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Tara Purvis
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Amanda G. Thrift
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Tharshanah Thayabaranathan
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Fiona Ellery
- grid.418025.a0000 0004 0606 5526Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Garveeta Sookram
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia
| | - Maree Hackett
- grid.1005.40000 0004 4902 0432The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ian Kneebone
- grid.117476.20000 0004 1936 7611Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Avril Drummond
- grid.4563.40000 0004 1936 8868Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Dominique A. Cadilhac
- grid.1002.30000 0004 1936 7857Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168 Australia ,grid.418025.a0000 0004 0606 5526Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
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Thayabaranathan T, Kim J, Cadilhac DA, Thrift AG, Donnan GA, Howard G, Howard VJ, Rothwell PM, Feigin V, Norrving B, Owolabi M, Pandian J, Liu L, Olaiya MT. Global stroke statistics 2022. Int J Stroke 2022; 17:946-956. [PMID: 35975986 PMCID: PMC9980380 DOI: 10.1177/17474930221123175] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contemporary data on stroke epidemiology and the availability of national stroke clinical registries are important for providing evidence to improve practice and support policy decisions. AIMS To update the most current incidence, case-fatality, and mortality rates on stroke and identify national stroke clinical registries worldwide. METHODS We searched multiple databases (based on our existing search strategy) to identify new original papers, published between 1 November 2018 and 15 December 2021, that met ideal criteria for data on stroke incidence and case-fatality, and added these to the studies reported in our last review. To identify national stroke clinical registries, we updated our last search, using PubMed, from 6 February 2015 until 6 January 2022. We also screened reference lists of review papers, citation history of papers, and the gray literature. Mortality codes for International Classification of Diseases (ICD)-9 and ICD-10 were extracted from the World Health Organization (WHO) for each country providing these data. Population denominators were obtained from the United Nations (UN) or WHO (when data were unavailable in the UN database). Crude and adjusted stroke mortality rates were calculated using country-specific population denominators, and the most recent years of mortality data available for each country. RESULTS Since our last report in 2020, there were two countries (Chile and France) with new incidence studies meeting criteria for ideal population-based studies. New data on case-fatality were found for Chile and Kenya. The most current mortality data were available for the year 2014 (1 country), 2015 (2 countries), 2016 (11 countries), 2017 (10 countries), 2018 (19 countries), 2019 (36 countries), and 2020 (29 countries). Four countries (Libya, Solomon Islands, United Arab Emirates, and Lebanon) reported mortality data for the first time. Since our last report on registries in 2017, we identified seven more national stroke clinical registries, predominantly in high-income countries. These newly identified registries yielded limited information. CONCLUSIONS Up-to-date data on stroke incidence, case-fatality, and mortality continue to provide evidence of disparities and the scale of burden in low- and middle-income countries. Although more national stroke clinical registries were identified, information from these newly identified registries was limited. Highlighting data scarcity or even where a country is ranked might help facilitate more research or greater policy attention in this field.
