Abstract
BackgroundData estimating the recurrence and risk of death are lacking in low and middle income countries, where two thirds of the stroke burden occurs. Previously we had shown that the incidence and mortality have been decreasing over the last 18 years in Joinville, Southern Brazil. In this study, we aim to determine the recurrence rates, survival rates and the cause of death in 3 years after their first-ever incident in a urban population-based setting.MethodsFrom the Joinville Stroke Registry, we identified all the cases of first-ever stroke that occurred from October 2009 to September 2010. Multiple overlapping sources of information were used to ensure the completeness of case identification. Patients were followed up prospectively at regular intervals from 30-days to 3 years after the index event. Kaplan-Meir and Cox proportional hazards were used to assess the cumulative risk of death and recurrence.ResultsWe registered 407 first-ever stroke patients. After 3 years, 136 (33%) had died. In the first year of stroke the risk of death was 28% (95% CI, 25 to 32). Beyond the first year, approximately 3 to 5% of survivors died each year. The cumulative risk of death in ischemic stroke (IS) subtypes was 3.6 higher for cardioembolic (CE) IS (hazard ratio 3.6, 95% CI, 2.1 to 6.4; p = 0.001) and 3.3 times higher for undetermined IS (HR 3.3, 95% CI 1.9 to 5.8; p = 0.001) compared to small artery occlusion IS. Over 3 years, the overall stroke recurrence risk was 9% (35/407). We found no difference in stroke recurrence risk between IS subtypes. Cardiovascular disease was the main cause of death all follow up time.ConclusionsCompared to other cohort studies conducted between 10 and 20 years ago in high-income countries, our recurrence rates and 3-year risk of death were similar. Among IS subtypes, we confirmed that CE has highest risk of death. The most common cause of death after a first-ever stroke is cardiovascular disease. This has implications for the uptake of current secondary preventive strategies and the development of new strategies.
Highlights
Data estimating the recurrence and risk of death are lacking in low and middle income countries, where two thirds of the stroke burden occurs
Recurrence and survival rates are useful data to compare the natural history of a disease against the effect of therapeutic interventions
Study population We identified 727 patients with stroke from October 1, 2009 to September 30, 2010
Summary
Data estimating the recurrence and risk of death are lacking in low and middle income countries, where two thirds of the stroke burden occurs. We aim to determine the recurrence rates, survival rates and the cause of death in 3 years after their first-ever incident in a urban population-based setting. The overall burden of disease data from the World Health Organization shows stroke is still in the top 6 based on disability adjusted life-years [4]. In community-based studies which included all major stroke types together, the 3year cumulative risk of recurrent stroke has been reported to be varied from 6 to 25% [7,8,9,10]. The reported cumulative risk of death in population-based studies which included all stroke types ranged across the last three decades in high and middle-income countries. In the 2000s, in Belarus, the 1-year risk was 38% and the 5-year risk was Cabral et al BMC Neurology (2015) 15:70
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