Trends In Stroke Mortality Research Articles

TEMPORAL TRENDS OF ISCHEMIC AND HEMORRHAGIC STROKE AFTER LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION IN THE UNITED STATES (2017-2019)

TEMPORAL TRENDS OF ISCHEMIC AND HEMORRHAGIC STROKE AFTER LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION IN THE UNITED STATES (2017-2019)

A Dynamic Visualization Tool of Local Trends in Heart Disease and Stroke Mortality in the United States.

Efforts in the US to prevent and treat cardiovascular disease (CVD) contributed to large decreases in death rates for decades; however, in the last decade, progress has stalled, and in many counties, CVD death rates have increased. Because of these increases, there is heightened urgency to disseminate high-quality data on the temporal trends in CVD mortality. The Local Trends in Heart Disease and Stroke Mortality Dashboard is an online, interactive visualization of US county-level death rates and trends for several CVD outcomes across stratifications of age, race and ethnicity, and sex. This powerful visualization tool generates national maps of death rates and trends, state maps of death rates and trends, county-level line plots of annual death rates, and bar charts of percentage changes. County-level death rates and trends were estimated by applying a Bayesian spatiotemporal model to data obtained from the National Vital Statistics System of the National Center for Health Statistics and US Census bridged-race intercensal estimates for the years 1999 through 2019. The Local Trends in Heart Disease and Stroke Mortality Dashboard makes it easy for public health practitioners, health care providers, and community leaders to monitor county-level spatiotemporal trends in CVD mortality by age group, race and ethnicity, and sex and provides key information for identifying and addressing local health inequities in CVD mortality trends.

Time Trends in Stroke and Subtypes Mortality Attributable to Household Air Pollution in Chinese and Indian Adults: An Age-Period-Cohort Analysis Using the Global Burden of Disease Study 2019.

Household air pollution (HAP) exposure is recognized as a major health concern in areas relied on residential burning of solid fuels for cooking and heating. However, previous study has focused on mortality across time and reported changes in age-specific mortality globally but failed to distinguish cohort from period effects. Therefore, this study aimed to differentiate the relative contributions of period and cohort effects to overall time trends of HAP-attributable stroke mortality between the most presentative East and South Asia countries. Data were obtained from the Global Burden of Disease (GBD) database. The age, period, and cohort effects were estimated using the age-period-cohort (APC) model. The overall age-standardized mortality rates (ASMRs) of stroke in China decreased by 39.8% compared with 35.8% in India, while stroke subtypes in both the sexes and countries showed consecutive significant declines from 1990 to 2019. The age-specific and cohort-specific HAP-attributable stroke mortality declined over time in China and India. By APC analysis, substantially increasing age effects were presented for stroke and subtypes from 25 to 84 years. China had a rapid reduction in the independent period and cohort effects. Also, the risk of death for subarachnoid hemorrhage (SAH) had the most striking decline for both sexes in period and cohort effects. Reductions of India were less favorable than China, but the independent period and cohort effects progressively decreased during the entire period for both the sexes. Males experienced a slightly higher mortality risk than females in both countries. Although prominent reductions were observed in HAP-attributable stroke and subtypes mortality during the past 30 years, China and India still suffered uneven HAP-attributable stroke burden. Thus, it is of high significance to introduce advanced solid fuels replace technology and knowledge regarding clean fuel use.

