Abstract TMP58: Preliminary Population-Based Temporal Trends in Stroke Incidence: Racial Disparity and Stroke Incidence From 1993-2015

Background and Purpose— Population-based studies provide the most reliable data on stroke incidence. A previous systematic review of population-based studies suggested that stroke incidence in high-income countries decreased by 42% between the 1970s and early 2000s. However, it is uncertain whether this trend of steady decline has been maintained in more recent periods. Methods— Data from OCSP (Oxfordshire Community Stroke Project; 1981–1986) and OXVASC (Oxford Vascular Study; 2002–2017) along with other published population-based stroke incidence studies that reported temporal trends of stroke incidence since 1990 in high-income countries were included. Age-standardized relative incidence rate ratios were calculated for each study and then pooled with inverse-variance weighted random-effects meta-analysis. Projection estimates were calculated for the number of incident stroke patients in the United Kingdom from year 2015 to 2045. Results— In Oxfordshire, stroke incidence fell by 32% from OCSP to OXVASC, with a similar trend before or after year 2000. With the projected aging population, if the age-specific stroke incidence continued to decrease at its current rate (6% every 5 years), there would still be a 13% increase of the number of first-ever strokes in the United Kingdom up to year 2045. Incorporating the Oxfordshire data with other 12 population-based studies, stroke incidence declined steadily between the 1990s and 2010s within each study, resulting in a 28% decline over an average period of 16.5 years (pooled incidence rate ratio, 0.72 [95% CI, 0.66–0.79]; P <0.0001). The trend was the same for men (0.69 [95% CI, 0.61–0.77]; P <0.0001) and women (0.66 [95% CI, 0.59–0.74]; P <0.0001) and remained consistent after year 2010 in OXVASC. Proportion of disabling or fatal stroke also decreased over time (early versus later period, 53.6% versus 46.1%; P =0.02). Conclusions— Stroke incidence is continuing to decline with steady rate in Oxfordshire and in other high-income settings. However, the absolute number of strokes occurring is not falling.

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Temporal trends in stroke incidence and case-fatality rates in Arcadia, Greece: A sequential, prospective, population-based study

International Journal of Stroke ◽

10.1177/1747493021995594 ◽

2021 ◽

pp. 174749302199559

Author(s):

Eleni Karantali ◽

Konstantinos Vemmos ◽

Evangelos Tsampalas ◽

Konstantinos Xynos ◽

Persefoni Karachalia ◽

...

Keyword(s):

Case Fatality Rate ◽

Temporal Trends ◽

Case Fatality ◽

Population Based ◽

Incidence Rates ◽

European Population ◽

Fatality Rate ◽

Population Based Study ◽

Stroke Incidence ◽

Southern Greece

Background Stroke incidence and case-fatality are reported to decline in high-income countries during the last decades. Epidemiological studies are important for health services to organize prevention and treatment strategies. Aims The aim of this population-based study was to determine temporal trends of stroke incidence and case-fatality rates of first-ever stroke in Arcadia, a prefecture in southern Greece. Methods All first-ever stroke cases in the Arcadia prefecture were ascertained using the same standard criteria and multiple overlapping sources in three study periods: from November 1993 to October 1995; 2004; and 2015–2016. Crude and age-adjusted to European population incidence rates were compared using Poisson regression. Twenty-eight days case fatality rates were estimated and compared using the same method. Results In total, 1315 patients with first-ever stroke were identified. The age-standardized incidence to the European population was 252 per 100,000 person-years (95% CI 231–239) in 1993/1995, 252 (95% CI 223–286) in 2004, and 211 (192–232) in 2015/2016. The overall age- and sex-adjusted incidence rates fell by 16% (incidence rates ratio 0.84, 95% CI: 0.72–0.97). Similarly, 28-day case-fatality rate decreased by 28% (case fatality rate ratio = 0.72, 95% CI: 0.58–0.90). Conclusions This population-based study reports a significant decline in stroke incidence and mortality rates in southern Greece between 1993 and 2016.

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Abstract T MP63: Temporal Trends in Stroke Incidence Over the Past Twenty Years: Stroke Incidence Has Stabilized, Racial Disparity is not Improving

Stroke ◽

10.1161/str.45.suppl_1.tmp63 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Dawn Kleindorfer ◽

Kathleen Alwell ◽

Jane Khoury ◽

Charles J Moomaw ◽

Daniel Woo ◽

...

Keyword(s):

Racial Disparities ◽

Racial Disparity ◽

Temporal Trends ◽

Census Bureau ◽

Incidence Rates ◽

Ohio River ◽

Stroke Subtype ◽

Stroke Incidence ◽

Physician Review ◽

Health Significance

Introduction: We previously reported that the incidence of stroke was decreasing for whites but stable for blacks from 1993/94 to 2005. We sought to describe recent temporal trends and racial disparities in stroke incidence within our large, bi-racial population, by including a more recent study period. Methods: The Greater Cincinnati/Northern Kentucky region includes two southern Ohio and three Northern Kentucky counties on the Ohio River, a population of 1.3 million. Our study ascertained all hospitalized strokes that occurred in the population between 7/1/93 and 6/30/94 and in calendar years 1999, 2005, and 2010. For 2010, nursing review of medical records is complete but physician review is not; thus, rates for 2010 (calculated using a weighted estimation for events not completely reviewed) are preliminary. The denominator for the calculation of incidence rates (in those aged >20 years) was estimated from the U.S. Census Bureau website (www.census.gov). The 95% confidence intervals (CI) for the incidence rates were calculated assuming a Poisson distribution. Rates are age, gender, and race adjusted, as appropriate, and standardized to the 2000 U.S. population. Results: Stroke incidence rates stratified by subtype, race, and study period are presented in the Table. We project that stroke incidence did not significantly change in 2010 vs. 2005 for either blacks or whites, regardless of stroke subtype. Blacks have a substantially higher incidence of stroke compared with whites in all study periods. Discussion: In contrast to the trend seen from 1993-94 to 2005, there was no further decline of stroke incidence in whites in 2010, a disappointing finding of great public health significance. Stroke incidence in blacks remains unchanged over all periods. The substantial black > white racial disparity in stroke incidence has not changed over time. Further study is needed to understand and eventually reduce these racial disparities.

