Epidemiology Of Stroke Research Articles

Epidemiology of stroke in France

Background: It has been nearly 10 years since the first national stroke plan in France.Aims: To examine the epidemiology of strokes, how they are managed and patient outcomes.Methods: Adults hospitalized for stroke in 2022 were identified in the national database. Stroke prevalence at 1 January 2023 was defined as the number of people alive at that date with a history of hospitalization for stroke or a chronic long-term disease status due to stroke (2012–2022). Patients were monitored up for up to 1 year after hospitalization for a stroke.Results: In 2022, 122,422 adults were hospitalized due to stroke, and there were an estimated 1,086,795 cases. Important geographical and socioeconomic disparities were observed. Admission to a stroke intensive care unit was found in 46.8% of patients, with significant variations by department of residence, age and gender. Only 7.2% of ischaemic strokes resulted in mechanical thrombectomy. Among survivors at 6 months, admission to a rehabilitation unit was found for 34.3% for patients with ischaemic strokes and 41.7% of those with haemorrhagic strokes, while 28.8% and 18.8%, respectively, had a consultation with a neurologist, and 19.5% and 10.9% were seen by a cardiologist within 6 months. Mortality rates after 1 year were 20.8% and 37.9% among patients hospitalized due to ischaemic and haemorrhagic strokes, respectively.Conclusion: The considerable numbers and rates of stroke – and disparities by age, sex and area – highlight the need for more effective stroke prevention, regular information campaigns on the symptoms of stroke and improved availability and accessibility of stroke units.

The Impact of the COVID-19 Pandemic on the Stroke Unit of a Portuguese Community Hospital.

It is essential to understand the consequences of the COVID-19 pandemic on stroke care, contemplating the potential health and economic consequences of missed diagnoses or treatments. This study examined the pandemic's effects on stroke epidemiology, clinical characteristics, and treatment in a hospital setting, comparing data from March 2020 to February 2021 with the homologous period the previous year. A secondary analysis focused on the state of emergency periods (March 19 to May 2 and November 6 to February 28). The sample included 730 stroke admissions, with 343 during the pandemic. There was a 24.75% reduction in the average daily occupancy rate (p<0.001) and a slight decrease in average daily admissions, especially in June from 132% to 74% (p=0.01). There was a moderate negative correlation between the number of COVID-19 cases and occupancy rates in January (r{s}=-0.422, p=0.01) and February (r{s}=-0.532, p=0.01). Admissions for ischemic stroke decreased by 7.2% (p=0.026), particularly mild events, with a 6.8% decrease in lacunar syndromes (p=0.048). Mechanical thrombectomy (MT) increased by 5.4% (p=0.046), while intravenous thrombolysis (IVT) decreased by 2.8% (p=0.048), especially in severe stroke cases (-21.4%, p=0.001). The pandemic period documented more MT procedures than IVT. Hemorrhagic stroke admissions increased by 6.7% (p=0.01). The analysis suggests a reduction in mild ischemic stroke admissions and fewer patients undergoing IVT for severe strokes during the pandemic. Broader-scale studies are necessary to confirm these findings. Considering the documented decline in diagnosis and treatment, minimizing the impact on stroke care during potential sanitary crises is paramount.

Global, regional, and national temporal trends in metabolism-related ischemic stroke mortality and disability from 1990 to 2021

BackgroundStroke ranks as the second leading cause of mortality and the third leading cause of disability worldwide. Nonetheless, the evolving burden of ischemic stroke attributable to various metabolic risk factors remains inadequately elucidated. A thorough grasp of these trends is crucial for a nuanced comprehension of stroke epidemiology and the formulation of effective preventive and interventional measures. MethodBased on the Global Burden of Disease, Injury, and Risk Factors Study 2021 (GBD), we analyzed national temporal trends in the burden of metabolism-associated ischemic stroke in 204 countries and territories globally from 1990-2021, as measured by the average annual percentage change (AAPC), using join-point regression models. The burden of disease was assessed using age-standardized (ASR) mortality rates and disability-adjusted life years (DALY) per 100 000 population. Cross-country inequalities in ischemic stroke burden were quantified using standard health equity methods and changes in ischemic stroke burden were projected to 2045. ResultsGlobally, the ASR for ischemic stroke mortality linked to overall dietary metabolic risk declined by an average of 1.6% annually, while the ASR for disability-adjusted life years saw an average annual decrease of 1.3%. High systolic blood pressure remained a primary contributor to metabolism-related ischemic stroke, accounting for 57.9% of deaths and 58.0% of disability in 2021. Disparities associated with the sociodemographic index (SDI) diminished, with the gap in DALYs between countries with the highest and lowest SDIs narrowing from 592.2 (95% CI: 440.2-744.4) to 480.4 (95% CI: 309.7-651.2) in 2021. Projections indicate a continued decline in overall metabolism-related ischemic stroke deaths, mortality rates, and ASRs through 2045, although an increase in DALYs and ASRs is anticipated within the male population. ConclusionThe global burden of metabolic risk-associated ischemic stroke has generally been decreasing from 2019 to 2021. This study highlights significant challenges in controlling and managing metabolic risk-associated ischemic stroke, including an increase in the number of cases in certain countries and regions, as well as an uneven distribution worldwide. These findings may provide valuable insights for the development of improved public health policies and the rational allocation of healthcare resources.