Abstract 103: Burden Of Ischemic And Hemorrhagic Stroke Across The Us From 1990-2019: A Global Burden Of Disease Study

Introduction: We sought to present burden estimates of ischemic and hemorrhagic stroke in the US in 2019 and to describe trends from 1990 to 2019 by age, sex, and geographic location. Methods: We performed an analysis of the Global Burden of Disease (GBD) 2019 study. Data on stroke incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2019 were obtained from the GBD results tool. We measured crude and age-standardized incidence, prevalence, mortality, and DALYs per 100,000 (with 95% uncertainty intervals) for all stroke, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage from 1990 to 2019. Results: In the US in 2019, there were 0.46 million (0.40-0.52) incident strokes, of which 67.5% were ischemic (0.31 million [0.26-0.38]), 0.19 million (0.17-0.21) stroke-related deaths and 3.83 million (3.47-4.16) stroke-attributable DALYs. The crude number of incident strokes, prevalent strokes, mortality, and DALYs increased from 1990 to 2019 but age-standardized stroke burden measures declined or remained flat (Figure 1). Trends in stroke incidence, prevalence, mortality, and DALYs varied by age group and geographic location, with stroke incidence decreasing in older adults nationwide and increasing in younger adults (15-49 years) in the South and Midwest US (Figure 2). Conclusions: While age-standardized measures of stroke burden are decreasing, there is a large and increasing number of people affected by stroke in the US, especially among younger populations in the South and Midwest.Public health efforts to reduce stroke burden across the lifespan should incorporate location-specific stroke trends.

Trends in Stroke Mortality Rate - China, 2004-2019.

IntroductionStroke has been the leading cause of death in China for decades. This study described the trends in stroke mortality in China from 2004 to 2019.MethodsData was obtained from the National Disease Surveillance Point (DSP) system. A descriptive analysis was conducted. The adjusted mortality rate (AMR) and age-standardized mortality rate (ASMR) of stroke were calculated.ResultsFrom 2004 to 2019, the ASMR substantially decreased, with a reduction of 39.8%, but the AMR stayed relatively stable. The mortality rate of stroke in rural areas was consistently higher than in urban areas. A geographical gradient in mortality of stroke was also apparent, with an increased rate in the western part of China and a decreased rate in the eastern part of China. In central China, the rate remained relatively stable.ConclusionsAlthough the ASMR of stroke continued to decline in China, the stagnant crude mortality rates suggested that China had not achieved sufficient decline to offset the demographic forces of population growth and ageing. More vigorous and effective prevention and treatment strategies are urgently needed to mitigate the disease burden of stroke in China, especially in areas with high stroke burden and limited resources.

Abstract 11637: Decline in Stroke Mortality in the United States, 1975-2019: Impact of Obesity Among Women and Men

Introduction: The extent to which shifting age distributions, changes in stroke subtypes, and increases in obesity rates have impacted stroke mortality remain uncertain. Hypothesis: We hypothesize strong age and period effects on trends in stroke mortality, with obesity playing an important role in these trends. Methods: We designed a sequential time series analysis of 4,060,259 stroke deaths among women and men aged 18-84 years in the US, 1975-2019. The US annual mortality data, and US mid-year population data were accessed from Our World in Data and the CDC. Mortality rates were examined for overall stroke, and ischemic and hemorrhagic strokes. Trends in stroke mortality based on changes in the distribution of age, period, and birth cohorts (APC) were evaluated from Poisson models. We also aimed to quantify how much of the temporal increase in obesity rates explain the variance in stroke mortality trends. Results: Age-standardized stroke mortality declined for women (87.5 [95% confidence interval , CI, 86.8, 88.1] per 100,000 in 1975 to 30.9 [95% CI, 30.6, 31.2] in 2019) and men (112.1 [95% CI, 111.3, 113.0] per 100,000 in 1975 to 38.7 [95% CI, 38.3, 39.0] in 2019). In an APC analysis, stroke mortality increased sharply with advancing age (Figure). Ischemic and hemorrhagic strokes declined by period. There was a cohort effect for ischemic, but not hemorrhagic stroke. In 2019, the rate ratio (RR) of mortality for men versus women was 1.30 (95% CI, 1.27, 1.33) for ischemic stroke and 1.12 (95% CI, 1.09, 1.15) for hemorrhagic stroke. Increasing rates of obesity accounted for 86% and 80% of the temporal decline in stroke mortality rates among women and men, respectively. Conclusions: In the US, mortality rates from stroke have declined over the last 45 years. While men are more likely to die from stroke, the gender difference has narrowed for ischemic stroke, but widened for hemorrhagic strokes. Obesity appears to have contributed substantially to the decline in stroke mortality.

