Abstract T MP66: Injury to the Head or Neck Increases Risk of Ischemic Stroke Three-fold After Trauma.

Background: Over 2 million people under age 50 are seen in a U.S. emergency room monthly for non-fatal injuries. Our objective was to measure ischemic stroke incidence after traumatic injury in young patients and identify stroke risk factors. Methods: We performed a population-based study of ischemic stroke after trauma among people <50 years old in a Northern Californian integrated health care system. We electronically identified a cohort of patients with diagnostic codes for trauma (ICD-9 800-959.9) in emergency and inpatient encounters from 1997-2011, then identified ischemic stroke outcomes within 4 weeks. To determine stroke, we required an ICD-9 stroke code (433-438) plus a radiology report of brain imaging containing a keyword: stroke, infarct#, thromb#, ischemi#, lacun#, or dissect#. A neurologist reviewed the reports to exclude those inconsistent with ischemic stroke. We obtained clinical data such as injury type from electronic databases to calculate stratified incidence rates and risk ratios. Results: From 1.5 million trauma encounters, we identified 197 ischemic strokes. The 4-week stroke incidence after any traumatic injury was 0.013% (95% CI 0.011, 0.015). Patients with stroke had a mean age of 37.7 years (SD 12.2) versus 24.0 years (SD 13.8) in those without stroke (P<0.0001). Patients with injury to the head or neck were more likely to have a stroke compared to those with other types of injuries (Table). The 4-week stroke incidence after head or neck injury was 0.07% (95% CI 0.05, 0.09) among adults and 0.005% (95% CI 0.001, 0.01) among children (P<0.0001). Of the 197 stroke cases, 16% (95% CI 11, 22) had a diagnostic code for cranio-cervical dissection. Conclusions: A 4-week stroke incidence of 0.013% suggests that 260 young people have an ischemic stroke after a traumatic injury every month in the U.S. Further research is needed to identify the highest risk groups, such as those with head or neck injury, and opportunities for stroke prevention.

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Seasonal Variation in Incidence of Stroke in a General Population of 1.4 Million Japanese: The Shiga Stroke Registry

Cerebrovascular Diseases ◽

10.1159/000518370 ◽

2021 ◽

pp. 1-7

Author(s):

Takako Fujii ◽

Hisatomi Arima ◽

Naoyuki Takashima ◽

Yoshikuni Kita ◽

Naomi Miyamatsu ◽

...

Keyword(s):

Ischemic Stroke ◽

Seasonal Variation ◽

General Population ◽

Intracerebral Hemorrhage ◽

Large Scale ◽

Population Based ◽

Incidence Rates ◽

Stroke Incidence ◽

Stroke Registry ◽

Age And Sex

Introduction: The purpose of this study was to investigate seasonal variation in stroke incidence using data from a large-scale stroke registry of general population in current Japan. Methods: Shiga Stroke Registry (SSR) is an ongoing population-based registry of stroke that occurred in the Shiga Prefecture in central Honshu, Japan. A total 6,688 cases of first-ever stroke, with onset dates ranging from 1 January 2011 to 31 December in 2013 were included in this study. Incidence rates of first-ever stroke in each season were estimated using the person-year approach and adjusted for age and sex using the Poisson regression models. Results: From 2011 to 2013, we identified a total of 6,688 stroke cases (3,570 men, 3,118 women), of which 4,480 cases had ischemic stroke (2,518 men, 1,962 women), 1,588 had intracerebral hemorrhage (857 men, 731 women) and 563 had subarachnoid hemorrhage (166 men, 397 women). Age- and sex-adjusted incidence rates of total stroke were 151 (95% confidence interval [CI] 144–160, p = <0.001 vs. summer) in spring, 130 (95% CI 122–137) in summer, 141 (95% CI 133–149, p = 0.020 vs. summer) in autumn and 170 (95% CI 161–179, p = <0.001 vs. summer) in winter. Seasonal variation was more pronounced in intracerebral hemorrhage than in ischemic stroke. Conclusion: In the present large-scale stroke registry of general population, incidence rates of stroke were highest in winter and lowest in summer in current Japan.