Prevalence of poststroke fatigue and its relationship with clinical characteristics among community-dwelling stroke survivors: A cross-sectional survey

Background and objectivePoststroke fatigue is widely overlooked due to a lack of awareness, definite cause, and cure. It is influenced by cultural variance in psychosocial factors and stroke epidemiology patterns across different countries. To date, the prevalence of poststroke fatigue has not been determined in the Indian setting. Hence our objective was to estimate the prevalence of fatigue among community-living late subacute and chronic stroke survivors. Additionally, we determined the association between poststroke fatigue and participants’ clinical and demographic data. MethodsA cross-sectional survey was conducted among first-time stroke survivors following discharge from two tertiary care hospitals. Medical records were screened and included if they met the criteria for age >18 years, able to follow a two-step command with no existing neurological or systemic conditions that would influence fatigue scores. Telephonic consent was obtained, and an interview was conducted to obtain the scores for fatigue, daytime sleepiness, depression, functional mobility, and disability. ResultsA total of 323 participants (mean age: 60.3 ± 12.6 years, mean stroke duration: 8.6 ± 4.4 months) completed the interview. Poststroke fatigue was reported in 11.8 % (n = 38) of the population. Occupational status (χ2 = 5.73), functional mobility (χ2 = 5.84), and disability scores (χ2 = 8.00) were significantly associated (p < 0.05) with fatigue scores. Individuals with disability exhibited five times (OR = 5.00, CI: 1.45–17.23, p = 0.01) higher odds of experiencing fatigue than those without disability. ConclusionOur study reported a relatively lower prevalence of fatigue among community-living late subacute and chronic stroke survivors. Implementing strategies to address these contributing factors could effectively ease fatigue in individuals recovering from stroke.

Population-based cohort across stroke life course in India-The NIMHANS-NH-SKAN stroke project: A study protocol.

Stroke is a leading cause of death and disability worldwide. In India, it is the fourth leading cause of death and fifth leading cause of disability, posing a major public health concern. National surveys reveal an increasing trend in stroke risk factors such as tobacco use, physical activity, alcohol use, hypertension, and dyslipidemia. However, knowledge regarding the combined effect of these risk factors and their various combinations is limited. Understanding the individual, combined, and synergistic effects of known risk factors, along with new risk factors, is essential to address gaps in stroke epidemiology. This study aims to examine the effect of various risk factors of acute stroke and their association with stroke occurrence and its outcomes (survival, disability and quality of life). This retrospective-prospective cohort will be conducted in one taluka of Kolara district and two urban wards of Bengaluru with a total population of ~400,000. All stroke-free individuals above 30 years of age ~200,000 individuals in the selected sites will be participants of stroke-free period and all first ever stroke patients in the community will be part of stroke and post-stroke period respectively. The study subjects will be recruited through a complete house-to-house survey at baseline and undergo annual follow-ups during the stroke-free period, with specific assessments at defined time points during the stroke and post-stroke period for a period of one year. Efforts are implemented to minimize loss to follow-up, including community engagement, a helpline number, and hospital-based surveillance. This large population-based cohort study addressing stroke epidemiology in the country, is one -of-its-kind, attempting to fill certain critical gaps in the natural history, management, and outcomes of stroke in India. This research has the potential to provide important insights into the effect of novel risk factors of stroke and various combinations of risk factors of stroke. Furthermore, the development of a stroke risk predictability calculator will add value to the existing Indian National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) and offers a model for similar countries once developed.