Age-period-cohort analysis of stroke mortality attributable to high systolic blood pressure in China and Japan

Stroke is a principal cause of mortality in China and Japan. High systolic blood pressure (SBP) was considered a chief risk factor for stroke mortality. Herein, we evaluated temporal trends of high SBP-attributable stroke mortality in China and Japan between 1990 and 2017. Data on stroke mortality were retrieved from the Global Burden of Disease Study 2017 (GBD 2017). Using the age-period-cohort method, we computed overall net drifts, local drifts, longitudinal age curves, and cohort/period rate ratios (RRs) for high SBP-attributable stroke mortality. The age-standardized mortality rates (ASMRs) displayed decreasing trends for high SBP-attributable stroke mortality. The annual net drift values were − 1.4% and − 3.5% in Chinese men and women versus − 3.1% and − 4.9% in Japanese men and women. The local drift values in both countries were < 0 among all age groups but were lower in women than in men. The longitudinal age curves showed a greater high SBP-attributable stroke mortality in men than in women across all age groups. Similar decreasing patterns were shown in the period and cohort RRs in both sexes with women having a quicker decline than men. In China and Japan, the ASMRs, as well as the period and cohort RRs of high SBP-attributable stroke mortality, decreased between 1990 and 2017 in both sexes and across all age groups. Yet, the prevalence of high SBP remained worrisome in both countries. Thus, SBP control should be encouraged to prevent stroke mortality.

Has stroke mortality stopped declining in Spain?

ObjectivesTo analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. MethodsMortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. ResultsJoinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from –3.4% in Catalonia and Extremadura, to –6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands. In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from –3.1% in Catalonia to –6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. ConclusionsCurrent data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.

Coronary heart disease and stroke mortality trends in Brazil 2000-2018.

To analyse the mortality rate trend due to coronary heart disease (CHD) and stroke in the adult population in Brazil. From 2000 to 2018, a time trend study with joinpoint regression was conducted among Brazilian men and women aged 35 years and over. Age-adjusted and age, sex specific CHD and stroke trend rate mortality were measured. Crude mortality rates from CHD decreased in both sexes and in all age groups, except for males over 85 years old with an increase of 1.78%. The most accentuated declining occurred for age range 35 to 44 years for both men (52.1%) and women (53.2%) due to stroke and in men (33%) due to CHD, and among women (32%) aged 65 to 74 years due to CHD. Age-adjusted mortality rates for CHD and stroke decreased in both sexes, in the period from 2000 to 2018. The average annual rate for CHD went from 97.09 during 2000-2008 to 78.75 during 2016-2018, whereas the highest percentage of change was observed during 2008 to 2013 (APC -2.5%; 95% CI). The average annual rate for stroke decreased from 104.96 to 69.93, between 2000-2008 and 2016-2018, and the highest percentage of change occurred during the periods from 2008 to 2013 and 2016 to 2018 (APC 4.7%; 95% CI). The downward trend CHD and stroke mortality rates is continuing. Policy intervention directed to strengthen care provision and improve population diets and lifestyles might explain the continued progress, but there is no room for complacency.

Trends in acute ischemic stroke treatments and mortality in the United States from 2012 to 2018.