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Temporal Trends in the Incidence of Ischemic Stroke in Young Adults: Dijon Stroke Registry

Neuroepidemiology ◽

10.1159/000516054 ◽

2021 ◽

pp. 1-6

Author(s):

Yannick Béjot ◽

Gauthier Duloquin ◽

Quentin Thomas ◽

Sophie Mohr ◽

Lucie Garnier ◽

...

Keyword(s):

Young Adults ◽

Sex Differences ◽

Ischemic Stroke ◽

Temporal Trends ◽

Population Based ◽

Incidence Rates ◽

Stroke Incidence ◽

Stroke Registry ◽

Stroke In Young Adults ◽

Stroke In Young

Introduction: Stroke is associated with major consequences in terms of socioeconomic impact and lost disability-adjusted life in young victims, thus justifying a careful surveillance of epidemiological trends. This study aimed to assess changes in the incidence of ischemic stroke in young adults over a long period. Methods: All cases of first-ever ischemic stroke that occurred among adults aged 18–55 years were prospectively recorded using the population-based Dijon Stroke Registry, from 1985 to 2017. Sex-specific annual incidence rates were calculated and were presented according to 6 time periods. Incidence rate ratios (IRRs) were determined to assess sex differences in stroke incidence. Results: Over the whole study period, 4,451 patients suffered a first-ever ischemic stroke. Among these patients, 469 (10.5%) were young adults (median age: 46 years, IQR: 39–50; 53.9% men). Incidence rates rose from the study period 2003 to 2007 compared with previous periods and remained stable thereafter, both in men and women. Hence, incidence per 100,000 per year was globally 11.0 (95% CI: 9.4–12.7) before 2003 and 22.9 (20.3–25.6) thereafter. In individuals aged 18–45 years, incidence rates were 5.4 (4.3–6.9) overall, 4.1 (2.7–6.0) in men, and 6.7 (4.9–9.0) in women, before 2003. After 2003, incidence rates rose to 12.8 (10.7–15.1) overall, 12.0 (9.2–15.4) in men, and 13.6 (10.6–17.0) in women. In this age group, the men/women IRR was 0.78 (95% CI: 0.62–1.26, p = 0.08), although sex differences decreased over time (IRR = 0.62; 95% CI: 0.36–1.02, p = 0.046 before 2003, vs. IRR = 0.88; 95% CI: 0.62–1.26, p = 0.48 after 2003). In individuals aged 45–55 years, incidence rates before 2003 were 47 (37–61) in men and 25 (17–35) in women (IRR = 1.90; 95% CI: 1.24–2.97, p < 0.001), and they increased to 82 (67–100) in men and 46 (35–59) in women (IRR = 1.79; 95% CI: 1.29–2.49, p < 0.001) after 2003. Conclusions: The incidence of ischemic stroke in young adults increased during the early 2000s and remained stable thereafter. These results highlight the priority need for dedicated prevention strategies for the young to reduce the burden of stroke.

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Abstract P625: Rate of Hemorrhagic Transformation After Ischemic Stroke and Associated Risk Factors: The Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS)

Stroke ◽

10.1161/str.52.suppl_1.p625 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Robert J Stanton ◽

Eleni Antzoulatos ◽

Elisheva R Coleman ◽

Felipe De Los Rios La Rosa ◽

Stacie L Demel ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Case Fatality ◽