Epidemiology and Functional Outcome of Acute Stroke Patients in Korea using Nationwide data.

Korea's healthcare system and policy promotes early, actively stroke treatment to improve prognosis. This study represents stroke epidemiology and outcomes in Korea. This study investigated data from the Acute Stroke Assessment Registry. The registry collects data from over 220 hospitals nationwide, focusing on quality stroke service management. Data analysis included patient demographics, stroke severity assessment, and discharge prognosis measurement using standardized scales. 86,568 acute stroke patients were collected with demographic and clinical characteristics during 18 months from 2016 to 2021, focusing on acute subarachnoid hemorrhage, acute intracerebral hemorrhage, and acute ischemic stroke. Of these 86,568 patients, 8.3% was subarachnoid hemorrhage, 16.3% intracerebral hemorrhage, and 74.9% ischemic stroke. Trends showed decreasing subarachnoid hemorrhage and increasing intracerebral hemorrhage cases over the years. 68.3% stroke patients had the clear onset time. 49.6 % stroke patients arrived within 4.5 hours of symptom onset, with more treated at general hospitals. Good functional outcomes at discharge was obtained with 58.3% of acute stroke patients, 55.9% of subarachnoid hemorrhage patients, 34.6% of intracerebral hemorrhage patients, and 63.8% of ischemic stroke patients. The results showed that ischemic stroke was the most common subtype, followed by intracerebral hemorrhage and subarachnoid hemorrhage. Prognosis differed among subtypes, with favorable outcomes more common in ischemic stroke and subarachnoid hemorrhage compared to intracerebral hemorrhage.

Impact of war on stroke incidence in Ivano-Frankivsk, Ukraine

Stroke is an extensive health problem in Ukraine, the prominence and effects of which are aggravated by the burden of the ongoing Russo-Ukrainian War. In this study, we aimed to holistically examine the overall stroke epidemiology in Ivano-Frankivsk using data from a secondary healthcare center in the city. We determine an increasing trend in stroke admissions since 2020, with a notable 22.4% increase in 2023, mainly due to ischemic stroke occurrence. In the same year, a significant non-linear relationship between stroke incidence and frequency of news about attacks was observed. Ordinal regression analysis of general sociodemographic, clinical, and healthcare-related factors influencing outcomes for intravenous thrombolysis-treated patients, revealed the significance of the 24-h National Institutes of Health Stroke Scale score (0.32 ± 0.03) and interaction of age and Door-to-Needle Time (− 0.28 ± 0.08). However, the extension of the latter independently is not significantly correlated with patient outcomes. In conclusion, war-induced stress, intranational migrations, and lack of adequate chronic cardiovascular disease management are primarily responsible for these results. Modulations and improvements to the current healthcare system, including managing chronic diseases and early stroke symptom recognition, are necessary to optimize patient outcomes.

Differences in stroke clinical presentation among sexes

IntroductionThere are sex-based differences in stroke epidemiology, treatment, and outcomes. In this manuscript, we discuss the differences that exist in the clinical presentation of acute stroke among sexes. DiscussionWe present the differences in stroke presentation among sexes including age at the time of presentation, severity of stroke on presentation, and stroke type and location. We discuss the atypical clinical presentations, explore the radiographic findings on presentation (including location, infarct core volume, the impact of collateral circulation, hematoma location in intracranial hemorrhage), and discuss differences in time elapsed between symptom onset and management amongst sexes. ConclusionDifferences exist in stroke clinical presentation amongst sexes. These disparities have public health implications, and as they become better understood, impact awareness campaigns in both the public and healthcare communities.

Cancer-associated ischemic stroke: current knowledge and future directions

Because cancer is a strong prothrombotic, there is an increased risk of thromboembolism, which includes ischemic stroke, especially in the first six to twelve months following a cancer diagnosis. The risk of ischemic stroke differs according to the location and stage of cancer. Given that the risk increases prior to a cancer diagnosis, stroke may be the initial sign of occult cancer. Although data on the risk, treatment, and outcomes of cancer-associated stroke are more limited than those on cancer-associated venous thromboembolism, the condition is still recognized as a thrombotic complication of cancer. Up to 10% of ischemic stroke patients also have a concurrent cancer diagnosis, and these patients seem to have higher short-term mortality and morbidity rates. With more people expected to survive longer after cancer treatment and an increasing number of cancer survivors, the burden of stroke among cancer patients is predicted to rise. This narrative review aims to provide an overview of the pathophysiologic mechanisms, treatment options, and epidemiology of ischemic stroke, including cancer screening for those who have cryptogenic (unexplained) stroke.