The establishment of mechanical thrombectomy (MT) as a first-line treatment for select patients with acute ischemic stroke (AIS) and the expansion of stroke systems of care have been major advancements in the care of patients with AIS. In this study, the authors aimed to identify temporal trends in the usage of tissue-type plasminogen activator (tPA) and MT within the AIS population from 2012 to 2018, and the relationship to mortality. Using a nationwide private health insurance database, 117,834 patients who presented with a primary AIS between 2012 and 2018 in the United States were identified. The authors evaluated temporal trends in tPA and MT usage and clinical outcomes stratified by treatment and age using descriptive statistics. Among patients presenting with AIS in this population, the mean age was 69.1 years (SD ± 12.3 years), and 51.7% were female. Between 2012 and 2018, the use of tPA and MT increased significantly (tPA, 6.3% to 11.8%, p < 0.0001; MT, 1.6% to 5.7%, p < 0.0001). Mortality at 90 days decreased significantly in the overall AIS population (8.7% to 6.7%, p < 0.0001). The largest reduction in 90-day mortality was seen in patients treated with MT (21.4% to 14.1%, p = 0.0414) versus tPA (11.8% to 7.0%, p < 0.0001) versus no treatment (8.3% to 6.3%, p < 0.0001). Age-standardized mortality at 90 days decreased significantly only in patients aged 71-80 years (11.4% to 7.8%, p < 0.0001) and > 81 years (17.8% to 11.6%, p < 0.0001). Mortality at 90 days stagnated in patients aged 18 to 50 years (3.0% to 2.2%, p = 0.4919), 51 to 60 years (3.8% to 3.9%, p = 0.7632), and 61 to 70 years (5.5% to 5.2%, p = 0.2448). From 2012 to 2018, use of tPA and MT increased significantly, irrespective of age, while mortality decreased in the entire AIS population. The most dramatic decrease in mortality was seen in the MT-treated population. Age-standardized mortality improved only in patients older than 70 years, with no change in younger patients.

Mortality trends of stroke and dementia: Changing landscapes and new challenges.

Stroke and dementia are important causes of death in the United States and may be interrelated as competing risks for mortality. No previous studies have simultaneously compared age- and sex-specific mortality trends between stroke and subtypes of dementia at a population level. Insights gained from this study can help identify high-risk populations and inform healthcare service requirements for managing stroke and dementia in the United States. To examine nationwide trends in mortality from stroke and subtypes of dementia in the United States by age group and sex. Population-based cross-sectional study. U.S. mortality data from 2007 to 2016. All U.S. residents whose primary cause of death was stroke, Alzheimer's disease, vascular dementia, or Lewy body dementia. Age-adjusted mortality, mortality trends among men and women were analyzed separately using joinpoint regression. From 2007 to 2016, age-adjusted stroke mortality fell by 21.6%. Age-adjusted mortality (per 1,000,000) for Alzheimer's disease, vascular dementia, and Lewy body dementia increased by 1.2-fold, 2-fold, and 3-fold, respectively. Annual age-adjusted stroke mortality decreased by an average rate of 2.67% per year, while annual age-adjusted mortality for Alzheimer's disease, vascular dementia, and Lewy body dementia increased by an average rate of 2.06%, 4.90%, and 12.13% per year, respectively. Mortality from stroke and dementia increased with age. Greater reductions in stroke mortality and greater increases in dementia mortality were seen in women than men; and in older than younger (<65 years) people. There has been a striking rising trend in dementia mortality coincident with a reduction in stroke mortality in the United States. There are persistent age and sex disparities in stroke and dementia mortality trends. Our findings support the pathophysiological relationship between stroke and dementia, and have important implications for future research, healthcare planning, and provision.

Abstract P239: Trends in Ischemic Stroke Treatments and Mortality in the United States From 2012-2018

