The evolution of stroke in Quebec

Abstract

To estimate changes in rates of cerebral infarction and intracerebral hemorrhage, comorbidity profile, and case fatality rates in Quebec over 15 years. A population-based admission-to-discharge cohort study was conducted, selecting first stroke events from hospital discharge data (MedEcho) from 1988 to 2002. In this study (involving 101,831 persons with cerebral infarctions and 11,215 persons with intracerebral hemorrhages), there was a downturn in the rates of cerebral infarction over 15 years, especially during the last 5 years (32.5% decline for men and 25.5% for women). A concomitant increase in rates of intracerebral hemorrhage, 28% increase for men (2%/year) and 22% for women (1.6%/year), was also noted. Although age and comorbidity of the population increased, case fatality decreased over time. Age and type of stroke were strong predictors for early (< or =7 days) and later (8 to 30 days) case fatality, whereas comorbidity was important only for later death. In-hospital bed stay declined dramatically over time for all discharge destinations. A significant decrease in rates of cerebral infarction and a rise in rates of intracerebral hemorrhage were noted in Quebec over 15 years. Age and comorbidity of the population increased. Although stroke is increasingly a condition of the elderly, ill population, case fatality and in-hospital bed stay declined over time.