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Affiliation(s)
- Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Joosup Kim
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia,Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia,Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Geoffrey A Donnan
- Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Mayowa Owolabi
- Center for Genomic and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Polhill E, Kilkenny MF, Cadilhac DA, Lannin NA, Dalli LL, Purvis T, Andrew NE, Thrift AG, Sundararajan V, Olaiya MT. Factors Associated with Receiving a Discharge Care Plan After Stroke in Australia: A Linked Registry Study. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2310328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Snowdon DA, Ung D, Collyer TA, Lannin NA, Kilkenny MF, Thrift AG, Sundararajan V, Cadilhac DA, Andrew NE. Are Medicare Funded Multidisciplinary Care Policies Being Claimed in accordance to Rehabilitation Needs in Patients with Stroke? Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2309318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Olaiya MT, Andrew NE, Dalli LL, Ung D, Kim J, Sundararajan V, Cadilhac DA, Thrift AG, Nelson MR, Churilov L, Kilkenny MF. Does a History of Cancer Influence the Effectiveness of Statins on Outcomes After Stroke? Stroke 2022; 53:3202-3205. [PMID: 36065808 DOI: 10.1161/strokeaha.122.038829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence is growing on anticancer effects of statins. We investigated whether the effectiveness of treatment with statins after ischemic stroke on mortality is influenced by a history of cancer. METHODS Analyses of 90-day survivors of ischemic stroke (2012-2016; 45 hospitals) using linked registry and administrative data. Dispense of statins within 90 days postdischarge was determined from pharmaceutical records. Participants were followed from 91 days postdischarge until death or June 30, 2018. History of cancer was determined from hospital data. Propensity score-adjusted Cox proportional hazards regression model was used to determine the association between being dispensed statins and survival. The influence of history of cancer on this association was assessed based on the concepts of (1) statistical interaction and (2) biological interaction using 3 indices: relative excess risk due to interaction>0, attributable proportion due to interaction >0, or synergy index >1. RESULTS Among 9948 eligible participants (median age=72 years, 42% female), there were 1463 deaths. In adjusted analyses, there was no statistical interaction between being dispensed statins and history of cancer on mortality (P=0.156). However, being dispensed statins had a significant positive biological interaction with having a history of cancer on mortality: relative excess risk due to interaction, 2.80 (95% CI, 1.56-5.05), attributable proportion due to interaction, 0.45 (95% CI, 0.23-0.66), and synergy index, 2.14 (95% CI, 1.32-3.49). CONCLUSIONS Treatment with statins after ischemic stroke may confer additional survival benefits for people who also have had cancer.
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Affiliation(s)
- Muideen T Olaiya
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.)
| | - Nadine E Andrew
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.).,National Centre for Healthy Ageing, Frankston, Australia (N.E.A)
| | - Lachlan L Dalli
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.)
| | - David Ung
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.)
| | - Joosup Kim
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (J.K., D.A.C., L.C., M.F.K.)
| | | | - Dominique A Cadilhac
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (J.K., D.A.C., L.C., M.F.K.)
| | - Amanda G Thrift
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.)
| | - Mark R Nelson
- Menzies Institute for Medical Research, Hobart TAS, Australia (M.R.N.)
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (J.K., D.A.C., L.C., M.F.K.)
| | - Monique F Kilkenny
- Monash University, Clayton, VIC, Australia (M.T.O., N.E.A., L.L.D., D.U., J.K., D.A.C., A.G.T., M.F.K.).,The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (J.K., D.A.C., L.C., M.F.K.)
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Purvis T, Busingye D, Andrew NE, Kilkenny MF, Thrift AG, Li JC, Cameron J, Thijs V, Hackett ML, Kneebone I, Lannin NA, Cadilhac DA. Mixed methods evaluation to explore participant experiences of a pilot randomized trial to facilitate self-management of people living with stroke: Inspiring virtual enabled resources following vascular events (iVERVE). Health Expect 2022; 25:2570-2581. [PMID: 35999689 PMCID: PMC9615081 DOI: 10.1111/hex.13584] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/24/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Despite digital health tools being popular for supporting self‐management of chronic diseases, little research has been undertaken on stroke. We developed and pilot tested, using a randomized controlled design, a multicomponent digital health programme, known as Inspiring Virtual Enabled Resources following Vascular Events (iVERVE), to improve self‐management after stroke. The 4‐week trial incorporated facilitated person‐centred goal setting, with those in the intervention group receiving electronic messages aligned to their goals, versus limited administrative messages for the control group. In this paper, we describe the participant experience of the various components involved with the iVERVE trial. Methods Mixed method design: satisfaction surveys (control and intervention) and a focus group interview (purposively selected intervention participants). Experiences relating to goal setting and overall trial satisfaction were obtained from intervention and control participants, with feedback on the electronic message component from intervention participants. Inductive thematic analysis was used for interview data and open‐text responses, and closed questions were summarized descriptively. Triangulation of data allowed participants' perceptions to be explored in depth. Results Overall, 27/54 trial participants completed the survey (13 intervention: 52%; 14 control: 48%); and 5/8 invited participants in the intervention group attended the focus group. Goal setting: The approach was considered comprehensive, with the involvement of health professionals in the process helpful in developing realistic, meaningful and person‐centred goals. Electronic messages (intervention): Messages were perceived as easy to understand (92%), and the frequency of receipt was considered appropriate (11/13 survey; 4/5 focus group). The content of messages was considered motivational (62%) and assisted participants to achieve their goals (77%). Some participants described the benefits of receiving messages as a ‘reminder’ to act. Overall trial satisfaction: Messages were acceptable for educating about stroke (77%). Having options for short message services or email to receive messages was considered important. Feedback on the length of the intervention related to specific goals, and benefits of receiving the programme earlier after stroke was expressed. Conclusion The participant experience has indicated acceptance and utility of iVERVE. Feedback from this evaluation is invaluable to inform refinements to future Phase II and III trials, and wider research in the field. Patient or Public Contribution Two consumer representatives sourced from the Stroke Foundation (Australia) actively contributed to the design of the iVERVE programme. In this study, participant experiences directly contributed to the further development of the iVERVE intervention and future trial design.