Editorial: Diversity in stroke omic(s) and epidemiology research: opportunities and challenges

Editorial: Diversity in stroke omic(s) and epidemiology research: opportunities and challenges

Epidemiology of stroke in the Left bank area of Kyiv region on the eve of the 38th anniversary of the man-made Chernobyl disaster: implementing international experience into practice (modern view of the problem and own research)

The article highlights the global problems of stroke. Most of them are associated with three groups of risk factors for stroke: well-known pathogenetic, psychogenic, and ecological factors of environmental pollution. The authors draw attention to this on the eve of 38th anniversary of the man-made Chernobyl disaster (April 26, 1986) comparing data on the stroke in Japan after the Fukushima nuclear accident (March 11–12, 2011) due to the earthquake, which led to the reactor core melting at three power units. Issues of improving the provision of specialized medical care to patients with stroke, risk factors for stroke are considered to minimize the consequences, optimize treatment, prevention of risk factors, especially in areas where the population is exposed to incorporated radiation damage through food, water, milk, fish, meat, berries, mushrooms, as well as the issues of improving the specialized stroke care, creation of stroke centers in regions of Ukraine. Studies conducted show that there are many causes of strokes, and they are not yet fully understood. The features of the clinical course of strokes in the Chernobyl liquidators are their development in the middle (40–49 years) and advanced age, long vascular history characterized by vascular dystonia transformation into dyscirculatory (postradiation) encephalopathy during the onset, the predominance of ischemic stroke over hemorrhagic one, lesions mainly of the carotid system, the relative benignity of clinical course, progressive nature of mental disorders, concomitant somatic pathology, the presence of stable pathomorphological substrate from both vascular endothelial dysfunction and cerebral liquor system. The obtained information complements the data on the pathogenesis, clinical picture, diagnosis of cerebral strokes in Chernobyl liquidators and is of practical interest. Raised issues of optimizing the provision of specialized care in stroke units, centers and further rehabilitation, their sufficient supply, both in terms of staffing and equipment, are becoming a cornerstone in overcoming the stroke epidemic. Based on the above, there is still a need to continue substantial research in this area, promptly develop and implement a scientific concept on the prevention, early detection of major modifiable risk factors for stroke together with family medicine doctors, specialist physicians, proper stroke treatment, which will undoubtedly improve quality of life of patients and their relatives.

A systematic review of the epidemiology and the public health implications of stroke in Sub-Saharan Africa

BackgroundWith approximately 11 million strokes occurring annually worldwide, and over 6.5 million deaths annually, stroke has made its place as one of the major killers in the world. Although developing countries make up more than 4/5 of the global stroke burden, well-grounded information on stroke epidemiology remains lacking there. AimsThis systematic review study aimed to provide a synthesis of studies on the incidence and prevalence of stroke among adults in sub-Saharan Africa (SSA), subsequently deduce the associated risk factors and public health implications (mortality rates and economic costs) of the disease on the population of this region. MethodsA systematic review of studies carried out in the region and published on PUBMED. Eligibility criteria were established using the PEO (Population/Patient, Exposure, Outcome) format. Research articles investigating either (or all) of the following: ischemic or haemorrhagic stroke, incidence, prevalence, and risk factors of stroke in adults (≥ 18 years old), in at least one region of SSA were included. Exclusion criteria comprised studies involving populations younger than 18 years old, research conducted outside the designated research region, and articles inaccessible in full text. The PRISMA guidelines were used for the search strategy. ResultsFifty-two studies were included review. Among them, over 11 studies investigated the prevalence of the disease. Some older studies within the continent (Nigeria, 2011) showed a prevalence of 1.3 per 100 while more recent studies (Zambia, 2021) showed a prevalence of 4.3 per 1000. The highest prevalence noted in this region was in Madagascar (2017) with 48.17 per 100, while the lowest was recorded in (Zimbabwe, 2017) with 0.61 per 100. The study in Tanzania showed a crude incidence of 94·5 per 100 000 (76·0–115·0) while the study in Ghana in 2018 showed an incidence of 14.19 events per 1000 person-years [10.77–18.38]. The identified risk factors included hypertension, diabetes, smoking, alcohol consumption, physical inactivity, poor diets (more salt, less vegetables), dyslipidaemia, HIV/AIDS co-infection, heart disease (cardiomyopathies, cardiac arrhythmias), obesity, previous stroke and/or family history of stroke. Over 21 studies investigated the mortality rates due to stroke in SSA, with most of the studies being in West Africa. These studies revealed mortality rates as high as 43.3% in Ghana, and as low as 10.9% in Cameroon. Few studies reported on the economic costs of stroke in the region; two in Benin, two in Nigeria and one in Tanzania. ConclusionThe increasing incidence/prevalence, lifestyle factors and interactions with other diseases, including major communicable diseases, stroke is becoming a pressing public health problem for SSA. Reducing the incidence of stroke in Africa will surely lower mortality, morbidity, disability, and the neurological as well as cognitive aftereffects of stroke, as is clear from the experience of higher-income nations. We recommend a collective intervention involving the governments of nations, international organizations, civil society, and the private sector for greater impact and sustainable outcomes reducing the epidemiology and implications of stroke in SSA.

