Trends In Stroke Incidence Research Articles

A marked increase of ischemic stroke incidence between 1980 and 1994 in S. Caterina, Sicily

Stroke death rates have been declining for some decades in most of the industrialized countries. It is not clear, whether this has been associated with a decrease in stroke incidence. We studied temporal trends in stroke incidence in a rural community in Sicily, during two periods 1980-84 and 1990-94. There was a total of 231 patients (120 of them women). The diagnosis of stroke was based on the clinical evaluation and CT scan since 1982 and onward. There were 109 ischemic strokes (51 women) mean age 72.7 years, in 1980-84 period; 122 ischemic strokes (69 women) mean age 75.1, in 1990-94 period. Cardiovascular risk factor rates did not change in the two periods considered. The relative annual stroke incidence rate increased 37.0%; (2.7 in 1980-84 to 3.7/1000 inhabitants in 1990-94, p = 0.0161. In the population older than 65 years, the same parameter increased by 21.1% between the two periods; (16.1 in 1980-84 to 19.5/1000 inhabitants in 1990-94, not significant). This increase was due mainly to a 45.3% significant relative increase in women, from 7.5 to 11.0/1000 inhabitants (p = 0.039). These findings suggest a need of the reconsideration of effective strategies for the prevention of stroke.

Community-Based Stroke Incidence Trends From the 1970s Through the 1980s in East Germany

Stroke mortality has declined in most industrialized countries, but incidence rates have increased in some populations while they remained stable or even decreased in others. This study reports stroke incidence trends in East Germany over the past decades. Prospective community-based stroke registers were run in East Germany over two different time periods: 1972 through 1973 in the Berlin-Lichtenberg district and 1985 through 1988 in 14 districts in the central and southern part of the country. Stroke cases were collected and validated in a uniform way using both the World Health Organization (WHO) recommendations for community stroke registers and the guidelines of the WHO MONICA protocol. Annual age-adjusted incidence rates of first-ever strokes rose among men aged 25 to 64 years from 48.4 per 100,000 in 1972 through 1973 to 88.0 per 100,000 in 1985 through 1988 (P < .05); incidence rates remained unchanged among women in this age range (52.6 and 52.5 per 100,000, respectively). Age-specific incidence rates increased among men in all age groups up to 74 years. Rising stroke rates were also observed in women under 55 years and between the ages of 65 and 74 years, whereas in women aged 55 to 65 years incidence rates declined by more than a third (P < .05). During the period from 1985 through 1988, stroke rates did not change. An increase in stroke incidence was detected that can be associated with a deteriorating risk factor profile in the East German population and, in particular, with hypertension in men.

Use of Medicare claims data to estimate national trends in stroke incidence, 1985-1991.

Although stroke mortality has been declining in the United States for decades, recent trends in stroke incidence based on national data have not been described. We used Medicare hospitalization data to estimate national trends in the incidence of stroke among Americans aged 70 years or older, and we provide evidence of the validity of the estimate. We defined stroke as a principal diagnosis with International Classification of Diseases, 9th Revision, Clinical Modification codes 430 to 434 or 436 to 437. We excluded many recurrent cases from the analysis by eliminating persons hospitalized for stroke during the 5 years preceding the index stroke. We calculated annual adjusted incidence rates and examined trends graphically. We investigated the effect of different exclusion periods, trends in in-hospital mortality of stroke patients, and trends in out-of-hospital stroke mortality. We examined trends in relation to sex, race, and age. The estimated age- and sex-adjusted stroke incidence declined 9.5% from 1985 to 1989, then increased 3.3% to 1991. The pattern did not vary with the length of the exclusion period or when all listed diagnosis rather than principal diagnoses were used to identify stroke cases. Incidence trends resembled the overall trend for both men and women, for 5-year age groups, and for whites; the trend did not change for blacks. Stroke incidence declined steadily from 1985 to 1989 and then increased slightly to 1991. Several postulated potential sources of bias were investigated and found to be unlikely to account for the incidence decline, although some may have contributed to the subsequent incidence increase.