Population Based ◽

Hemorrhagic Transformation ◽

Incidence Rates ◽

Icd 10 ◽

Potential Risk Factors ◽

Adjusted Rate ◽

Associated Risk Factors

Background: Hemorrhagic transformation (HT) of ischemic stroke can have devastating consequences, leading to longer hospitalizations, increased morbidity and mortality. We sought to identify the rate of HT in stroke patients not treated with tPA within a large, biracial population. Methods: The GCNKSS is a population-based stroke epidemiology study from five counties in the Greater Cincinnati region. During 2015, we captured all hospitalized strokes by screening ICD-9 codes 430-436 and ICD-10 codes I60-I68, and G45-46. Study nurses abstracted all potential cases and physicians adjudicated cases, including classifying the degree of HT. Patients treated with thrombolytics were excluded. Incidence rates per 100,000 and associated 95% confidence intervals (CI) were estimated for HT cases, age and sex adjusted to the 2000 US population. Multiple logistic regression was used to examine risk factors associated with HT. Results: In 2015, there were 2301 ischemic strokes included in the analysis. Of these 104 (4.5%) had HT; 23 (22.1%) symptomatic, 55 (52.9%) asymptomatic and 26 (25%) unknown. Documented reasons for not receiving tPA in these patients were: time (71, 68.3%), anticoagulant use (1, 1.0%), other (18,17.3%) and unknown (14, 13.5%), which were not significantly different compared to those without HT. Only 29/104 (18.3%) had HT classified as PH-1 or PH-2. The age, sex and race-adjusted rate of HT was 9.8 (7.9, 11.6) per 100,000. The table shows rates of potential risk factors and the adjusted odds of developing HT. 90 day all-cause case fatality for patients with HT was significantly higher, 27.9% vs. 15.7%, p<0.0001. Conclusion: We found that 4.5% of non-tPA treated IS patients had HT. These patients had more severe strokes, were more likely to have abnormal coagulation tests or anticoagulant use, and were more likely to die within 90 days. We also report the first population-based incidence rate of HT in non-tPA treated of 9.8/100,000, a rate similar to the incidence of SAH.

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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.

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Abstract P287: Sex Differences in Stroke Incidence: The REGARDS Study

Circulation ◽

10.1161/circ.125.suppl_10.ap287 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Virginia J Howard ◽

Suzanne E Judd ◽

Abraham J Letter ◽

Dawn O Kleindorfer ◽

Leslie A McClure ◽

...

Keyword(s):

Sex Differences ◽

Stroke Risk ◽

Proportional Hazards ◽

Population Based ◽

Incidence Rates ◽

National Data ◽

Stroke Incidence ◽

The Difference ◽

Regards Study

Background: There are strikingly few national data available to describe sex differences in age-specific stroke incidence. Methods: REGARDS is a national, population-based, longitudinal study of black and white participants aged > 45 years old, with oversampling of blacks and residents of the stroke belt. Between 2003 and 2007, 30,239 participants were enrolled and examined; follow-up is every 6 months by telephone for self- or proxy-reported stroke, with retrieval and adjudication of medical records by physicians. This analysis included 27,756 participants with follow up data who had no physician-diagnosed stroke at baseline. Stroke incidence rates were calculated as the number of stroke events divided by the person-years at risk with 95% confidence limits. Proportional hazards models were used to assess the race-specific association of sex with stroke risk by age strata (<65, 65–74, and 75+) after adjustment for socioeconomic factors, and Framingham stroke risk factors. Results: There were 613 incident strokes events over 135,551 person-years of follow-up. Stroke incidence rates increased with age (from 237/100,000 to 1003/100,000), and were higher in men than women in both blacks and whites (left panel of figure). After multivariable adjustment, men had higher risk than women at younger ages (<75) but for the 65–75 age group, the difference is larger for blacks than whites (right panel of figure). Discussion: These national data confirm the patterns in male/female stroke risk observed in the Greater Cincinnati/Northern Kentucky Stroke Study, with smaller sex differences at older ages, and for men, larger excess risk in whites than blacks.

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Clinicopathologic Features and Outcome of Adenocarcinoma of the Anal Canal: A Population-Based Study

International Journal of Surgical Oncology ◽

10.1155/2020/5139236 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Shekhar Gogna ◽

Roberto Bergamaschi ◽

Agon Kajmolli ◽

Mahir Gachabayov ◽

Aram Rojas ◽

...

Keyword(s):

