Abstract P215: Trends in Hemorrhagic Stroke in Japan, from 1986 to 2010: Circulatory Risk in Communities Study (CIRCS).

Background: The incidence of hemorrhagic stroke has substantially decreased nearly to a quarter over years from 1960s to 1980s in Japan. However, there is little evidence on the trends after 1980, or whether subtypes of hemorrhagic stroke have decreased. We examined trends in the incidence of hemorrhagic stroke and its subtypes. Hypothesis: Hemorrhagic stroke have decreased after 1980s. For intraparenchymal hemorrhage (IPH), lobar and cerebellar intraparenchymal hemorrhage has not decreased. Methods: All residents aged 30 to 84 years in two communities (Akita and Osaka, census population: 18,998 in 2000) in Japan was surveyed. The incidence of IPH and subarachnoid hemorrhage (SAH) from 1986 to 2010 was ascertained by systematic surveillance of hospital records and confirmed by physicians with CT or MRI images. The implementation rate of CT or MRI has not changed materially over years (78.9~97.4%). IPH was further categorized to lobar and cerebellar IPH, and deep IPH (thalamus, basal ganglia or brainstem). The respective age-adjusted incidence rates per 100,000 person-years were calculated by each 5 years of time periods: 1986-1990, 1991-1995, 1996-2000, 2001-2005, and 2006-2010. Results: Age-adjusted incidence of SAH has decreased in 1996-2000 but increased after 2000. Respective age-adjusted incidence rates (per 100,000 person-years) of SAH for 5 time periods were 46.2, 46.5, 14.5, 23.0, and 23.7 (p for trend=0.23). Age-adjusted incidence of all IPH has decreased from 1986-1990 to 2006-2010. Respective incidence rates of IPH were 56.8, 53.7, 48.7, 29.0, and 26.5 (p for trend=0.01). For the subtypes of IPH, incidence of lobar and cerebellar IPH has not decreased from 1986-1990 to 2006-2010, while it have decreased for deep IPH. Respective incidence rates for lobar and cerebellar IPH were 13.1, 7.6, 16.6, 10.9, and 10.3 (p for trend=0.85) and those of deep IPH were 52.0, 53.1, 49.8, 40.8, and 29.5 (p for trend=0.03). Conclusion: The age-adjusted incidence of IPH after 1980s has decreased over years, although such trend was not clear for SAH. Among IPH, the incidence of lobar and cerebellar IPH has not decreased, while the incidence of deep IPH has decreased.

Download Full-text

Decreasing incidence of subarachnoid hemorrhage

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014038 ◽

2018 ◽

Vol 11 (3) ◽

pp. 320-322 ◽

Cited By ~ 5

Author(s):

Patrick Nicholson ◽

Alan O’Hare ◽

Sarah Power ◽

Seamus Looby ◽

Mohsen Javadpour ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Population Data ◽

Incidence Rates ◽

Public Hospitals ◽

National Database ◽

Irish Hospital ◽

Acute Subarachnoid Hemorrhage ◽

Adjusted Rate ◽

Using Data ◽

Adjusted Incidence

ObjectiveTo determine the incidence and trends in subarachnoid hemorrhage in Ireland using data from a national database.Materials and methodsWe performed a retrospective nationwide query of the Irish Hospital In-patient Enquiry System (HIPE). This is a national database of all in-patient activity in acute public hospitals in Ireland. Each HIPE entry records one episode of in-patient care. The study period ranged from 1997 to 2015. Population data was obtained from the Irish Central Statistics Office, and the annual prevalence of smoking from the Irish National Tobacco Control Office. We were therefore able to calculate both crude annual acute subarachnoid hemorrhage (SAH) incidence rates, as well as population-standardized rates, and compared them with trends in the annual smoking rates.ResultsThe mean number of SAH cases per year is 549, with 465 cases in 1997 and 517 in 2015 (range: 465–624). The absolute incidence of SAH, therefore, remained relatively stable. Due to population increases over time, the population-adjusted rate of SAH therefore decreased, from 126.9/million people/year in 1997 to 111.5/million people/year in 2015. Nationally, there was a decrease in smoking prevalence, from 31% in 1998 to 19.2% in 2015. There was a statistically significant correlation between decreasing smoking rates and decreasing population-adjusted incidence of SAH (P=<0.0001).ConclusionsOur data suggests that the incidence of non-traumatic subarachnoid hemorrhage in our population appears to be decreasing, a decrease which is correlated with decreasing smoking rates. This provides important data both in terms of the epidemiology of SAH, as well as the possible role of public-health interventions in tackling both smoking and declining rates of SAH.