Declining trends in incidence, case-fatality and mortality of stroke in three geographic areas of Finland during 1983–1989. Results from the FINMONICA stroke register

Stroke mortality has decreased during the last decade in many industrialized countries, but there has been no clear evidence for a decline in the incidence of stroke. The present study analyzes the trends in the incidence, mortality and case-fatality of stroke in Finland from 1983 to 1989. We used data from the FINMONICA stroke register, a community based register collecting information on all suspected stroke cases aged 25–74 in three geographical areas of Finland. Annual attack rate, incidence, mortality and case-fatality rates were calculated for all strokes and for different subcategories of stroke. A linear regression model was applied to calculate the yearly trends of these rates. In men, the attack rate of stroke was 336/100,000 in 1983 and 310/100,000 in 1989 (-8% during the observation period); incidence declined from 269/100,000 in 1983 to 236/100,000 in 1989 (-12%); mortality declined from 82/100,000 to 64/100,000 (-22%), and case-fatality declined from 25% to 21% (-18%). Also among women similar declining trends were observed (-11%, −13%, -16%, and −10% respectively), but they were not statistically significant. In both incidence and mortality of stroke, the decline was seen in all age groups. Incidence and mortality of cerebral infarction declined similarly to all strokes. A large fall in the incidence (−24% in both men and women) and mortality (−38% in men and −27% in women) of subarachnoid haemorrhage was also observed. An increasing trend, although not significant, was instead observed for cerebral haemorrhage. First stroke and especially first cerebral infarction contributed most to the decline in case-fatality. The availability of computerized brain tomography improved from 18% in 1983 to 60% in 1989. We observed a fall in the incidence, mortality, and case-fatality of stroke during 1983–1989. Among the subtypes of stroke, cerebral infarction contributed most to the decline, but the data suggested also a declining trend in the incidence and mortality of subarachnoid haemorrhage, observed now for the first time in Finland since the 1960s. The fall in the incidence of stroke was not as steep during the 1980s as it was during the 1970s; Finland is anyhow the only European country which has reported a decreasing trend in stroke incidence during the 1980s. We need now to investigate how much the decline in the classical risk factors for stroke observed in Finland during the last two decades predicts the observed trends.

Trends in stroke incidence and mortality in Hawaiian Japanese men.

Vital statistics show a sharp decline in stroke mortality since the late 1960s. It is not clear whether this has been associated with a decline in stroke incidence. Since 1966 the Honolulu Heart Program has monitored the incidence and mortality of coronary heart disease and stroke in a target population of 11,136 men of Japanese ancestry living on Oahu. Trends were analyzed from January 1, 1969, through December 31, 1988. Of 7893 men aged 45 to 68 years and free of stroke at entry examination, 530 developed first episodes of stroke in the period 1969 to 1988 (389 cases of thromboembolic stroke, 124 cases of hemorrhagic stroke, and 17 cases of stroke of unknown type). Age-adjusted annual stroke incidence declined from 5.1 per 1000 person-years in 1969 to 1972 to 2.4 in 1985 to 1988. The incidences of thromboembolic stroke, hemorrhagic stroke, and total stroke decreased 3.5%, 4.2%, and 4.4% per year, respectively. The 1-month case-fatality rates for thromboembolic stroke decreased moderately; those for hemorrhagic stroke fell dramatically. These findings suggest that the decline in stroke mortality in the past two or three decades results from a decline in both incidence rates and early case-fatality rates in thromboembolic and hemorrhagic stroke and stroke of unknown type. The decreases may be related to changes in risk factors, such as the decline in blood pressure and the decrease in cigarette smoking, as well as improvements in diagnosis and treatment.