Anal Canal ◽

Cancer Survival ◽

Young Patients ◽

The United States ◽

Population Based ◽

Incidence Rates ◽

Term Survival ◽

Impact On Survival ◽

Patient Groups ◽

Well Differentiated

Background. Anal canal adenocarcinoma (AA) is an uncommon tumor of the gastrointestinal tract. We seek to provide a detailed description of the incidence, demographics, and outcome of this rare tumor in the United States. Methods. The data on anal canal adenocarcinoma from SEER Program, between 1973–2015, were extracted. We analyzed the incidence rates by demographics and tumor characteristics, followed by analysis of its impact on survival. Results. The incidence of AA increased initially by 4.03% yearly from 1973 to 1985 but had a modest decline of 0.32% annually thereafter. The mean age for diagnosis of AA was 68.12 ± 14.02 years. Males outnumbered females by 54.8 to 45.2%. Tumors were mostly localized on presentation (44.4%) and moderately differentiated (41.1%). Age generally correlated with poor overall cancer survival. However, young patients (age <40 years) also showed poor long-term survival. Patients with localized disease and well-differentiated tumors showed better survival outcomes. Surgical intervention improved survival significantly as compared to patients who did not (116.7 months vs 42.7 months, p<0.01). Conclusions. Anal canal adenocarcinoma demonstrated a poor bimodal cancer-free survival in both younger and older patient groups. Surgery significantly improves odds of survival and should be offered to patients amenable to intervention.

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Secular Trends of Stroke Epidemiology in Örebro, Sweden, 2017 Compared to the Trends in 1999: A Population-Based Study

Cerebrovascular Diseases ◽

10.1159/000504082 ◽

2019 ◽

Vol 48 (3-6) ◽

pp. 149-156 ◽

Cited By ~ 1

Author(s):

Peter Appelros

Keyword(s):

Length Of Stay ◽

Incidence Study ◽

Large Population ◽

Case Fatality ◽

Population Based ◽

Incidence Rates ◽

European Population ◽

Stroke Severity ◽

Stroke Incidence ◽

Preventive Medication

Background and Purpose: A stroke incidence study in Örebro, situated in Southern Sweden, that was carried out in 1999 showed high incidence rates. Since then, in many Western countries, declining incidence rates have been observed. The main purpose of this study is to examine whether there have been any changes in stroke incidence in the city of Örebro between 1999 and 2017. Secondary purposes are to show trends in stroke severity, length of stay and case fatality (CF). Methods: The criterion of an “ideal” stroke incidence study was used in both the 1999 and the present investigation. These criteria include uniform diagnostics, case ascertainment including strokes managed outside the hospital, and the use of several overlapping sources, prospective design, well-defined denominator, and a large population. Results: The overall stroke incidence rate of first ever stroke (adjusted to the 2013 European population) dropped from 346/100,000 (95% CI 314–380) to 168/100,000 (95% CI 148–190). Stroke severity declined from a median of 6 to 4 points on the National Institute of Health Stroke scale. CF within 28 days also declined from 19 to 16% (n.s.). Median length-of-stay in hospital was 16 days in 1999, and 10 days in 2017. Twenty-one per cent of all kinds of stroke were recurrent (not included in the above results). Conclusions: During the years between 1999 and 2017, there have been reductions in stroke incidence, severity and mortality. The explanation is most likely to be found in the prevalence of risk factors and how they are treated. The use of antihypertensives and statins has increased, corresponding to lower levels of blood pressure and cholesterol in the population. The use of anticoagulants in patients with atrial fibrillation has increased. Cigarette smoking has decreased. These are encouraging results that show that preventive medication and public health measures work in practice.

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Incidence, recurrence, and long-term survival of ischemic stroke subtypes: A population-based study in the Middle East

International Journal of Stroke ◽

10.1177/1747493016684843 ◽

2017 ◽

Vol 12 (8) ◽

pp. 835-843 ◽

Cited By ~ 15

Author(s):