Download Full-text

Substantial Within-Country Variation in the Incidence of Subarachnoid Hemorrhage: A Nationwide Finnish Study

Neurology ◽

10.1212/wnl.0000000000012129 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012129

Author(s):

Ilari Rautalin ◽

Joni Valdemar Lindbohm ◽

Jaakko Kaprio ◽

Miikka Korja

Keyword(s):

Subarachnoid Hemorrhage ◽

Poisson Regression ◽

Causes Of Death ◽

Incidence Rates ◽

Poisson Regression Model ◽

Geographical Regions ◽

Adjusted Incidence Rate ◽

Rate Ratios ◽

Adjusted Incidence ◽

Finnish Study

Objective:To study whether the incidence of subarachnoid hemorrhage (SAH) varies between geographical regions of Finland.Methods:By utilizing the nationwide Causes of Death and Hospital Discharge Registers, we identified all first-ever, hospitalized and sudden-death (dying before hospitalization) SAH events in Finland between 1998 and 2017. Based on the SAH patients’ home residence, we divided SAHs into five geographical regions: 1) Southern, 2) Central, 3) Western, 4) Eastern, and 5) Northern Finland. We calculated crude and European age-standardized (ESP2013) SAH incidence rates for each region, and used a Poisson regression model to calculate age-, sex- and calendar year-adjusted incidence rate ratios (IRRs) and 95% confidence intervals for regional and time-dependent differences.Results:During the total 106 510 337 cumulative person-years, we identified 9 443 first-ever SAH cases, of which 24% died before hospitalization. As compared to Western Finland, where the SAH incidence was the lowest (7.4 per 100 000 persons), the ESP-standardized SAH incidence was 1.4 times higher in Eastern (10.2 per 100 000 persons; adjusted IRR=1.37 (1.27–1.47)) and Northern Finland (10.4 per 100 000 persons; adjusted IRR=1.40 (1.30–1.51)). These differences were similar when men and women were analyzed independently. Although SAH incidence rates decreased in all five regions over two decades, the rate of decrease varied significantly by region.Conclusion:SAH incidence appears to vary substantially by region in Finland. Our results suggest that regional SAH studies can identify high-risk subpopulations, but can also considerably over- or underestimate incidence on a nationwide level.

Download Full-text

Age Conditional Probability of Ocular and Ocular Adnexal Malignancies

Ocular Oncology and Pathology ◽

10.1159/000511364 ◽

2020 ◽

pp. 1-4

Author(s):

Mathias Nittmann ◽

Curtis E. Margo

Keyword(s):

Conditional Probability ◽

Uveal Melanoma ◽

Incidence Rates ◽

Cross Sectional ◽

Pedagogical Tool ◽

United States Population ◽

Age Dependent ◽

Cumulative Risks ◽

Adjusted Incidence ◽

Communicating Risk

Aim: The aim of this study was to discuss and illustrate the role age-conditional probability has in communicating risk of developing ocular and ocular adnexal malignancies. Methods: Cross-sectional incidence for retinoblastoma, uveal melanoma, conjunctival melanoma, and lacrimal gland carcinomas from 2000 to 2017 were obtained from the Surveillance, Epidemiology and End Results (SEER) database. Incidence rates were age-adjusted to the 2000 United States population. Age-adjusted incidence was converted to age-interval and cumulative risks. Outcomes were examined in 20-year intervals and cumulatively for adult cancers and yearly for retinoblastoma. Results: The risk of each malignancy displayed age-dependent variation. For adult malignancies, men were at higher risk at most age intervals. Uveal melanoma had the greatest cumulative lifetime risk. The probability of developing retinoblastoma declines precipitously after age 3 years. Conclusions: Age-conditional probability of developing cancer is a conceptually friendly means of understanding and communicating risk. It is particularly useful in comparing the risks of uncommon or rare cancers, such as those found in and around the eye. The assessment of risk in terms of age-conditional probability is a versatile and an underutilized pedagogical tool.

