Abstract WP158: Case Fatality and Risk Factor Trend Contributions to Stroke Mortality in Non-Hispanic Blacks and Non-Hispanic Whites, 1999-2012

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Joanne Penko ◽  
Andrew E Moran ◽  
Antoinette Mason ◽  
Pamela G Coxson ◽  
Mark J Pletcher ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Racial Differences ◽  
Density Lipoprotein ◽  
Case Fatality ◽  
Stroke Mortality ◽  
Mortality Trends ◽  
Stroke Risk Factor ◽  
Stroke Incidence ◽  
Policy Model

Introduction: Stroke death rates have declined nationally, but less in men and non-Hispanic Blacks. We quantified case-fatality and risk factor trend contributions to non-Hispanic Black and non-Hispanic White 1999-2012 stroke mortality trends. Methods: The CVD Policy Model is a computer simulation of heart disease and stroke incidence, prevalence, and mortality in US adults ≥ 35 years old. We modeled mean systolic blood pressure (SBP), low-density lipoprotein (LDL), and body mass index (BMI), prevalence of diabetes and smoking, and case fatality for 1999-2002, 2003-06, and 2007-12 by sex and race (NHANES; NHDS) to predict stroke mortality trends and these predictions were compared with observed data (CDC Wonder; ICD-10 I60-69). We then simulated the effects of isolated risk factors on stroke mortality in younger (age 35-64 years) and older (age 65-84 years) men and women. Results: Model predictions mirrored observed trends for stroke mortality in Whites (men: predicted -27.0% v. observed -29.2%; women: -34.8% v. -33.3%) and Blacks (men: -23.8% v. -22.2%; women: -31.0% v. -30.0%). Case fatality was the main contributor to the observed decrease in stroke mortality (approximately -25%) but did not explain differences between race groups. Combined risk factor trends contributed to decreased mortality in women (-12.8% in Whites; -8.7% in Blacks), but not men. Decreased mean SBP contributed in all women (-10.7% to -12.6%, depending on age/race) and older men (-4.0%), but not young men. Increased diabetes prevalence offset improvements in stroke mortality in older White men (+2.5%), younger Blacks (men: +4.0, women: +1.5%) and, to a larger degree, older Blacks (men: +9.9%, women: +5.6% ). Conclusions: Reduced case fatality was the strongest driver of decreased stroke mortality from 1999-2012 overall, while risk factor trends explained gender and race differences. Targeting high blood pressure in young adult men and preventing diabetes at all ages could further decrease stroke mortality and reduce racial differences. Blacks would benefit most from more aggressive stroke risk factor control.

Abstract 52: Contributors to the Rural Excess in Stroke Mortality: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Dawn O Kleindorfer ◽  
D. L Long ◽  
Mary Cushman ◽  
Virginia J Howard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Case Fatality ◽  
Stroke Mortality ◽  
Rural Regions ◽  
Stroke Incidence ◽  
Regards Study ◽  
The Impact

Introduction: One NIH goal is to investigate the US nationwide rural-urban health disparities; however, few studies provide data to help understand the 30% higher rural stroke mortality. It is unknown if the higher stroke mortality is attributable to a higher incidence of stroke, or to a higher case fatality, in rural regions. Further, the role of risk factors or SES status in higher incidence or case-fatality is unknown. Methods: REGARDS participants stroke-free at baseline (n = 25,090) were stratified by Rural-Urban Commuting Area strata: urban, large rural city/town, or small rural town or isolated region. Participants were followed for incident stroke, and case fatality was defined as death within 30-days of a stroke. Difference in incident stroke was assessed using proportional hazards analysis, and case-fatality by logistic regression, each considered after adjustment for demographic factors, further adjustment for risk factors, and further adjustment for SES. Results: Over an average follow-up of 8.2 years, 1,060 incident strokes occurred, of which 160 died within 30 days. Risk of incident stroke increased with rurality (p = 0.016), with a hazard 1.21-times (95% CI: 1.00 - 1.46) higher in large rural cities/towns, and 1.24-times (95% CI: 1.00 - 1.54) higher in small rural towns or isolated regions (see table). Adjustment for risk factors and SES attenuated the estimated risk by 50%, and the association became non-significant. There was no evidence of a higher case-fatality from stroke in rural regions (p > 0.46). Discussion: The higher stroke mortality in rural regions appears to be attributable to higher stroke incidence, and not to higher case-fatality. Higher stroke incidence in rural regions is partially attributable to a worse risk factor profile and lower SES. Efforts to reduce rural disparity in stroke mortality should focus on preventive strategies, especially those relevant to risk factor development and control, and/or mitigating the impact of lower SES.

scholarly journals Consistent declining trends in stroke mortality in Brazil: mission accomplished?