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Affiliation(s)
- Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Doreen Busingye
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Population Health, Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,National Centre for Healthy Ageing, Monash University, Melbourne, Victoria, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Jonathan C Li
- Department of Electrical and Computer Systems Engineering, Monash University, Melbourne, Victoria, Australia
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Australian Centre for Heart Health, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia.,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Maree L Hackett
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, United Kingdom
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Allied Health Directorate, Alfred Health, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
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Thayabaranathan T, Baker C, Andrew NE, Stolwyk R, Thrift AG, Carter H, Moss K, Kim J, Wallace SJ, Brogan E, Grimley R, Lannin NA, Rose ML, Cadilhac DA. Exploring dimensions of quality-of-life in survivors of stroke with communication disabilities - a brief report. Top Stroke Rehabil 2022:1-7. [PMID: 35786371 DOI: 10.1080/10749357.2022.2095087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND People with communication disabilities post-stroke have poor quality-of-life. OBJECTIVES We aimed to explore the association of self-reported communication disabilities with different dimensions of quality-of-life between 90 and 180 days post-stroke. METHODS Cross-sectional survey data were obtained between 90 and 180 days post-stroke from registrants in the Australian Stroke Clinical Registry recruited from three hospitals in Queensland. The usual follow-up survey included the EQ5D-3L. Responses to the Hospital Anxiety and Depression Scale, and extra questions (e.g. communication disabilities) were also collected. We used χ2 statistics to determine differences. RESULTS Overall, 244/647 survivors completed the survey. Respondents with communication disabilities (n = 72) more often reported moderate to extreme problems in all EQ5D-3L dimensions, than those without communication disabilities (n = 172): anxiety or depression (74% vs 40%, p < .001), pain or discomfort (58% vs 39%, p = .006), self-care (46% vs 18%, p < .001), usual activities (77% vs 49%, p < .001), and mobility (68% vs 35%, p < .001). Respondents with communication disabilities reported less fatigue (66% vs 89%, p < .001), poorer cognitive skills (thinking) (16% vs 1%, p < .001) and lower social participation (31% vs 6%, p < .001) than those without communication disabilities. CONCLUSIONS Survivors of stroke with communication disabilities are more negatively impacted across different dimensions of quality-of-life (as reported between 90 and 180 days post-stroke) compared to those without communication disabilities. This highlights the need for timely and on-going comprehensive multidisciplinary person-centered support.