Introduction: The establishment of mechanical thrombectomy (MT) as a first line treatment for select patients with ischemic stroke (IS) and the resulting expansion of stroke systems of care have been major advancements in the care of IS patients. Our study aims to identify temporal trends in the usage of tPA and MT, as well as mortality for IS patients from 2012-2018. Hypothesis: We hypothesize that not only MT but also tPA utilization increased after 2015 compared to years previous, while mortality likely improved, given enhanced public education and optimization of stroke systems of care. Methods: Using a nation-wide, private health insurance database, we identified 141,959 patients who presented with a primary IS between 2012 and 2018. We evaluated trends in tPA and MT usage, and mortality stratified by treatment group using chi square and Cochran-Armitage testing. Results: Among patients presenting with IS in this population, the average age was 69.00 ± 12.23, and 47.43% were male. Between 2012-2018, the proportional use of tPA and MT increased significantly (tPA: 6.30%% to 11.79%, p&lt;0.0001; MT: 1.57% to 5.69%, p&lt;0.0001). Mortality at 30 days decreased significantly from 2012-2018 in the overall IS population (4.82% to 4.18%, p&lt;0.0001). Mortality following MT saw the greatest improvement (30-day: 16.42% to 9.04%, p=0.0291), followed by tPA (30-day: 8.54% to 4.91%, p&lt;0.0001) and finally by no treatment (30-day: 4.43% to 3.79%, p&lt;0.0001). Conclusion: From 2012-18, we found the use of tPA and MT increased significantly while 30-day mortality decreased in the entire IS population. The most dramatic decrease in mortality was seen in the MT population, followed by tPA and no treatment groups.

Rural Stroke Patients Have Higher Mortality: An Improvement Opportunity for Rural Emergency Medical Services Systems.

Early recognition and prompt prehospital care is a cornerstone of acute stroke treatment. Residents of rural areas have worse access to stroke services than urban residents. The purpose of this study was to (1) describe US trends in rural-urban stroke mortality and (2) identify possible factors associated with rural-urban stroke case-fatality disparities. This study was a nationwide retrospective cohort study of stroke admissions. The primary exposure was rurality of patient's residence. The primary outcome was death during hospital encounter. The secondary outcome was discharge to a care facility or home healthcare. Univariable and multivariable logistic regressions estimated the odds of mortality by subject rurality among stroke subjects. Rural stroke subjects had higher mortality than nonrural counterparts (18.6% rural vs 16.9% nonrural). After adjustment for patient and hospital factors, patient rurality was associated with increased odds of mortality (aOR = 1.11; 95% CI: 1.06-1.15; P < .001). For the secondary outcome of discharge to home, rural stroke subjects were less likely to be discharged to a care facility than nonrural stroke visits (aOR 0.94; 95% CI: 0.91-0.97; P < .001). Results were similar after adjusting for thrombolytics administration and transfer status. Rural stroke patients have higher mortality than their urban counterparts likely due to their increased burden of chronic disease, lower health literacy, and reduced access to prompt prehospital care. There may be an opportunity for emergency medical services systems to assist in increasing stroke awareness for both patients and clinicians and to establish response patterns to expedite emergency care.

Secular trends of stroke incidence and mortality in China, 1990 to 2016: The Global Burden of Disease Study 2016

BackgroundThe impact of socioeconomic developments on stroke incidence and mortality must be understood to target prevention strategies appropriately. We assessed the secular trends in stroke incidence and mortality in China based on data from the Global Burden of Disease Study 2016. MethodsTrends of stroke incidence and mortality of China was described in different categories of age, sex and stroke type using the GBD study database. Also a comparative study was conducted between China and Japan, U.S. to find reasonable references for development. Secular trends in incidence and mortality (per 100,000 population) were assessed for stroke, including ischemic and hemorrhagic stroke from 1990 to 2016. Population pyramid was used to illustrate changes in age- and sex-specific incidence and mortality rates. ResultsDuring the study period, stroke incidence in China increased from 204.52 to 403.08 and mortality increased from 122.09 to 130.94; the corresponding age-standardized rates changed from 335.63 to 353.70 and from 231.28 to 132.84, respectively. Among those aged 15–49 and 50–69 years, the incidence rates of ischemic stroke and hemorrhagic stroke both tended to increase, whereas the mortality rates tended to decline in all age groups. The incidence and mortality were highest among those aged ≥70 years. Compared with the U.S. and Japan, age-standardized rates of incidence and mortality were higher in China. ConclusionsAlthough the incidence of stroke has increased in China, overall mortality has decreased. A priority of stroke prevention and control strategies will transition from reducing mortality to controlling the incidence in at-risk populations.