Changes in stroke incidence and case-fatality in Auckland, New Zealand, 1981-91

The explanation for the substantial decline in stroke death rates can be investigated only by measuring trends in stroke incidence and case-fatality. Two community-based studies carried out in Auckland, New Zealand, in 1981 and 1991 used comparable methods and definitions, met criteria for well- designed studies, and had the power to detect small changes in incidence and case-fatality rates. 703 events (representing 50% of all strokes) were registered in 1981 and 1735 events in 1991. 521 (74·1%) and 1255 (72 3%) events in 1981 and 1991, respectively, were first-ever (in a lifetime) strokes. Although there was no change in overall stroke incidence between 1981 and 1991, there were changes in age and sex groups. The incidence rate among women younger than 75 years rose by a fifth (rate ratio 1 23 [95% Cl 1 04-1 47]), whereas that in men of 75 years and older fell by a third (rate ratio 0 67 [0·54-0·82]). The 28-day case-fatality declined from 27 1 (21·7-32·6)% to 21·9(18·1-25·7)% in men and from 37 6 (31·8-43·5)% to 25·8 (22·3-29·4)% in women from 1981 to 1991, but the decline was not statistically significant in any age or sex group. These findings suggest that we need to reappraise strategies for the prevention of stroke and assess the implications of improved survival in elderly stroke patients.

Secular trends in stroke in the Framingham study

Trends in stroke incidence, prevalence, fatality, and severity were examined in Framingham Study subjects, aged 55 to 64, during 3 successive decades beginning in 1953, 1963, and 1973. There was no significant decline in incidence or prevalence of total stroke and transient ischemic attacks (TIAs). In women, but not men, incidence of completed ischemic stroke declined significantly. Stroke severity did decrease significantly and severe neurologic deficit was less frequent in later decades; fewer patients with stroke were unconscious on admission to the hospital. There was no substantial change in the case mix and no significant decline in hemorrhage to account for the decline in severity. The proportion of isolated TIAs increased significantly over the 30 years studied, yielding an apparent decline in case-fatality rates, which was significant only in men. Secular trends in stroke incidence and fatality did not follow a clear pattern. There was a significant decline in stroke severity, but incidence of infarction fell only in women. The decline in total case-fatality rate occurred only in men, resulting largely from an increased incidence of isolated TIAs.

Trends in stroke incidence and mortality in Hawaiian Japanese men.

Vital statistics show a sharp decline in stroke mortality since the late 1960s. It is not clear whether this has been associated with a decline in stroke incidence.Since 1966 the Honolulu Heart Program has monitored the incidence and mortality of coronary heart disease and stroke in a target population of 11,136 men of Japanese ancestry living on Oahu. Trends were analyzed from January 1, 1969, through December 31, 1988.Of 7893 men aged 45 to 68 years and free of stroke at entry examination, 530 developed first episodes of stroke in the period 1969 to 1988 (389 cases of thromboembolic stroke, 124 cases of hemorrhagic stroke, and 17 cases of stroke of unknown type). Age-adjusted annual stroke incidence declined from 5.1 per 1000 person-years in 1969 to 1972 to 2.4 in 1985 to 1988. The incidences of thromboembolic stroke, hemorrhagic stroke, and total stroke decreased 3.5%, 4.2%, and 4.4% per year, respectively. The 1-month case-fatality rates for thromboembolic stroke decreased moderately; those for hemorr...

Stroke trends in an aging population. The Technology Assessment Methods Project Team.