Global, regional, and national temporal trends of diet-related ischemic stroke mortality and disability from 1990 to 2019.

Stroke is the second leading cause of death and the third leading cause of disability in the general population worldwide. However, the changing trend of ischemic stroke burden attributable to various dietary risk factors has not been fully revealed and may contribute to a better understanding of stroke epidemiology. Our article aimed to evaluate the temporal trend of diet-related ischemic stroke burden to inform future research and policy-making. This analysis was based on the data from the Global Burden of Disease (GBD) Study 2019 (spanning years 1990 to 2019), and we used the joinpoint regression to model temporal trends in diet-related ischemic stroke burden across countries and regions of the world during the study period. Six specific dietary factors known to influence stroke risk, including sodium, red meat, fiber, vegetables, whole grains, and fruits, were evaluated in the GBD study to determine their individual and joint impact on ischemic stroke. The changing trend was primarily measured by the average annual percent change (AAPC). Age-standardized rates (ASRs) of mortality and years lived with disability (YLD) per 100,000 population were used to evaluate disease burden. Finally, the socioeconomic background, which was quantified as sociodemographic index (SDI), and its association with diet-related ischemic stroke burden were also explored with the Pearson correlation coefficient. During the study period, the ischemic stroke ASR of mortality attributable to overall dietary risk decreased by an average of 1.6% per year, while the ASR of YLD decreased by an average of 0.2% per year. High sodium diet was still a key driver of diet-related ischemic stroke, accounting for 8.4% and 11.0% of deaths and disabilities, respectively, in 2019. In addition, we found a negative association between temporal evolution of stroke burden and socioeconomic background (r = -0.6603 for mortality and r = -0.4224 for disability, P < 0.001), which suggested that the developing countries with weak social and economic foundation faced greater challenges from the ongoing burden of diet-related strokes compared with developed countries. Our study found declining trends and revealed the current status of diet-related ischemic stroke mortality and disability. Interdisciplinary countermeasures involving the development of effective food policies, evidence-based guidelines, and public education are needed in the future to combat this global epidemic. The data used for analysis were open-access and can be obtained from https://vizhub.healthdata.org/gbd-results/.

Stroke epidemiology and in-hospital mortality in a Mexico City hospital: a prospective two-years study

Stroke epidemiology and in-hospital mortality in a Mexico City hospital: a prospective two-years study

Developing a national surveillance system for stroke and acute myocardial infarction using claims data in the Republic of Korea: a retrospective study.

Limited information is available concerning the epidemiology of stroke and acute myocardial infarction (AMI) in the Republic of Korea. This study aimed to develop a national surveillance system to monitor the incidence of stroke and AMI using national claims data. We developed and validated identification algorithms for stroke and AMI using claims data. This validation involved a 2-stage stratified sampling method with a review of medical records for sampled cases. The weighted positive predictive value (PPV) and negative predictive value (NPV) were calculated based on the sampling structure and the corresponding sampling rates. Incident cases and the incidence rates of stroke and AMI in the Republic of Korea were estimated by applying the algorithms and weighted PPV and NPV to the 2018 National Health Insurance Service claims data. In total, 2,200 cases (1,086 stroke cases and 1,114 AMI cases) were sampled from the 2018 claims database. The sensitivity and specificity of the algorithms were 94.3% and 88.6% for stroke and 97.9% and 90.1% for AMI, respectively. The estimated number of cases, including recurrent events, was 150,837 for stroke and 40,529 for AMI in 2018. The age- and sex-standardized incidence rate for stroke and AMI was 180.2 and 46.1 cases per 100,000 person-years, respectively, in 2018. This study demonstrates the feasibility of developing a national surveillance system based on claims data and identification algorithms for stroke and AMI to monitor their incidence rates.