Download Full-text

The physiopathology of spontaneous hemorrhagic stroke: a systematic review

Reviews in the Neurosciences ◽

10.1515/revneuro-2020-0131 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Alcivan Batista de Morais Filho ◽

Thiago Luis de Holanda Rego ◽

Letícia de Lima Mendonça ◽

Sulyanne Saraiva de Almeida ◽

Mariana Lima da Nóbrega ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Natural History ◽

Hemorrhagic Stroke ◽

Recent Literature ◽

Clinical Manifestations ◽

The Road ◽

History Of

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

Download Full-text

Effect of COPD on the Hospital Outcomes and Mortality among Hemorrhagic Stroke Patients. Sex Differences in a Population-Based Study

Journal of Clinical Medicine ◽

10.3390/jcm10112491 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2491

Author(s):

Javier de Miguel-Diez ◽

Marta Lopez-Herranz ◽

Rodrigo Jiménez-García ◽

Valentín Hernández-Barrera ◽

Isabel Jimenez-Trujillo ◽

...

Keyword(s):

Sex Differences ◽

Decompressive Craniectomy ◽

Hemorrhagic Stroke ◽

Population Based ◽

Stroke Patients ◽

National Hospital ◽

Population Based Study ◽

Factors Associated ◽

Adjusted Incidence ◽

Discharge Database

(1) Background: It is not well known whether there is an association between COPD and hemorrhagic stroke (HS). We aim to analyze the incidence, clinical characteristics, procedures, and outcomes of HS in patients with and without COPD and to assess sex differences. Secondly, to identify factors associated with in-hospital mortality (IHM). (2) Methods: Patients aged ≥40 years hospitalized with HS included in the Spanish National Hospital Discharge Database (2016–2018) were analyzed. Propensity score matching (PSM) was used to compare patients according to sex and COPD status. (3) Results: We included 55,615 patients (44.29% women). Among men with COPD the HS adjusted incidence was higher (IRR 1.31; 95% CI 1.24–1.57) than among non-COPD men. COPD men had higher adjusted incidence of HS than COPD women (IRR 1.87; 95% CI 1.85–1.89). After matching, COPD men had a higher IHM (29.96% vs. 27.46%; p = 0.032) than non-COPD men. Decompressive craniectomy was more frequently conducted among COPD men than COPD women (6.74% vs. 4.54%; p = 0.014). IHM increased with age and atrial fibrillation, while decompressive craniectomy reduced IHM. (4) Conclusions: COPD men had higher incidence and IHM of HS than men without COPD. COPD men had higher incidence of HS than COPD women. Decompressive craniectomy was more frequently conducted in COPD men than COPD women and this procedure was associated to better survival.

Download Full-text

Alemtuzumab CARE-MS II 5-year follow-up

Neurology ◽

10.1212/wnl.0000000000004354 ◽

2017 ◽

Vol 89 (11) ◽

pp. 1117-1126 ◽

Cited By ~ 132

Author(s):

Alasdair J. Coles ◽

Jeffrey A. Cohen ◽

Edward J. Fox ◽

Gavin Giovannoni ◽

Hans-Peter Hartung ◽

...

