Abstract T P163: Inpatient Stroke Mortality Has Been Declining in Japan: Japanese Stroke Databank

Abstract

Background and Purpose: Although thrombolytic therapy, novel oral anticoagulants and neuroendovascular therapy became available in this decade, the stroke victims are facing the increasing risk of death including the comorbidity such as pneumonia due to rapid aging in Japan. As a part of the Japan Standard Stroke Registry Study (JSSRS) which is a multi-center registration study of acute stroke cases in Japan, we analyzed the trends in the inpatient stroke mortality in relation to the demographic data and stroke subtypes. Subjects and Methods: The present study was based on 101,160 acute stroke cases including 59,493 men (58.8%) and 41,667 women (41.2%) who were registered to the JSSRS databank between 1999 and 2012. Among them, 72,774 cases (71.9%) were diagnosed as having cerebral infarction (CI), 17,723 cases (17.5%) as intracerebral hemorrhage (ICH), 5,343 (5.3%) as subarachnoid hemorrhage (SAH), and 5,320 cases (5.3%) as transient ischemic attack (TIA). Results: There were 7,651 deceased cases and the overall mortality rate (MR) was 7.6%. The MR was greater in women (9.2%) than in men (6.4%), and greater in those who were 75 years or older (10.2%) than in younger age categories. The MR was greater for SAH (23.5%) and ICH (15.1%) than for CI (5.1%), and greater for cardiogenic embolism (11.7%) than for atherothrombotic infarction (3.8%) and lacunar infarction (0.6%). Among the deceased cases, 53.7% died in the acute stage whereas 26.0% died in the subacute stage and 20.3% died in the chronic stage. 23% of the in-hospital death was due to SAH in women, whereas that was only 9% in men. The overall MR was 9.2 % and the MR was 6.8% for CI and 15.6% for ICH in 2000, whereas the overall MR was 6.3% and the MR was 3.9% for CI and 13.3% for ICH in 2012. The MR for SAH was 21.4% in 2000 and 21.8% in 2012. Conclusions: The greater stroke MR in women was considered to be due to the greater MR for SAH. Our data revealed the stroke MR decreased significantly in last 12 years. This decline can be partly explained by the improved outcome in cerebral infarction in the acute phase.