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Affiliation(s)
- T Thayabaranathan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia
| | - C Baker
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,Speech Pathology Department, Monash Health, Victoria, Australia
| | - N E Andrew
- Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia
| | - R Stolwyk
- Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia
| | - A G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - H Carter
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - K Moss
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - J Kim
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - S J Wallace
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,Queensland Aphasia Research Centre, University of Queensland, Queensland, Australia
| | - E Brogan
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.,Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - R Grimley
- Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,School of Medicine, Griffith University, Birtinya, Queensland, Australia
| | - N A Lannin
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,Central Clinical School, Monash University, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - M L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | - D A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Adeoye AM, Adebusoye LA, Fakunle AG, Aderonmu OI, Adebayo OM, Michael OS, Adetona MO, Thrift AG, Olaiya MT, Owolabi MO. Day and night blood pressure variability among older persons in South-Western Nigeria. Niger Postgrad Med J 2022; 29:206-213. [PMID: 35900456 DOI: 10.4103/npmj.npmj_24_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hypertension is the largest contributor to the global burden of disease. Emerging risk factors for cardiovascular disease include blood pressure variability (BPV), but evidence on BPV is lacking among older Nigerians. We reported BPV in a cohort of older persons at the University College Hospital (UCH), Ibadan. METHODS We conducted a retrospective cohort study of respondents aged >50 years within the Ibadan Ambulatory Blood Pressure Registry at the UCH, Ibadan, Nigeria. Socio-demographic characteristics, lifestyle habits and anthropometric measurements were obtained. RESULTS Among 639 respondents, 332 (52.0%) were female. The blood pressure (BP) variables were strongly associated with age. Compared with younger age groups, mean diastolic BP (DBP) was less at an older age, whereas mean pulse pressure was greater. During the wake-up and sleep periods, mean DBP and mean arterial BP were less with each increasing age category, whereas mean pulse pressure was larger with each increasing age category. BP dipping, systolic, diastolic and mean arterial BP decreased with age. Overall, timed BPV increased significantly with increasing age. The prevalence of white-coat hypertension was greater among older participants than younger participants. Most respondents in the 50-59 years' age group were non-dippers (55.8%), whereas 33.7% of older respondents were reverse-dippers. CONCLUSION Older persons experienced a greater abnormal circadian blood variation and greater BPV than younger people. In Nigeria, follow-up data are needed to determine the prognostic significance of these data in this population.
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Affiliation(s)
| | | | | | | | | | - Obaro S Michael
- Department of Pharmacology and Therapeutic, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Muideen T Olaiya
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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Birhanu MM, Zaman SB, Thrift AG, Evans RG, Zengin A. Risk factors for incident cardiovascular events among adults in low- and middle-income countries: A systematic review and meta-analysis of prospective cohort studies. Prev Med 2022; 158:107036. [PMID: 35358600 DOI: 10.1016/j.ypmed.2022.107036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/03/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
The relative contributions of risk factors for cardiovascular events at a population level has received little attention in low- and middle-income countries (LMICs). We estimated the population attributable fraction (PAF) of risk factors associated with incident cardiovascular events in LMICs. We searched six databases for relevant articles, supplemented with a manual search of reference lists. Articles included in the meta-analyses were those based on prospective community-based cohorts and incorporating adjusted hazard ratios (HR) or relative risks with 95% confidence intervals (95% CI) for associations between risk factors and a composite cardiovascular and/or stroke endpoint. Pooled HRs and 95% CI were calculated using the random effects model. We assessed heterogeneity using the I2 test and study quality using the Newcastle-Ottawa Scale. We calculated the PAF of each associated risk factor. The protocol was registered in PROSPERO (CRD42019122741). We identified 18 cohorts from LMICs with 1,125,846 participants, 77,045 composite cardiovascular events and 42,216 strokes. Substantial proportions of incident cardiovascular events were attributable to hypertension (HR [95% CI], 2.23 [2.01-2.48], PAF = 28%); current smoking (1.44 [1.31-1.58], PAF = 10%); and diabetes mellitus (1.93 [1.67-2.23], PAF = 8%). Other risk factors identified included number of children, depression, bone mineral density, and air pollution. A substantial proportion of incident cardiovascular events were linked to traditional metabolic and behavioural modifiable risk factors. However, other novel risk factors also appear to contribute. Targeting of these established and novel risk factors has the potential to reduce the burden of CVD in LMICs.