Keyword(s):

Multiple Sclerosis ◽

Incidence Rates ◽

Continuous Treatment ◽

Inadequate Response ◽

Class Iii ◽

Prior Therapy ◽

Link Type ◽

Brain Volume Loss ◽

Core Study ◽

Adjusted Incidence

Objective:To evaluate 5-year efficacy and safety of alemtuzumab in patients with active relapsing-remitting multiple sclerosis and inadequate response to prior therapy.Methods:In the 2-year Comparison of Alemtuzumab and Rebif Efficacy in Multiple Sclerosis (CARE-MS) II study (NCT00548405), alemtuzumab-treated patients received 2 courses (baseline and 12 months later). Patients could enter an extension (NCT00930553), with as-needed alemtuzumab retreatment for relapse or MRI activity. Annualized relapse rate (ARR), 6-month confirmed disability worsening (CDW; ≥1-point Expanded Disability Status Scale [EDSS] score increase [≥1.5 if baseline EDSS = 0]), 6-month confirmed disability improvement (CDI; ≥1-point EDSS decrease [baseline score ≥2.0]), no evidence of disease activity (NEDA), brain volume loss (BVL), and adverse events (AEs) were assessed.Results:Most alemtuzumab-treated patients (92.9%) who completed CARE-MS II entered the extension; 59.8% received no alemtuzumab retreatment. ARR was low in each extension year (years 3–5: 0.22, 0.23, 0.18). Through 5 years, 75.1% of patients were free of 6-month CDW; 42.9% achieved 6-month CDI. In years 3, 4, and 5, proportions with NEDA were 52.9%, 54.2%, and 58.2%, respectively. Median yearly BVL remained low in the extension (years 1–5: −0.48%, −0.22%, −0.10%, −0.19%, −0.07%). AE exposure-adjusted incidence rates in the extension were lower than in the core study. Thyroid disorders peaked at year 3, declining thereafter.Conclusions:Alemtuzumab provides durable efficacy through 5 years in patients with an inadequate response to prior therapy in the absence of continuous treatment.Classification of evidence:This study provides Class III evidence that alemtuzumab provides efficacy and slowing of brain atrophy through 5 years.

Download Full-text

Dengue Fever in Italy: The “Eternal Return” of an Emerging Arboviral Disease

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed7010010 ◽

2022 ◽

Vol 7 (1) ◽

pp. 10

Author(s):

Matteo Riccò ◽

Simona Peruzzi ◽

Federica Balzarini ◽

Alessandro Zaniboni ◽

Silvia Ranzieri

Keyword(s):

Incidence Rate ◽

Central Italy ◽

Denv Infection ◽

Incidence Rates ◽

Annual Incidence ◽

Annual Reports ◽

Foreign Born ◽

Time Period ◽

Adjusted Incidence Rate ◽

Adjusted Incidence

Enhanced surveillance for dengue virus (DENV) infections in Italy has been implemented since 2012, with annual reports from the National Health Institute. In this study, we summarize available evidence on the epidemiology of officially notified DENV infections from 2010–2021. In total, 1043 DENV infection cases were diagnosed, and most of them occurred in travelers, with only 11 autochthonous cases. The annual incidence rates of DENV infections peaked during 2019 with 0.277 cases per 100,000 (95% confidence interval [95% CI] 0.187–0.267), (age-adjusted incidence rate: 0.328, 95% CI 0.314–0.314). Cases of DENV were clustered during the summer months of July (11.4%), August (19.3%), and September (12.7%). The areas characterized by higher notification rates were north-western (29.0%), and mostly north-eastern Italy (41.3%). The risk for DENV infection in travelers increased in the time period 2015–2019 (risk ratio [RR] 1.808, 95% CI 1.594–2.051) and even during 2020–2021 (RR 1.771, 95% CI 1.238–2.543). Higher risk for DENV was additionally reported in male subjects compared with females subjects, and aged 25 to 44 years, and in individuals from northern and central Italy compared to southern regions and islands. In a multivariable Poisson regression model, the increased number of travelers per 100 inhabitants (incidence rate ratio [IRR] 1.065, 95% CI 1.036–1.096), the incidence in other countries (IRR 1.323, 95% CI 1.165–1.481), the share of individuals aged 25 to 44 years (IRR 1.622, 95% CI 1.338–1.968), and foreign-born residents (IRR 2.717, 95% CI 1.555–3.881), were identified as effectors of annual incidence. In summary, although the circulation of DENV remains clustered among travelers, enhanced surveillance is vital for the early detection of human cases and the prompt implementation of response measures.