Trends in stroke incidence and survival determine changes in stroke morbidity and mortality. This study examines the extent of the incidence decline and survival improvement in the Netherlands from 1979 to 1989. In addition, it projects future changes in stroke morbidity during the period 1985 to 2005, when the country's population will be aging. A state-event transition model is used, which combines Dutch population projections and existing data on stroke epidemiology. Based on the clinical course of stroke, the model describes historical national age- and sex-specific hospital admission and mortality rates for stroke. It extrapolates observed trends and projects future changes in stroke morbidity rates. There is evidence of a continuing incidence decline. The most plausible rate of change is an annual decline of -1.9% (range, -1.7% to -2.1%) for men and -2.4% (range, -2.3% to -2.8%) for women. Projecting a constant mortality decline, the model shows a 35% decrease of the stroke incidence rate for a period of 20 years. Prevalence rates for major stroke will decline among the younger age groups but increase among the oldest because of increased survival in the latter. In absolute numbers this results in an 18% decrease of acute stroke episodes and an 11% increase of major stroke cases. The increase in survival cannot fully explain the observed mortality decline and, therefore, a concomitant incidence decline has to be assumed. Aging of the population partially outweighs the effect of an incidence decline on the total burden of stroke. Increase in cardiovascular survival leads to a further increase in major stroke prevalence among the oldest age groups.

Secular trends in stroke incidence and mortality.

HomeStrokeVol. 24, No. 4Secular trends in stroke incidence and mortality. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBSecular trends in stroke incidence and mortality. J Grotta J GrottaJ Grotta Search for more papers by this author Originally published5 Apr 2018https://doi.org/10.1161/str.24.4.614aStroke. 1993;24:614 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Bennett M and Huxlin K (1996) Neuronal cell death in the mammalian nervous system: the calmortin hypothesis, General Pharmacology: The Vascular System, 10.1016/0306-3623(95)02069-1, 27:3, (407-419), Online publication date: 1-Apr-1996. April 1993Vol 24, Issue 4 Advertisement Article InformationMetrics Copyright © 1993 by American Heart Associationhttps://doi.org/10.1161/str.24.4.614aPMID: 8465372 Originally publishedApril 5, 2018 PDF download Advertisement

Secular trends in stroke incidence and mortality. The Framingham Study.

The reduction in US stroke mortality has been attributed to declining stroke incidence. However, evidence is accumulating of a trend in declining stroke severity. We examined secular trends in stroke incidence, prevalence, and fatality in Framingham Study subjects aged 55-64 years in three successive decades beginning in 1953, 1963, and 1973. No significant decline in overall stroke and transient ischemic attack incidence or prevalence occurred. In women, but not men, incidence of completed ischemic stroke declined significantly. Stroke severity, however, decreased significantly over time. Stroke with severe neurological deficit decreased in later decades, with a fall in rates of severe stroke cases in which patients were unconscious on admission to the hospital. There was no substantial change in the case mix of infarcts and hemorrhages and no decline in hemorrhage to account for the decline in severity. The proportion of isolated transient ischemic attacks increased significantly over the 30 years studied, yielding an apparent and significant decline in case-fatality rates in men only. Secular trends in stroke incidence and fatality did not follow a clear or definite pattern of decline. While a significant decline in stroke severity occurred over three decades, incidence of infarction fell only in women. The decline in total case fatality rates occurred only in men and resulted largely from an increased incidence of isolated transient ischemic attacks. The severity of completed stroke was significantly lower in the later decades under study.

Stroke incidence in Copenhagen, 1976-1988.

Temporal trends in stroke incidence in Denmark have not been previously reported. The Copenhagen City Heart Study is a prospective study based on a randomly selected sample of an urban population of, initially, 19,698 participants followed since 1976. Over a period of 12 years, we studied three important aspects of stroke incidence in 848 identified cases: temporal trends, dependence on age and sex, and comparison of responders and nonresponders. The participants were invited to two health examinations at 5-year intervals. The participants who attended at least one of the two examinations are termed responders and those who attended none nonresponders. The cases of first-ever stroke were collected from responders, the National Patient Register, and the National Register of Deaths and were verified by study of hospital records and death certificates. For responders aged 35-64 years and greater than or equal to 65 years, there were no significant changes in the weighted rates in four consecutive 3-year periods. There was a tendency toward decreasing rates among younger women, but not in older women or men. The age- and sex-adjusted rates per 1,000 (based on the Danish population in 1982) in responders in the entire 12-year follow-up period were 1.61 in women, 2.67 in men, and 2.14 in both sexes combined. Stroke incidence rates increased exponentially with age in both sexes, with rates in men generally twice those in women, even in the greater than or equal to 75 years of age group. Age-adjusted rates were higher in nonresponders than in responders. For women, this ratio was 1.7; for men, 1.1. The stroke incidence in Copenhagen is relatively high and has shown no decreasing tendency over the period 1976-1988.