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Affiliation(s)
- Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia; Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
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Birhanu MM, Evans RG, Zengin A, Riddell M, Kalyanram K, Kartik K, Suresh O, Thomas NJ, Srikanth VK, Thrift AG. Absolute cardiovascular risk scores and medication use in rural India: a cross-sectional study. BMJ Open 2022; 12:e054617. [PMID: 35459666 PMCID: PMC9036467 DOI: 10.1136/bmjopen-2021-054617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We compared the performance of laboratory-based cardiovascular risk prediction tools in a low-income and middle-income country setting, and estimated the use of antihypertensive and lipid-lowering medications in those deemed at high risk of a cardiovascular event. DESIGN A cross-sectional study. SETTING The study population comprised adult residents (aged ≥18 years) of the Rishi Valley region located in Chittoor District, south-western Andhra Pradesh, India. PARTICIPANTS 7935 participants were surveyed between 2012 and 2015. We computed the 10-year cardiovascular risk and undertook pair-to-pair analyses between various risk tools used to predict a fatal or non-fatal cardiovascular event (Framingham Risk Score (FRS), World Health Organization Risk Score (WHO-RS) and Australian Risk Score (ARS)), or a fatal cardiovascular event (Systematic COronary Risk Evaluation (SCORE-high and SCORE-low)). Concordance was assessed by ordinary least-products (OLP) regression (for risk score) and quadratic weighted kappa (κw, for risk category). RESULTS Of participants aged 35-74 years, 3.5% had prior cardiovascular disease. The relationships between risk scores were quasi-linear with good agreement between the FRS and ARS (OLP slope=0.96, κw=0.89). However, the WHO-RS underestimated cardiovascular risk compared with all other tools. Twenty per cent of participants had ≥20% risk of an event using the ARS; 5% greater than the FRS and nearly threefold greater than the WHO-RS. Similarly, 16% of participants had a risk score ≥5% using SCORE-high which was 6% greater than for SCORE-low. Overall, absolute cardiovascular risk increased with age and was greater in men than women. Only 9%-12% of those deemed 'high risk' were taking lipid-lowering or antihypertensive medication. CONCLUSIONS Cardiovascular risk prediction tools perform disparately in this setting of disadvantage. Few deemed at high risk were receiving the recommended treatment.
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Affiliation(s)
- Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michaela Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Nihal Jacob Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Velandai K Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
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Ramani-Chander A, Joshi R, van Olmen J, Wouters E, Delobelle P, Vedanthan R, Miranda JJ, Oldenburg B, Sherwood S, Rawal LB, Mash RJ, Irazola VE, Martens M, Lazo-Porras M, Liu H, Agarwal G, Waqa G, Marcolino MS, Esandi ME, Ribeiro ALP, Probandari A, González-Salazar F, Shrestha A, Sujarwoto S, Levitt N, Paredes M, Sugishita T, Batal M, Li Y, Haghparast-Bidgoli H, Naanyu V, He FJ, Zhang P, Mfinanga SG, De Neve JW, Daivadanam M, Siddiqi K, Geldsetzer P, Klipstein-Grobusch K, Huffman MD, Webster J, Ojji D, Beratarrechea A, Tian M, Postma M, Owolabi MO, Birungi J, Antonietti L, Ortiz Z, Patel A, Peiris D, Schouw D, Koot J, Nakamura K, Tampubolon G, Thrift AG. Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries: protocol for a longitudinal mixed-methods study. BMJ Open 2022; 12:e053122. [PMID: 35437244 PMCID: PMC9016402 DOI: 10.1136/bmjopen-2021-053122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions. METHODS AND ANALYSIS We will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (TP), initiation of implementation (T0) and 1-year postinitiation (T1). We will extract project-related data from secondary documents at TP and conduct multistakeholder qualitative interviews to gather data at T0 and T1. We will undertake descriptive statistical analysis of TP data and analyse T0 and T1 data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks. ETHICS AND DISSEMINATION The current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network.