2016 ◽  
Vol 74 (5) ◽  
pp. 376-381 ◽  
Author(s):  
Valéria M. A. Passos ◽  
Lenice H. Ishitani ◽  
Glaura C. Franco ◽  
Gustavo C. Lana ◽  
Daisy M. X. Abreu ◽  
...  
Keyword(s):  
State Space Model ◽  
Case Fatality ◽  
Stroke Mortality ◽  
Correct Interpretation ◽  
Mortality Trends ◽  
Stroke Incidence ◽  
Space Model ◽  
Steady Decrease ◽  
Northern Regions ◽  
Mortality Estimates

ABSTRACT Stroke mortality rates are declining in Brazil, but diferences among regions need to be better investigated. The age-adjusted stroke mortality trends among adults (30-69 years-old) from Brazilian regions were studied between 1996 and 2011. Method Data were analyzed after: 1) reallocation of deaths with non-registered sex or age; 2) redistribution of garbage codes and 3) underreporting correction. A linear regression model with autoregressive errors and a state space model were fitted to the data, aiming the estimation of annual trends at every point in time. Results Although there were high values, a steady decrease of rates was observed. The decreasing trends among all regions were statistically significant, with higher values of decline among the Northeast and Northern regions, where rates were the highest. Conclusion Standardized methodology use is mandatory for correct interpretation of mortality estimates. Although declining, rates are still extremely high and efforts must be made towards prevention of stroke incidence, reduction of case-fatality rates and prevention of sequelae.

scholarly journals Incidence and Case Fatality at the County Level as Contributors to Geographic Disparities in Stroke Mortality

2016 ◽  
Vol 47 (2) ◽  
pp. 96-102 ◽  
Author(s):  
Darwin R. Labarthe ◽  
George Howard ◽  
Monika M. Safford ◽  
Virginia J. Howard ◽  
Suzanne E. Judd ◽  
...  
Keyword(s):  
Racial Differences ◽  
Stroke Prevention ◽  
Case Fatality ◽  
Stroke Care ◽  
The United States ◽  
Hazard Ratio ◽  
Mortality Data ◽  
Stroke Mortality ◽  
Stroke Incidence ◽  
Stroke Case

Background: Is the high stroke mortality in the Southeastern parts of the United States driven by differences in stroke incidence or case-fatality? This question remains unanswered. Differences in incidence would underscore the need for stroke prevention, while differences in case fatality would call for improved stroke care. Methods: Quartiles of US counties were defined by stroke mortality, and this gradient was related with stroke incidence and stroke case fatality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, where 1,317 incident stroke events (of which 242 were fatal) occurred among 29,650 participants. Results: There was a significant (p = 0.0025) gradient of fatal stroke events in REGARDS (quartile 4 vs. quartile 1 (Q4/Q1) hazard ratio 1.95, 95% CI 1.35-2.81), demonstrating the consistency of REGARDS with national mortality data. The gradient for incident stroke (fatal + nonfatal) was also significant (p = 0.0023; Q4/Q1 hazard ratio 1.29, 95% CI 1.10-1.52). The gradient for stroke case-fatality was marginally significant (p = 0.058), though the OR for Q4/Q1 (1.71, 95% CI 1.13-2.25) was large. Conclusions: Both stroke incidence and case-fatality in REGARDS appear to be contributing, underscoring the need for strengthening both stroke prevention and acute stroke care in order to reduce the disparity.

scholarly journals An Examination of Stroke-Related Knowledge in Male Stroke Survivors Living in the South Carolina Stroke Belt

2014 ◽  
Vol 8 (6) ◽  
pp. 532-537 ◽  
Author(s):  
Charles Ellis
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Risk Factor ◽  
Racial Differences ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Stroke Survivors ◽  
Stroke Risk Factor ◽  
Stroke Risk Factors ◽  
Stroke Knowledge