Radon Exposure and Incident Stroke Risk in the Women's Health Initiative.

Little is known about the role of radon in the epidemiology of stroke among women. We therefore examined the association between home radon exposure and risk of stroke among middle-aged and older women in the United States. We conducted a prospective cohort study of postmenopausal women aged 50-79 years at baseline (1993-1998) in the Women's Health Initiative. We measured exposures as 2-day, indoor, lowest living-level average radon concentrations in picocuries per liter (pCi/L) as estimated in 1993 by the US Geological Survey and reviewed by the Association of American State Geologists under the Indoor Radon Abatement Act. We used Cox proportional hazards models to estimate risk of incident, neurologist-adjudicated stroke during follow-up through 2020 as a hazard ratio and 95% CI, adjusting for study design and participant demographic, social, behavioral, and clinical characteristics. Among 158,910 women without stroke at baseline (mean age 63.2 years; 83% white), 6,979 incident strokes were identified over follow-up (mean 13.4 years). Incidence rates were 333, 343, and 349 strokes per 100,000 woman-years at radon concentrations of <2, 2-4, and >4 pCi/L, respectively. Compared with women living at concentrations <2 pCi/L, those at 2-4 and >4 pCi/L had higher covariate-adjusted risks of incident stroke: hazard ratio (95% CI) 1.06 (0.99-1.13) and 1.14 (1.05-1.22). Using nonlinear spline functions to model radon, stroke risk was significantly elevated at concentrations ranging from 2 to 4 pCi/L (p = 0.0004), that is, below the United States Environmental Protection Agency Radon Action Level for mitigation (4 pCi/L). Associations were slightly stronger for ischemic (especially cardioembolic, small vessel occlusive, and large artery atherosclerotic) than hemorrhagic stroke, but otherwise robust in sensitivity analyses. Radon exposure is associated with moderately increased stroke risk among middle-aged and older women in the United States, suggesting that promulgation of a lower Radon Action Level may help reduce the domestic impact of cerebrovascular disease on public health.

Abstract WP97: Disparities in Health-Related Quality of Life Among Adults With Heart Disease, Stroke, and Both Conditions

Background: Notable racial and ethnic disparities exist in cardiovascular disease (CVD) and stroke epidemiology; however, few studies have assessed the disparate quality of life (QOL) among individuals living with CVD, stroke, or both. This study evaluated the impact of these conditions on health related QOL (HRQOL) and quantified demographic disparities. Methods: Using data from the 2021 National Health Interview Survey (NHIS), we calculated the Health and Activity Limitation Index (HALex)—a generic HRQOL measure comprising perceived health and activity limitations—for 29,482 adults. Stratified analysis and ordinary least-squares regressions were used to adjust for sex, age, income, education, urbanicity, marital status, household size, region of residence, and insurance status. Differences in HRQOL were estimated across racial and ethnic groups with and without CVD, stroke, or both conditions. To test the robustness of study findings, analyses were repeated using the EQ-5D. Results: Adjusted HRQOL was lower for Blacks (-0.014, SE=0.004) and Hispanics (-0.012, SE=0.003) compared to Whites. Compared those with neither CVD nor stroke, individuals with CVD only (-0.21, SE=0.015), stroke only (-0.29, SE=0.028), and both conditions (-0.44, SE=0.040) had 20% to 44% lower HRQOL. Even after for age, income, education, and income, diagnosis with stroke only (-0.19, SE=0.081), CVD only (-0.12, SE=0.051), or both (-0.44, SE=0.040) lowered the HRQOL more for Blacks than Whites, while other racial/ethnic groups showed no statistically significant difference HRQOL. In general, geographic location, sex, and household composition had little impact on HRQOL, but higher age, lower educational attainment, and low/middle income was associated with significant reductions in HRQOL. Conclusion: CVD and stroke were independently associated with significantly low HRQOL, their co-occurrence has a substantially negative impact on HRQOL for all individuals particularly Blacks who had the largest HRQOL impact in all three condition groups. Findings suggest that public health interventions should be aimed at improving HRQOL among individuals diagnosed with these conditions, especially the most vulnerable groups.