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Affiliation(s)
- Anusha Ramani-Chander
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Rohina Joshi
- The George Institute for Global Health, New Delhi, India
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Josefien van Olmen
- Department of Family Health and Population Medicine, University of Antwerp, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology, Centre for Population, Family & Health, Faculty of Social Sciences, Univesrity of Antwerp, Antwerp, Belgium
| | - Peter Delobelle
- Chronic Diseases Initiative of Africa, University of Cape Town, Cape Town, South Africa
- Department of Public Health, Vrije Universiteit, Brussel, Belgium
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Oldenburg
- Department of Cardiovascular Research, Translation and Implementation, Baker Heart and Diabetes Institute and La Trobe University, Melbourne, Victoria, Australia
| | - Stephen Sherwood
- Fundación EkoRural and Knowledge, Technology and Innovation, Wageningen University, Wageningen, The Netherlands
| | - Lal B Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney, New South Wales, Australia
| | - Robert James Mash
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Vilma Edith Irazola
- Department of Chronic Diseases-CESCAS, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Monika Martens
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maria Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hueiming Liu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gade Waqa
- C-POND, Fiji National University, College of Medicine, Nursing and Health Sciences, Suva, Fiji
| | - Milena Soriano Marcolino
- Medical School and Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Eugenia Esandi
- Epidemiological Research Institute, National Academy of Medicine, Buenos Aires, Argentina
| | - Antonio Luiz Pinho Ribeiro
- Internal Medicine Department, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Head of Research and Innovation, Hospital das Clínicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebalas Maret, Saurakarta, Indonesia
| | - Francisco González-Salazar
- Departamento de Ciencias Básicas, Division de Ciencias de la Salud, Universidad de Monterrey, Monterrey, Mexico
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Dhulikhel Hospital, Dhulikhel, Nepal
| | - Sujarwoto Sujarwoto
- Department of Public Administration, University of Brawijaya, Malang, Indonesia
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Myriam Paredes
- Facultad Latinoamericana de Ciencias Sociales Sede Ecuador (FLACSO), Quito, Ecuador
| | - Tomohiko Sugishita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Malek Batal
- Nutrition Department, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
- Centre for Public Health Research (CReSP), Montreal, Québec, Canada
| | - Yuan Li
- Nutrition and Lifestyle Program, The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Sqaure, London, UK
| | - Puhong Zhang
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Heath at Peking University Health Science Center, Beijing, China
| | - Sayoki Godfrey Mfinanga
- Muhimbili Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Meena Daivadanam
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Instituet, Solna, Sweden
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, USA
- Chan Zuckerberg Biohub, San Franciso, Caliornia, USA
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark D Huffman
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jacqui Webster
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Dike Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Andrea Beratarrechea
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Maarten Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center, Groningen, The Netherlands
| | | | - Josephine Birungi
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI& LSHTM), Entebbe, Uganda
- The AIDS Support Organisation (TASO), Entebbe, Uganda
| | - Laura Antonietti
- Health Sciences Institute, Universidad Nacional Arturo Jauretche, Florencio Varela, Buenos Aires, Argentina
| | - Zulma Ortiz
- Epidemiological Research Institute, National Academy of Medicine, Buenos Aires, Argentina
| | - Anushka Patel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Darcelle Schouw
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Jaap Koot
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health,Tokyo Medical and Dental University, Tokyo, Japan
| | - Gindo Tampubolon
- Global Development Institute, University of Manchester, Manchester, UK