Racial differences have been observed in stroke-related knowledge and knowledge of specific stroke risk factors and stroke prevention practices. Using data from 134 male stroke survivors, racial differences in overall knowledge, risk factor knowledge, and stroke prevention practices were examined using the Stroke Knowledge Test. Knowledge that diabetes doubles ones risk of stroke was present in 48% of the participants, while knowledge of aspirin in the prevention of stroke by stopping blood clot formation was reported in 83% of the participants. Findings indicate participants were knowledgeable that obesity increased risk of stroke (71%) and high blood pressure was the most important stroke risk factor (70%). Participants indicated knowledge that diet, exercise, and controlling blood pressure and cholesterol reduces risk of stroke (86%). In regression models, there were no significant race differences in overall stroke knowledge or the odds of knowledge of information related to stroke risk factors and stroke prevention practices after adjusting for age, education, and marital status. Although stroke-related knowledge did not differ by race, stroke survivors exhibited gaps in stroke knowledge particularly of knowledge of common risk factors. These factors should be considered in approaches to improve stroke-related knowledge in all stroke survivors.

Abstract 84: Where Should Interventions be Focused to Reduce the Black-white Disparity in Stroke Mortality? Insights From the Reasons For Geographic And Racial Differences In Stroke (REGARDS) Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Claudia S Moy ◽  
Virginia J Howard ◽  
Leslie A McClure ◽  
Dawn O Kleindorfer ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Case Fatality ◽  
Major Contributor ◽  
Stroke Mortality ◽  
Stroke Event ◽  
Stroke Incidence ◽  
Fatal Stroke ◽  
Initial Event

Introduction: The study of racial disparities in stroke mortality should guide interventions to reduce these disparities. A higher mortality in blacks than whites could result from a higher incidence of stroke in blacks, a higher case-fatality of stroke in blacks, or both. Interventions focusing on primary prevention are needed if incidence is a major contributor to disparities, while interventions addressing treatment are a priority if case-fatality is a major contributor. Hypothesis: Higher stroke mortality in REGARDS will be attributable to higher incidence, higher case fatality, or both. Methods: 29,681 black and white participants aged 45+ were followed for stroke over 7 years. Fatal stroke (stroke mortality) was defined as a stroke event with death within 30-days, incident stroke included all stroke events (regardless of death), and case-fatality as the proportion of stroke events with death within 30-days. Black-white differences in stroke mortality and stroke incidence were assessed using proportional hazards models, and case-fatality using logistic regression (with adjustment for age and sex). Results: There were 954 incident events with 242 deaths within 30-days. We showed higher stroke mortality in blacks, with a black-white disparity in fatal stroke at young ages (at age 45, HR = 4.35; 95% CI: 1.94-9.76), but a declining magnitude of the disparity at older ages (at age 85, HR = 0.87; 95% CI: 0.56 - 1.35). The pattern was similar for incident stroke, although the magnitude of the black-white disparity was smaller (at age 45: HR = 2.40; 95% CI: 1.72 - 3.33; at age 85: HR = 0.95; 95% CI: 0.76 - 1.19). There was no evidence of a black-white disparity in case-fatality rate (OR = 1.26; 95% CI: 0.93 - 1.71). Conclusion: In a nationwide cohort, we found that the black-white disparity in stroke mortality was primarily attributable to a racial disparity in stroke incidence, not case fatality. Thus, interventions designed to reduce the black-white disparity in stroke mortality require a primary prevention focus aimed at reducing the disparity in stroke incidence. While effective interventions to improve stroke outcomes are needed, these data suggest that improving treatment after the initial event will not reduce black-white disparities in stroke mortality.

Abstract 88: Social Inequalities in Stroke Mortality, Incidence and Case-fatality in Europe.