Addressing disparities in the global epidemiology of stroke.

Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities.

Trends Over Time in Stroke Incidence by Race in the Greater Cincinnati Northern Kentucky Stroke Study.

Understanding the current status of and temporal trends of stroke epidemiology by age, race, and stroke subtype is critical to evaluate past prevention efforts and to plan future interventions to eliminate existing inequities. We investigated trends in stroke incidence and case fatality over a 22-year time period. In this population-based stroke surveillance study, all cases of stroke in acute care hospitals within a 5-county population of southern Ohio/northern Kentucky in adults aged ≥20 years were ascertained during a full year every 5 years from 1993 to 2015. Temporal trends in stroke epidemiology were evaluated by age, race (Black or White), and subtype (ischemic stroke [IS], intracranial hemorrhage [ICH], or subarachnoid hemorrhage [SAH]). Stroke incidence rates per 100,000 individuals from 1993 to 2015 were calculated using US Census data and age-standardized, race-standardized, and sex-standardized as appropriate. Thirty-day case fatality rates were also reported. Incidence rates for stroke of any type and IS decreased in the combined population and among White individuals (any type, per 100,000, 215 [95% CI 204-226] in 1993/4 to 170 [95% CI 161-179] in 2015, p = 0.015). Among Black individuals, incidence rates for stroke of any type decreased over the study period (per 100,000, 349 [95% CI 311-386] in 1993/4 to 311 [95% CI 282-340] in 2015, p = 0.015). Incidence of ICH was stable over time in the combined population and in race-specific subgroups, and SAH decreased in the combined groups and in White adults. Incidence rates among Black adults were higher than those of White adults in all time periods, and Black:White risk ratios were highest in adults in young and middle age groups. Case fatality rates were similar by race and by time period with the exception of SAH in which 30-day case fatality rates decreased in the combined population and White adults over time. Stroke incidence is decreasing over time in both Black and White adults, an encouraging trend in the burden of cerebrovascular disease in the US population. Unfortunately, however, Black:White disparities have not decreased over a 22-year period, especially among younger and middle-aged adults, suggesting the need for more effective interventions to eliminate inequities by race.

Age, gender, and regional variations in stroke epidemiology in India: A systematic review and meta-analysis

Abstract Introduction: There is a wide variation in stroke epidemiology in India due to the differences in culture and the variability in the distribution of risk factors across the states. The present meta-analysis provides a pooled estimate of age, gender, and region-based stroke epidemiology in India based on epidemiological transition level (ETL) groups described in the Global Burden of Disease (GBD) Study (2016). Methods: We searched in PubMed and Google Scholar, and relevant studies published till February 2022 were included. Observational studies conducted in the Indian setting were included and global or Indian studies that exclusively estimated the prevalence, incidence, or mortality data among patients with stroke were excluded. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used for the risk-of-bias assessment and publication bias was evaluated by funnel plots and Egger’s test. The R software was used to perform this meta-analysis; I2 statistics were calculated to measure heterogeneity among studies. Results: We included 58 studies in the systematic review, and after quality assessment, 47 studies were finally included for meta-analysis. The sample sizes of the included studies ranged from 40 to 4989 and the mean age of the participants ranged from 31.7 (Standard Deviation, SD-7.4) to 70.5 (SD-10.7). The burden of stroke was estimated based on the ETL groups described in the GBD Study 2016. We found a male preponderance (64.5%; 95% confidence interval [CI]: 62.5%-68.3%) in the gender distribution of strokes and 75.2% (95% CI: 68.7%-81.7%) of the stroke occurred above the age of 50 years. Ischemic stroke is the predominant subtype of stroke in India, with a higher proportion in the middle ETL region (74.0%; 95% CI: 65.1%-81.3%) as compared to those with low ETL (67.2%; 95% CI: 49.9%-80.8%) and high ETL regions (67.5%; 95% CI: 57.0%-76.4%). Conclusion: There was a significant heterogeneity among the included studies. Majority of strokes occurred in the age group of more than 50 years with a male preponderance. Ischemic stroke was the most common type of stroke with its proportion varying from 67% to 74% depending on ETL. PROSPERO Registration: CRD42022316774.