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Chandra RV, Maingard J, Slater LA, Cheung NK, Lai LT, Gall SL, Thrift AG, Phan TG. A Meta-Analysis of Rupture Risk for Intracranial Aneurysms 10 mm or Less in Size Selected for Conservative Management Without Repair. Front Neurol 2022; 12:743023. [PMID: 35250788 PMCID: PMC8893017 DOI: 10.3389/fneur.2021.743023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/28/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Small unruptured intracranial aneurysms (UIAs) are considered to have low risk of rupture. The proportion of UIAs measuring 10 mm or less in size that rupture when selected for conservative management without repair is not well known. The aim of this study is to determine the proportion of UIAs that rupture by size threshold from ≤10 to ≤3 mm when selected for management without repair and to determine the level of precision and sources of heterogeneity in the rupture risk estimate. METHODS This study was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019121522). The Ovid MEDLINE, EMBASE, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials were searched (inception to August 2020). Studies with longitudinal follow-up of patients with UIAs ( ≤10 mm to ≤3 mm) without endovascular or neurosurgical repair were eligible. We included studies, which provided details of aneurysm size and in which UIA rupture was reported as an outcome. The primary outcome of the pooled proportion of UIA rupture during follow-up was synthesized with random-effects meta-analysis; heterogeneity was explored using meta-regression. RESULTS A total of 31 studies that included 13,800 UIAs ≤10 mm in size were eligible for data synthesis. The pooled proportion of ≤10 mm UIAs that ruptured when managed without repair was 1.1% (95% CI 0.8-1.5; I 2 = 52.9%) over 3.7 years. Findings were consistent in sensitivity analyses at all the size stratified thresholds including ≤5 and ≤3 mm; rupture occurred in 1.0% (95% CI 0.8-1.3; I 2 = 0%) of 7,280 ≤5 mm UIAs and 0.8% (95% CI 0.4-1.5; I 2 = 0%) of 1,228 ≤3 mm UIAs managed without repair. In higher quality studies with lower risk of bias, rupture occurred in 1.8% (95% CI 1.5-2.0; I 2 = 0%) over 3.9 years. In meta-regression, aneurysm size, shape, anatomical location, and exposure to prior subarachnoid hemorrhage were not identified as sources of heterogeneity. CONCLUSION For every 1,000 UIAs that are 10 mm or less in size and selected for conservative management without repair, between 8 and 15 UIAs are estimated to rupture over 3.7 years. When stratified by size, these pooled rupture risk estimates are consistent and clinically applicable for ≤5 mm UIAs selected for management without repair. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42019121522.
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Affiliation(s)
- Ronil V. Chandra
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Julian Maingard
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Lee-Anne Slater
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Nicholas K. Cheung
- NeuroInterventional Radiology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Leon T. Lai
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Seana L. Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Amanda G. Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Thanh G. Phan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
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Nguyen TP, Stirling C, Nichols L, Chandra RV, Rehman S, Buscot MJ, Smith KL, Blizzard L, Lai L, Asadi H, Arvind D, Froelich J, Thani N, Reeves MJ, Thrift AG, Gall SL. Abstract TMP11: Predictors Of Timely Treatment Of Aneurysmal Subarachnoid Hemorrhage - The Reddish Study. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tmp11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Receiving early treatment for aneurysmal subarachnoid hemorrhage (aSAH) is associated with better outcomes for the patient. However, delays in treatment of aSAH are common but the causes are not well understood. We explored predictors of early treatment within 12.5 hours or 24 hours after aSAH.
Methods:
Consecutive cases of confirmed first-ever aSAH were identified from two Australian tertiary referral centers between 2010 and 2016. We used medical and ambulance records to extract details of participants, including time from onset to definitive treatment of either endovascular coiling or neurosurgical clipping, demographics, severity of aSAH (modified Fisher grade; World Federation of Neurosurgeons Scale [WFNS]), risk factors, pre-hospital care, and presenting symptoms. Factors associated with treatment to secure the aneurysm within 12.5 hours or 24 hours on univariable logistic regression were entered into a multivariable model to identify factors independently associated with (odds ratio [OR], 95% CI) earlier treatment.
Results:
Among 482 patients (mean [SD] age 54.1 [14.5]; 69.9% female) with aSAH, median (IQR) time to treatment was 19.4 (10.6, 31.0) hours, 30% were treated <12.5h and 62% were treated <24h from onset. In multivariable analyses (see figure), arriving by ambulance, urgent triage category (1-2) and severe aSAH (modified Fisher Scale 3-4) predicted treatment <12.5h and <24h. Less severe aSAH (WFNS score 1-3) and arriving overnight (11pm to 7am) were associated with treatment <24h. In contrast, people with no risk factors for aSAH (smoking, hypertension or alcohol use), presenting with a stiff neck or interfacility transfer more often had treatment ≥12.5h.
Conclusions:
A substantial proportion of people after aSAH were not treated within timeframes associated with better outcomes. Recognition of the urgency and severity aSAH cases were associated with more timely treatment of aSAH.