Download Full-text

Incidence of outbreak-associated COVID-19 cases by industry in Ontario, Canada, April 1, 2020- March 31, 2021

10.1101/2021.06.30.21259770 ◽

2021 ◽

Author(s):

Sarah A Buchan ◽

Peter M Smith ◽

Christine Warren ◽

Michelle Murti ◽

Cameron Mustard ◽

...

Keyword(s):

Labour Force ◽

Population Based ◽

Cross Sectional Study ◽

Incidence Rates ◽

American Industry ◽

Cross Sectional ◽

Market Participants ◽

Working Age ◽

Time Periods ◽

Statistics Canada

Objectives The objective of our study was to estimate the rate of workplace outbreak-associated cases of COVID-19 by industry in labour market participants aged 15-69 years who reported working the majority of hours outside the home in Ontario, Canada. Methods We conducted a population based cross-sectional study of COVID-19 workplace outbreaks and associated-cases reported in Ontario between April 1, 2020 and March 31, 2021. All outbreaks were manually classified into two digit North American Industry Classification System (NAICS) codes. We obtained denominator data from the Statistics Canada Labour Force Survey in order to estimate the incidence of outbreak-associated cases per 100,000,000 hours amongst individuals who reported the majority of hours were worked outside the home. We performed this analysis across industries and in three distinct time periods. Results Overall, 12% of cases were attributed to workplace outbreaks among working age adults across our study period. While incidence varied across the time periods, the five industries with the highest incidence rates across our study period were agriculture; healthcare and social assistance; food manufacturing; educational services; and, transportation and warehousing. Conclusions Certain industries have consistently increased incidence of COVID-19 over the course of the pandemic. These results may assist in ongoing efforts to reduce transmission of COVID-19, by prioritizing resources, as well as industry-specific guidance, vaccination, and public health messaging.

Download Full-text

Abstract TP178: Walk Score and Risk of Ischemic Stroke Among Town Residents

Stroke ◽

10.1161/str.44.suppl_1.atp178 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Malik M Adil ◽

Mariam Suri ◽

Basit Rahim ◽

Sarwat I Gilani ◽

Adnan I Qureshi

Keyword(s):

Ischemic Stroke ◽

The United States ◽

Incidence Rates ◽

Physical Activities ◽

Online Database ◽

Stroke Incidence ◽

Walk Score ◽

Attractive Option ◽

Ready Availability ◽

Adjusted Incidence

BACKGROUND: Regular physical activities, including light-to-moderate activities, such as walking, have well-established benefits for reducing the risk of ischemic stroke. It remains unknown whether certain area characteristics can influence the risk of stroke through promoting such activities. OBJECTIVES: We tested the hypothesis that how walkable an area is will be negatively associated with the risk of ischemic stroke in persons residing in the area. METHODS: We calculated the age- adjusted annual incidence rates of ischemic stroke among residents in each of the 63 cities in Minnesota between 2007 and 2011. The walk score, an online database, provides a numerical walkability score for any location within the United States, ranging between 0 and 100 that is computed by using exclusive algorithms. The route to amenities is sorted into nine different categories: grocery, restaurants, shopping, coffee, banks, parks, schools, books, and entertainment, which are weighed according to their prominence. RESULTS: There are 2,901,389 persons residing in 63 cities in Minnesota (average population per town is 46053). The average walk score of the 63 towns in Minnesota was 37, ranging from 14 to 69. The average median age of residents was similar in tertiles of towns based on walk score as follows: ≤25 (n=9) 36 years; 26-50(n=46) 36 years; and 51-100(n=8) 34 years. The age adjusted incidence of ischemic stroke was similar in tertiles of towns based on walk score as follows: ≤25 (n=9) 2157 per 100,000; 26-50(n=46) 1924 per 100,000; and 51-100(n=8) 2856 per 100,000 residents. The correlation between age adjusted ischemic stroke incidence and walk score was low (R2=0.32) within Minnesota. CONCLUSIONS: The ready availability of indices such as walk score makes it an attractive option but currently such indices lack the sensitivity to measure the magnitude and health benefits of light-to-moderate activities performed within a town.

Download Full-text