Impact of smoke-free legislation on acute myocardial infarction and stroke mortality: Tianjin, China, 2007–2015

BackgroundSmoke-free legislation is an effective way to protect the population from the harms of secondhand smoke and has been implemented in many countries. On 31 May 2012, Tianjin became one...

¿Ha dejado de disminuir la mortalidad por enfermedades cerebrovasculares en España?

ObjectivesTo analyse the changes in stroke mortality trends in Spain by autonomous community and by sex during the period 1980-2016, using joinpoint regression models. MethodsMortality data were obtained from the Spanish National Statistics Institute. Crude and standardised rates were calculated for each Spanish autonomous community, and for each sex. Joinpoint analysis was used to identify the best-fitting points showing a statistically significant change in the trend. ResultsJoinpoint analysis enabled us to differentiate between communities in which mortality rates showed a continuous decline throughout the study period in both sexes (Asturias, Cantabria, Castile and Leon, Ceuta, and Melilla) or in men only (Extremadura). In men, in all those communities in which changes in the trend were observed (all but Aragon, the Balearic Islands, and Murcia, where rates remained stable), we observed an initial period of decline (ranging from –3.4% in Catalonia and Extremadura, to –6.0% in Madrid) and a final period where the trends diverged: mortality rates continued to fall in Andalusia, Aragon, the Balearic Islands, and Madrid, but began to stabilise in Castile-La Mancha and Murcia and to increase in the Canary Islands.In women, in those communities where changes were observed (all but Aragon, Murcia, and the Basque Country, where rates remained stable), we observed an initial period of decline (ranging from –3.1% in Catalonia to –6.4% in Navarre) and a final period where divergent trends were observed: rates continued to decline in Andalusia, Aragon, Catalonia, Galicia, Madrid, and the Basque Country, but began to stabilise in Extremadura and Murcia and to increase in the Canary Islands. ConclusionsCurrent data show that stroke mortality rates have decreased (in women in Andalusia), stabilised (in both sexes in Murcia, in men in Castile-La Mancha, and in women in Extremadura), and have even reversed (in both sexes in the Canary Islands). Further study is needed to identify the causes of these trends.

Stagnating National Declines in Stroke Mortality Mask Widespread County-Level Increases, 2010-2016.

Background and Purpose- Recent national and state-level trends show a stalling or reversal of previously declining stroke death rates. These national trends may mask local geographic variation and changes in stroke mortality. We assessed county-level trends in stroke mortality among adults aged 35 to 64 and ≥65 years. Methods- We used data from National Vital Statistics Systems and a Bayesian multivariate space-time conditional autoregressive model to estimate age-standardized annual stroke death rates for 2010 through 2016 among middle-aged adults (35-64 years) and older adults (≥65 years) in US counties. We used log-linear regression models to estimate average annual and total percent change in stroke mortality during the period. Results- Nationally, the annual percent change in stroke mortality from 2010 to 2016 was -0.7% (95% CI, -4.2% to 3.0%) among middle-aged adults and -3.5% (95% CI, -10.7% to 4.3%) among older adults, resulting in 2016 rates of 15.0 per 100 000 and 259.8 per 100 000, respectively. Increasing county-level stroke mortality was more prevalent among middle-aged adults (56.6% of counties) compared with among older adults (26.1% of counties). About half (48.3%) of middle-aged adults, representing 60.2 million individuals, lived in counties in which stroke mortality increased. Conclusions- County-level increases in stroke mortality clarify previously reported national and state-level trends, particularly among middle-aged adults. Roughly 3×as many counties experienced increases in stroke death rates for middle-aged adults compared with older adults. This highlights a need to address stroke prevention and treatment for middle-aged adults while continuing efforts to reduce stroke mortality among the more highly burdened older adults. Efforts to reverse these troubling local trends will likely require joint public health and clinical efforts to develop innovative and integrated approaches for stroke prevention and care, with a focus on community-level characteristics that support stroke-free living for all.

Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study 2017

BackgroundSocioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden.MethodsWe extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from 1990 to 2017. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle-, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from 1990 to 2017.ResultsDespite a growth in crude number of stroke events from 1990 to 2017, there has been an 11.3% decrease in age-standardised stroke incidence rate worldwide (150.5, 95% uncertainty interval [UI] 140.3–161.8 per 100,000 in 2017). This has been accompanied by an overall 3.1% increase in age-standardised stroke prevalence rate (1300.6, UI 1229.0–1374.7 per 100,000 in 2017) and a 33.4% decrease in age-standardised stroke mortality rate (80.5, UI 78.9–82.6 per 100,000 in 2017) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since 2005. Further, there has been almost a 34% reduction in stroke death rate (67.8, UI 64.1–71.1 per 100,000 in 2017) attributable to modifiable risk factors, more prominently in wealthier countries.ConclusionsAlmost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden; thus, screening of people from low SES at higher stroke risk is crucial.

Stroke Mortality Rates and Trends in Romania, 1994-2017

Background and Aim: Romanian national level stroke mortality data is relatively scarce. The current study investigated stroke mortality rates and trends in Romania. Methods: All individual deaths registered in Romania during 1994-2017 were analyzed using an anonymized database, based on death certificates. Stroke crude mortality rates (CMR) and age-standardized mortality rates (ASMR) were calculated and expressed per 100,000 persons-year. Results: Between 1994 and 2017, 6,281,873 persons died in Romania, stroke being registered as the underlying cause of death in 959,319 cases. The overall stroke CMR was 188.2 (199.3 for women and 176.5 for men). The CMR for hemorrhagic stroke (HEMS) was 32.4 and for ischemic stroke (ISCS) 10.9. There was a significant decrease in stroke ASMR from 344.4 (95% confidence interval [CI] 343.4-345.4) in 1994 to 192.1 (95% CI 191.5-192.7) in 2017, with an annual percent change (APC) of 2.53% per year (95% CI 2.50-2.55, P < .001). Although compared with men, women had higher CMRs, when those rates were age-standardized men had higher ASMR as compared with women. The decline in HEMS ASMR had an APC of 4.65% per year (95% CI 4.59-4.70, P < .001). ISCS ASMR showed an initial increase in ASMR during 1994-2005, with APC 6.39% per year (95% CI 6.09-6.70, P < .001), followed by a significant decrease until 2017, with APC 2.83% per year (95% CI 2.59-3.07, P < .001). Conclusion: There was a significant reduction in stroke ASMR during 1994-2017. The decline was slow until 2002 and became steeper after that, with significant differences in gender analysis.

Stroke among the adult population of Burkina Faso: magnitude and trend

Background: Strokes are the second leading cause of death and the third leading cause of disability-adjusted life-years lost in the world. Most of incident and prevalent cases of strokes occur in low-income and middle-income countries. The purpose of this study was to describe the overall trend of stroke prevalence and mortality among adults in Burkina Faso. Methods: This was an exhaustive document review of strokes using the Ministry of Health’s statistical yearbooks over an 11 years period. Patients aged 15 years or over were taken into consideration. The process of compiling statistical yearbooks takes place from the periphery to central level. The assessment of temporal trends was performed using linear equations. Results: From 2002 to 2012, the number of adult stroke consultations increased from 15,976 to 134,049. We noticed a clear increase in the number of hospitalized patients of both genders, from 523 in 2002 to 9,047 in 2012. Furthermore, we observed a regression of in-hospital mortality rates from 2004 onwards. Conclusions: In our study, we noted a substantial increase in the number of stroke cases requiring consultation and hospitalisation. In contrast, the mortality rate was decreasing.