Changing rates of stroke in the province of Quebec, Canada: 1981-1988.

Using more than 37,000 hospital discharges attributed to hemorrhagic or occlusive stroke in the province of Quebec, Canada, we analyzed trends in stroke incidence during the period 1981-1988. There were large and statistically significant (p less than 0.05) increases in the rates of hemorrhagic stroke over this period. Dramatic increases occurred among men in the rates of both intracerebral (International Classification of Diseases--Ninth Revision [ICD9] code 431) and intracranial (ICD9 code 432) hemorrhagic strokes (40-204% depending on age). In contrast, the rates of occlusion of the precerebral arteries (ICD9 code 433) declined in younger men and women but increased substantially (107%) in older men. Rates of occlusion of the cerebral arteries (ICD9 code 434) declined in men over the age of 50 years and in women aged 50-79 years. Despite the decline in the rate of occlusion of the cerebral arteries, the rate of hemorrhagic stroke appears to have increased. Changes in the hospitalization rates for hemorrhagic stroke were not accompanied by consistent decreases in the case-fatality rate. This finding tends to support the hypothesis of an actual increase in the hospitalization rate fo hemorrhagic stroke rather than an artifactually elevated rate due to enhanced diagnosis by computed tomography.

Reduced stroke incidence with structured hypertension care: the Skaraborg Hypertension Project

The Skaraborg Hypertension Project is a 5-year trial testing the impact of structured hypertension care implemented in half of the country, the other half serving as control. Population investigations revealed improved blood pressure control in all treated hypertensives in the study area, blood pressure reduction averaging 2-5 mmHg. The primary trial hypothesis of a possible impact on stroke incidence in the community was tested in this study. Cases of fatal and non-fatal stroke were identified from local and national mortality and morbidity registers, and diagnoses were validated against medical records. Of an initial 1169 reported cases, 1097 proved to be true stroke after validation. A statistically significant difference in stroke incidence trends (fatal and non-fatal) between the study and control populations was identified (P = 0.0251). Improved hypertension control in the study area seems the most plausible explanation for the relative decline in stroke incidence in the study area.

Stroke in blacks.

In an attempt to answer unresolved questions and to suggest directions for future research concerning stroke in black populations, data from the National Center for Health Statistics were examined and published studies were reviewed. Stroke was the third leading cause of death among U.S. blacks in 1982, accounting for 18,698 deaths, 8.25% of the total. Black men aged 35-74 years were 2.5 times and black women 2.4 times as likely as whites to die of stroke. A long-term decline in stroke mortality rates continued through 1982, with the declines since 1968 probably due to improved hypertension control. Data on morbidity trends are lacking. About 7% of black men and 11% of black women in the U.S. noninstitutionalized population aged 65 and over reported having had a stroke in 1977, black women having the highest prevalence of any group. In several studies, black women had higher incidence rates of stroke than white women in each age group. Black men had higher incidence rates than whites up to age 75 years. Survivorship and outcome following stroke may have been poorer in blacks than in whites. Advanced age and elevated blood pressure were the only putative risk factors for stroke for which published data were adequate to firmly establish the association in blacks. Thus, data are needed to examine trends in stroke incidence and survivorship in blacks and to assess the relation of many variables to the risk of stroke.

GEOGRAPHICAL AND SECULAR TRENDS IN STROKE INCIDENCE

Etude de la morbidite et de la mortalite selon les pays et les epoques (depuis 1955). Criteres d'une etude epidemiologique «ideale»