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Affiliation(s)
| | | | | | | | - Sabah Rehman
- Menzies Rsch Institute, Univ of Tasmania, Hobart, Australia
| | | | | | - Leigh Blizzard
- Menzies Institute for Med Rsch, Univ of Tasmania, Hobart, Australia
| | - Leon Lai
- Monash Health, Clayton, Australia
| | - Hamed Asadi
- Austin and Monash Health, Melbourne, Australia
| | | | | | | | | | | | - Seana L Gall
- Menzies Institute for Med Rsch, Univ of Tasmania, Hobart, Australia
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Orman Z, Thrift AG, Olaiya MT, Ung D, Cadilhac DA, Phan T, Nelson MR, Srikanth VK, Vuong J, Bladin CF, Gerraty RP, Fitzgerald SM, Frayne J, Kim J. Quality of life after stroke: a longitudinal analysis of a cluster randomized trial. Qual Life Res 2022; 31:2445-2455. [DOI: 10.1007/s11136-021-03066-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
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Zaman SB, Khan RK, Evans RG, Thrift AG, Maddison R, Islam SMS. Exploring Barriers to and Enablers of the Adoption of Information and Communication Technology for the Care of Older Adults With Chronic Diseases: Scoping Review. JMIR Aging 2022; 5:e25251. [PMID: 34994695 PMCID: PMC8783284 DOI: 10.2196/25251] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/10/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023] Open
Abstract
Background Information and communication technology (ICT) offers considerable potential for supporting older adults in managing their health, including chronic diseases. However, there are mixed opinions about the benefits and effectiveness of ICT interventions for older adults with chronic diseases. Objective We aim to map the use of ICT interventions in health care and identified barriers to and enablers of its use among older adults with chronic disease. Methods A scoping review was conducted using 5 databases (Ovid MEDLINE, Embase, Scopus, PsycINFO, and ProQuest) to identify eligible articles from January 2000 to July 2020. Publications incorporating the use of ICT interventions, otherwise known as eHealth, such as mobile health, telehealth and telemedicine, decision support systems, electronic health records, and remote monitoring in people aged ≥55 years with chronic diseases were included. We conducted a strengths, weaknesses, opportunities, and threats framework analysis to explore the implied enablers of and barriers to the use of ICT interventions. Results Of the 1149 identified articles, 31 (2.7%; n=4185 participants) met the inclusion criteria. Of the 31 articles, 5 (16%) mentioned the use of various eHealth interventions. A range of technologies was reported, including mobile health (8/31, 26%), telehealth (7/31, 23%), electronic health record (2/31, 6%), and mixed ICT interventions (14/31, 45%). Various chronic diseases affecting older adults were identified, including congestive heart failure (9/31, 29%), diabetes (7/31, 23%), chronic respiratory disease (6/31, 19%), and mental health disorders (8/31, 26%). ICT interventions were all designed to help people self-manage chronic diseases and demonstrated positive effects. However, patient-related and health care provider–related challenges, in integrating ICT interventions in routine practice, were identified. Barriers to using ICT interventions in older adults included knowledge gaps, a lack of willingness to adopt new skills, and reluctance to use technologies. Implementation challenges related to ICT interventions such as slow internet connectivity and lack of an appropriate reimbursement policy were reported. Advantages of using ICT interventions include their nonpharmacological nature, provision of health education, encouragement for continued physical activity, and maintenance of a healthy diet. Participants reported that the use of ICT was a fun and effective way of increasing their motivation and supporting self-management tasks. It gave them reassurance and peace of mind by promoting a sense of security and reducing anxiety. Conclusions ICT interventions have the potential to support the care of older adults with chronic diseases. However, they have not been effectively integrated with routine health care. There is a need to improve awareness and education about ICT interventions among those who could benefit from them, including older adults, caregivers, and health care providers. More sustainable funding is required to promote the adoption of ICT interventions. We recommend involving clinicians and caregivers at the time of designing ICT interventions.
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Affiliation(s)
- Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Raihan Kabir Khan
- Department of Health Sciences, James Madison University, Harrisonburg, VA, United States
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute, Monash University, Melbourne, Australia.,Department of Physiology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise & Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise & Nutrition Sciences, Deakin University, Geelong, Australia
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