Hamidreza Saber ◽

Amanda G Thrift ◽

Moira K Kapral ◽

Ashkan Shoamanesh ◽

Amin Amiri ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle East ◽

Incidence Study ◽

Incidence Rates ◽

Large Artery ◽

Small Artery ◽

Community Based ◽

Stroke Incidence ◽

Stroke Subtypes ◽

Artery Disease

Background Incidence, risk factors, case fatality and survival rates of ischemic stroke subtypes are unknown in the Middle East due to the lack of community-based incidence stroke studies in this region. Aim To characterize ischemic stroke subtypes in a Middle Eastern population. Methods The Mashad Stroke Incidence Study is a community-based study that prospectively ascertained all cases of stroke among the 450,229 inhabitants of Mashhad, Iran between 2006 and 2007. We identified 512 cases of first-ever ischemic stroke [264 men (mean age 65.5 ± 14.4) and 248 women (mean age 64.14 ± 14.5)]. Subtypes of ischemic stroke were classified according to the TOAST criteria. Incidence rates were age standardized to the WHO and European populations. Results The proportion of stroke subtypes was distributed as follows: 14.1% large artery disease, 15% cardioembolic, 22.5% small artery disease, 43.9% undetermined and 4.5% other. The greatest overall incidence rates were attributed to undetermined infarction (49.97/100,000) followed by small artery disease (25.54/100,000). Prevalence of hypertension, diabetes and atrial fibrillation differed among ischemic stroke subtypes. Overall, there were 268 (52.34%) deaths and 73 (14.25%) recurrent strokes at five years after incident ischemic stroke, with the greatest risk of recurrence seen in the large artery disease (35.6%) and cardioembolic (35.5%) subgroups. Survival was similar in men and women for each stroke subtype. Conclusions We observed markedly greater incidence rates of ischemic stroke subtypes than in other countries within the Mashad Stroke Incidence Study after age standardization. Our findings should be considered when planning prevention and stroke care services in this region.

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Increased Risk of Ischemic Stroke in Young Patients with Ankylosing Spondylitis: A Population-Based Longitudinal Follow-Up Study

PLoS ONE ◽

10.1371/journal.pone.0094027 ◽

2014 ◽

Vol 9 (4) ◽

pp. e94027 ◽

Cited By ~ 19

Author(s):

Chia-Wei Lin ◽

Ya-Ping Huang ◽

Yueh-Hsia Chiu ◽

Yu-Tsun Ho ◽

Shin-Liang Pan

Keyword(s):

Ischemic Stroke ◽

Ankylosing Spondylitis ◽

Young Patients ◽

Population Based ◽

Follow Up Study ◽

Increased Risk ◽

Stroke In Young

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Traditional Chinese Medicine Reduces the Incidence of Chemotherapy-Induced Stroke: A Five-Year Nationwide Population-Based Cohort Study From Taiwan

Frontiers in Pharmacology ◽

10.3389/fphar.2021.614606 ◽

2021 ◽

Vol 12 ◽

Author(s):

Chien-Chen Huang ◽

Yu-Cih Yang ◽

Iona MacDonald ◽

Ching-Yuan Lai ◽

Cheng-Hao Tu ◽

...

Keyword(s):

Risk Factor ◽

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Large Scale ◽

Population Based ◽

Incidence Rates ◽

First Year ◽

Subdistribution Hazard ◽

Stroke Incidence ◽

Kaplan Meier

Background: Chemotherapy is suspected to be a risk factor for stroke in patients with cancer, athough the results from large-scale studies are controversial. Few strategies are available for reducing the stroke-related risks.Methods: We analyzed stroke incidence rates in Taiwan’s Longitudinal Health Insurance database 2000 (LHID2000) for patients aged ≥20 years with newly-diagnosed cancer between Jan 1, 2000 and Dec 31, 2006, who did or did not receive chemotherapy. Moreover, we compared stroke incidence rates among chemotherapy users who did or did not use traditional Chinese medicine. All study participants were followed-up for 5 years or until they had a stroke.Results: In adjusted Kaplan-Meier analysis, the incidence of stroke was higher within the first year of cancer diagnosis among chemotherapy recipients compared with those who did not receive chemotherapy (31.1 vs. 9.75; adjusted subdistribution hazard ratio [sHR] 2.21; 95% confidence interval [CI], 1.52–3.20; p < 0.001). This between-group difference persisted at 4 years of follow-up (13.6 vs. 5.42; adjusted sHR 1.94; 95% CI, 1.53–2.46; p < 0.001). Similarly, the 5-year incidence rate of stroke was significantly lower among chemotherapy recipients using TCM vs. non-TCM users (0.19 vs. 0.46; adjusted sHR 0.45; 95% CI, 0.26–0.79; p < 0.001), as was the mortality rate (adjusted sHR 0.55; 95% CI, 0.44–0.68; p < 0.001).Conclusion: These Taiwanese data suggest that chemotherapy is a risk factor for stroke and that the use of TCM can significantly mitigate this risk. TCM also appears to reduce the mortality risk associated with chemotherapy.

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