Abstract
One major objective of the St. Vincent Declaration was to reduce excess risk of stroke in people with diabetes mellitus. The aim of this study is to estimate the trend of incidence and relative risk of stroke in the diabetic and the non-diabetic populations in Germany over a 17-year period. We estimated age–sex standardised incidence rates of all stroke and ischaemic stroke in people with and without diabetes based on an ongoing prospective community-based stroke register covering 105,000 inhabitants. Time trends were analysed using Poisson regression. In total, 3,111 individuals (diabetes: 28.4%, men 46.9%, mean age 73.1 years (SD 13.2)) had a first stroke, 84.9% of which were ischaemic stroke. Among people with diabetes we observed a significant reduction in all stroke incidence by 1.5% per year (relative risk: 0.985; 95% confidence interval 0.972–0.9995) Likewise, this incidence tended to decrease for ischaemic stroke by 1% per year (0.993; 0.979–1.008). In contrast, the incidence rate for all stroke remained nearly stable among people without diabetes (1.003; 0.993–1.013) and for ischaemic stroke (1.002; 0.991–1.013). The relative risk comparing diabetic and non-diabetic population decreased for all stroke (two percent annual reduction) but not for ischaemic stroke. Time trends were similar for both sexes regarding all and ischaemic strokes. We found a reduction in risk of stroke in the diabetic population while this rate did not materially change in the non-diabetic population.
Highlights
One of the primary objectives of the St
Several studies found an about two- to threefold elevated risk of stroke among individuals with diabetes compared to subjects without diabetes with particular high relative risks (RR) in the younger population [3,4,5,6,7]
We found only two studies analysing trends of the incidence rate (IR) of stroke in the diabetic compared with the non-diabetic population: Rautio and colleagues found declining IR of stroke in Sweden in non-diabetic men and women and diabetic women, but not in men with diabetes [13]
Summary
One of the primary objectives of the St. Vincent declaration was the decrease of stroke risk among persons with diabetes towards to that risk of the non-diabetic population [1, 2]. Several studies found an about two- to threefold elevated risk of stroke among individuals with diabetes compared to subjects without diabetes with particular high relative risks (RR) in the younger population [3,4,5,6,7]. Only few studies evaluated the incidence rate (IR) of stroke in the diabetic compared with the non-diabetic population and their RRs. In a previous study analysing the IR of stroke in health insurance data for the years 2005–2007 in Germany [8], we found the IR of stroke in the diabetic population to be approximately double that in the non-diabetic population. No investigation of time trend could be considered due to the short time span
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