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Marco M Ferrario ◽  
Giovanni Veronesi ◽  
Kari Kuulasmaa ◽  
Martin Bobak ◽  
Lloyd E Chambless ◽  
...  
Keyword(s):  
Risk Factors ◽  
Social Inequalities ◽  
Cox Regression ◽  
Case Fatality ◽  
Stroke Mortality ◽  
Stroke Incidence ◽  
Low Education ◽  
Mortality Incidence ◽  
European Populations

Introduction and aim: There are limited comparative data on social inequalities in stroke morbidity across Europe. We aimed to assess the magnitude of educational class inequalities in stroke mortality, incidence and 1-year case-fatality in European populations. Methods: The MORGAM study comprised 45 cohorts from Finland, Denmark, Sweden, Northern Ireland, Scotland, France, Germany, Italy, Lithuania, Poland and Russia, mostly recruited in mid 1980s-early 90s. Baseline data collection and follow-up (median 12 years) for fatal and non-fatal strokes adhered to MONICA-like procedures. Stroke mortality was defined according to the underlying cause of death (ICD-IX codes 430-438 or ICD-X I60-I69). We derived 3 educational classes from population-, sex- and birth year-specific tertiles of years of schooling. We estimated the age-adjusted difference in event rates, and the age- and risk factor-adjusted hazard ratios (HRs), between the bottom and the top of the educational class distribution from sex- and population-specific Poisson and Cox regression models, respectively. The association between 1-year case-fatality and education was estimated through logistic models adjusted for risk factors. Results: Among the 91,563 CVD-free participants aged 35-74 at baseline, 1037 stroke deaths and 3902 incident strokes occurred during follow-up. Low education accounted for 26 additional stroke deaths per 100,000 person-years in men (95%CI: 9 to 42), and 19 (7 to 32) in women. In both genders, inequalities in fatal stroke rates were larger in the East EU and in the Nordic Countries populations. The age-adjusted pooled HRs of first stroke, fatal or non-fatal, for the least educated men and women were 1.52 (95%CI: 1.29-1.78) and 1.51 (1.25-1.81), respectively, consistently across populations. Adjustment for smoking, blood pressure, HDL-cholesterol and diabetes attenuated the pooled HRs to 1.34 (95%CI: 1.14-1.57) in men and 1.29 (1.07-1.55) in women. A significant association between low education and increased 1-year case-fatality was observed in Northern Sweden only. Conclusions: Social inequalities in stroke incidence are widespread in most European populations, and less than half of the gap is explained by major risk factors.

Abstract T MP99: What Are the Blood Pressure Levels Associated With the Lowest Stroke Rates in the Elderly? Findings From the Reasons for Geographic and Racial Differences in Stroke (regards) Cohort Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Maciej Banach ◽  
Samantha Bromfield ◽  
George Howard ◽  
Virginia J Howard ◽  
Alberto Zanchetti ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Incidence Rate ◽  
Racial Differences ◽  
Stroke Risk ◽  
Reference Group ◽  
Elderly Persons ◽  
Stroke Incidence ◽  
Increased Risk ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence

OBJECTIVES: To identify the blood pressure (BP) level associated with the lowest stroke incidence in elderly persons taking antihypertensive medication in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. METHODS: We categorized 13,948 REGARDS participants with hypertension into 3 age groups: 55-64, 65-74 and ≥75 years old and 5 levels of treated systolic BP (SBP): <120 (reference group), 120-129, 130-139, 140-149, and ≥150 mmHg, and 4 levels of diastolic BP (DBP) levels: <70 (reference group), 70-79, 80-89, and ≥90 mmHg. Participants without a history of stroke were followed for a median of 5.7 years (maximum 8.5 years) for incident stroke (n=425). RESULTS: For participants at age 55-64 SBP level <120 mmHg and DBP <70 mmHg were associated with the lowest risk of stroke (incidence per 1,000 person-years: 2.4, 95%Cl: 1.4-4.0 and 2.5, 95%Cl: 1.3-4.7, respectively). Higher stroke risk was observed at SBP ≥140 mmHg. For those aged 65-74, stroke incidence was increased at SBP ≥130 mmHg and at lower DBP levels (with the lowest stroke risk for DBP ≥90 mmHg). For participants ≥75 years SBP ≥150 mmHg was associated with the highest risk of stroke (incidence rate: 15.0, 95%Cl: 10.5-21.3) but no increased risk was observed for SBP between 120-149 mmHg. For DBP, stroke incidence was highest for DBP <70 mmHg (adjusted incidence rate: 9.8; 95%Cl: 6.8-14.1), and lowest for DBP ≥90 mmHg (adjusted incidence rate: 6.5; 95%Cl: 2.9-14.5) (see table). CONCLUSIONS: These results suggest that the lowest risk for stroke for the participants between 55-64 years old are at BP levels <140/70 mmHg, for persons 65-74 we should aim at SBP levels <130 mmHg, and for the oldest patients at SBP <150 with DBP ≥90 mmHg for both groups. For participants aged ≥65 a caution should be kept with the reduction of DBP <90 mmHg, what requires further investigations. Key words: blood pressure, elderly, hypertension, treatment, mortality, stroke.