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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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Temporal Trends of Stroke Epidemiology in Southern Sweden: A Population-Based Study on Stroke Incidence and Early Case-Fatality

Neuroepidemiology ◽

10.1159/000487948 ◽

2018 ◽

Vol 50 (3-4) ◽

pp. 174-182 ◽

Cited By ~ 14

Author(s):

Joseph Aked ◽

Hossein Delavaran ◽

Bo Norrving ◽

Arne Lindgren

Keyword(s):

Temporal Trends ◽

Case Fatality ◽

Population Based ◽

Southern Sweden ◽

Population Based Study ◽

Stroke Incidence ◽

Early Case ◽

Stroke Epidemiology

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Temporal Trends in Ischemic Stroke Rates by Ethnicity, Sex, and Age 2000–2017: The Brain Attack Surveillance in Corpus Christi Project

Neurology ◽

10.1212/wnl.0000000000012877 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012877

Author(s):

Lynda D. Lisabeth ◽

Devin L. Brown ◽

Darin B. Zahuranec ◽

Sehee Kim ◽

Jaewon Lim ◽

...

Keyword(s):

Ischemic Stroke ◽

Mexican Americans ◽

Temporal Trends ◽

Age Groups ◽

Population Based ◽

Relative Increase ◽

Stroke Incidence ◽

Corpus Christi ◽

Time Interaction ◽

Diagnosis Codes

Objective:To compare 18-year (2000-2017) temporal trends in ischemic stroke rates by ethnicity, sex and age.Methods:Data are from a population-based stroke surveillance study conducted in Nueces County, Texas, USA, a geographically isolated, bi-ethnic, urban community. Active (screening hospital admission logs, hospital wards, intensive care units) and passive (screening inpatient/ED discharge diagnosis codes) surveillance were used to identify cases aged ≥45 (n=4,874) validated by stroke physicians using a consistent stroke definition over time. Ischemic stroke rates were derived from Poisson regression using annual population counts from US Census to estimate at-risk population.Results:In those aged 45-59, rates increased in non-Hispanic Whites (104.3% relative increase; p<0.001) but decreased in Mexican Americans (-21.9%; p=0.03) such that rates were significantly higher in non-Hispanic Whites in 2016-2017 (p for ethnicity-time interaction<0.001). In those age 60-74, rates declined in both groups but more so in Mexican Americans (non-Hispanic Whites -18.2%, p=0.05; Mexican Americans -40.1%, p=0.002) resulting in similar rates for the two groups in 2016-2017 (p for ethnicity-time interaction=0.06). In those aged ≥75, trends did not vary by ethnicity, with declines noted in both groups (non-Hispanic Whites -33.7%, p=0.002; Mexican Americans -26.9%, p=0.02). Decreases in rates were observed in men (age 60-74 -25.7%, p=0.009; age ≥75 -39.2% p=0.002) and women (age 60-74 -34.3%, p=0.007; age ≥75 -24.0% p=0.02) in the two older age groups, while rates did not change in either sex in those age 45-59.Interpretation:Previously documented ethnic stroke incidence disparities have ended as a result of declining rates in Mexican Americans and increasing rates in non-Hispanic whites, most notably in midlife.

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Temporal trends in stroke incidence in South Asian, Chinese and white patients: A population based analysis

PLoS ONE ◽

10.1371/journal.pone.0175556 ◽

2017 ◽

Vol 12 (5) ◽

pp. e0175556 ◽

Cited By ~ 5

Author(s):

Nadia A. Khan ◽

Finlay A. McAlister ◽

Louise Pilote ◽

Anita Palepu ◽

Hude Quan ◽

...

Keyword(s):

South Asian ◽

Temporal Trends ◽

Population Based ◽

Stroke Incidence ◽

White Patients

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Temporal Trends in Undervaccination: A Population-Based Cohort Study

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2021.01.037 ◽

2021 ◽

Author(s):

Matthew F. Daley ◽

Liza M. Reifler ◽

Jo Ann Shoup ◽

Komal J. Narwaney ◽

Elyse O. Kharbanda ◽

...

Keyword(s):

Cohort Study ◽

Temporal Trends ◽

Population Based

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A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations

European Heart Journal ◽

10.1093/ehjci/ehaa946.0960 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Jimenez ◽

M Cainzos-Achirica ◽

D Monterde ◽

L Garcia-Eroles ◽

C Enjuanes ◽

...

Keyword(s):

Heart Failure ◽

Chronic Conditions ◽

Temporal Trends ◽

Population Level ◽

Population Based ◽

Relative Increase ◽

Funding Source ◽

Private Company ◽

Healthcare Database ◽

Evolutionary Changes

Abstract Background Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts. Purpose To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions. Methods In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN). Results The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase). Conclusion In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.

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