Abstract 183: Depressive Symptoms and Incident Stroke in Black and White Participants in the REGARDS Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Audrey L Austin ◽  
Michael G Crowe ◽  
Martha R Crowther ◽  
Virginia J Howard ◽  
Abraham J Letter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Depressive Symptoms ◽  
Racial Differences ◽  
Stroke Risk ◽  
Depression Scale ◽  
Stroke Incidence ◽  
Blacks And Whites ◽  
The Impact

Background and Purpose: Research suggests that depression may contribute to stroke risk independent of other known risk factors. Most studies examining the impact of depression on stroke have been conducted with predominantly white cohorts, though blacks are known to have higher stroke incidence than whites. The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke in blacks and whites, and determine whether depressive symptomatology was differentially predictive of stroke among blacks and whites. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS), is a national, population-based longitudinal study designed to examine risk factors associated with black-white and regional disparities in stroke incidence. Among 30,239 participants (42% black) accrued from 2003-2007, excluding those lacking follow-up or data on depressive symptoms, 27,557 were stroke-free at baseline. As of the January 2011 data closure, over an average follow-up of 4.6 years, 548 incident stroke cases were verified by study physicians based on medical records review. The association between baseline depressive symptoms (assessed via the Center for Epidemiological Studies Depression scale, 4-item version) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographic factors (age, race, and sex), stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, and history of heart disease), and social factors (education, income, and social network). Results: For the total sample, depressive symptoms were predictive of incident stroke. The association between depressive symptoms and stroke did not differ significantly based on race (Wald X 2 = 2.38, p = .1229). However, race-stratified analyses indicated that the association between depressive symptoms and stroke was stronger among whites and non-significant among blacks. Conclusions: Depressive symptoms were an independent risk factor for incident stroke among a national sample of blacks and whites. These findings suggest that assessment of depressive symptoms may warrant inclusion in stroke risk scales. The potential for a stronger association in whites than blacks requires further study.

scholarly journals Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: Results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry

2019 ◽  
Vol 26 (8) ◽  
pp. 824-835 ◽  
Author(s):  
Kornelia Kotseva ◽  
Guy De Backer ◽  
Dirk De Bacquer ◽  
Lars Rydén ◽  
Arno Hoes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cardiovascular Prevention ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Coronary Patients

Aims The aim of this study was to determine whether the Joint European Societies guidelines on secondary cardiovascular prevention are followed in everyday practice. Design A cross-sectional ESC-EORP survey (EUROASPIRE V) at 131 centres in 81 regions in 27 countries. Methods Patients (<80 years old) with verified coronary artery events or interventions were interviewed and examined ≥6 months later. Results A total of 8261 patients (females 26%) were interviewed. Nineteen per cent smoked and 55% of them were persistent smokers, 38% were obese (body mass index ≥30 kg/m2), 59% were centrally obese (waist circumference: men ≥102 cm; women ≥88 cm) while 66% were physically active <30 min 5 times/week. Forty-two per cent had a blood pressure ≥140/90 mmHg (≥140/85 if diabetic), 71% had low-density lipoprotein cholesterol ≥1.8 mmol/L (≥70 mg/dL) and 29% reported having diabetes. Cardioprotective medication was: anti-platelets 93%, beta-blockers 81%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75% and statins 80%. Conclusion A large majority of coronary patients have unhealthy lifestyles in terms of smoking, diet and sedentary behaviour, which adversely impacts major cardiovascular risk factors. A majority did not achieve their blood pressure, low-density lipoprotein cholesterol and glucose targets. Cardiovascular prevention requires modern preventive cardiology programmes delivered by interdisciplinary teams of healthcare professionals addressing all aspects of lifestyle and risk factor management, in order to reduce the risk of recurrent cardiovascular events.

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