Time Trends in Incidence and Case Fatality of Ischemic Stroke

Background and Purpose— Ischemic stroke incidence has declined in industrialized countries the last decades, with possible exception for the youngest age groups. We estimated age- and sex-specific trends in incidence and case fatality of first-ever ischemic stroke between 1977 and 2010 in a Norwegian municipality. Methods— Age-adjusted time trends in incidence from 1977 to 2010 were estimated by fractional polynomial and Poisson regression, and case fatality by logistic regression in 36 575 participants of the population-based Tromsø Study. Results— There were 1214 first-ever ischemic strokes within a total follow-up time of 611 176 person-years. The overall age- and sex-adjusted incidence decreased by 24% in 1995 to 2010. In women aged 30 to 49 years, the incidence increased significantly from 1980 to 2010. In men aged 30 to 49 years, there was a nonsignificant, rising trend from 1977 to 2010. Men aged 50 to 64 years had similar incidence in 2010 compared with 1989. From the mid-1990s to 2010, the incidence declined significantly in women aged 50 to 74 years and in men aged 65 to 74 years, but remained stable in those aged ≥75 years. Case fatality decreased significantly in men aged 30 to 84 years from 1995 to 2010, whereas there was no significant change in women. Conclusions— Age-adjusted incidence of first-ever ischemic stroke increased in young women, declined in women aged 50 to 74 years and men aged 65 to 74 years and remained stable among the oldest. Case fatality declined in men aged 30 to 84 years, but not in women.

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Twenty-Year Time Trends in Long-Term Case-Fatality and Recurrence Rates After Ischemic Stroke Stratified by Etiology

Stroke ◽

10.1161/strokeaha.120.029972 ◽

2020 ◽

Vol 51 (9) ◽

pp. 2778-2785 ◽

Cited By ~ 1

Author(s):

Viktoria Rücker ◽

Peter U. Heuschmann ◽

Martin O’Flaherty ◽

Michael Weingärtner ◽

Manuela Hess ◽

...

Keyword(s):

Ischemic Stroke ◽

Time Trends ◽

Cox Regression ◽

Case Fatality ◽

Population Based ◽

Artery Occlusion ◽

Recurrence Rates ◽

Term Survival ◽

Small Artery Occlusion

Background and Purpose: Data on long-term survival and recurrence after stroke are lacking. We investigated time trends in ischemic stroke case-fatality and recurrence rates over 20-years stratified by etiological subtype according to the Trial of ORG 10172 in Acute Stroke Treatment classification within a population-based stroke register in Germany. Methods: Data was collected within the Erlangen Stroke Project, a prospective, population-based stroke register covering a source population of 105 164 inhabitants (2010). Case fatality and recurrence rates for 3 months, 1 year, and 5 years were estimated with Kaplan-Meier estimates. Sex-specific time trends for case-fatality and recurrence rates were estimated with Cox regression. We adjusted for age, sex, and year of event and stratified for etiological subtypes. A sensitivity analysis with competing risk analysis for time trends in recurrence were performed. Results: Between 1996 and 2015, 3346 patients with first ischemic stroke were included; age-standardized incidence per 100 000 was 75.8 in women and 131.6 in men (2015). Overall, 5-year survival probabilities were 50.4% (95% CI, 47.9–53.1) in women and 59.2% (95% CI, 56.4–62.0) in men; 5-year survival was highest in patients with first stroke due to small-artery occlusion (women, 71.8% [95% CI, 67.1–76.9]; men, 75.9% [95% CI, 71.3–80.9]) and lowest in cardioembolic stroke (women, 35.7% [95% CI, 31.0–41.1]; men, 47.8% [95% CI, 42.2–54.3]). Five-year recurrence rates were 20.1% (95% CI, 17.5–22.6) in women and 20.1% (95% CI, 17.5–22.7) in men; 5-year recurrence rate was lowest in women in stroke due to small artery occlusion 16.0% (95% CI, 11.7–20.1) and in men in large-artery atherosclerosis 16.6% (95% CI, 8.7–23.9); highest risk of recurrence was observed in undefined strokes (women, 22.3% [95% CI, 17.8–26.6]; men, 21.4% [95% CI, 16.7–25.9]). Cox regression revealed improvements in case-fatality rates over time with differences in stroke causes. No time trends in recurrence rates were observed. Conclusions: Long-term survival and recurrence varied substantially by first stroke cause. Survival probabilities improved over the past 2 decades; no major trends in stroke recurrence rates were observed.

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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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Time Trends in Epidemiology and Characteristics of Psoriatic Arthritis Over 3 Decades: A Population-based Study

The Journal of Rheumatology ◽

10.3899/jrheum.080691 ◽

2009 ◽

Vol 36 (2) ◽

pp. 361-367 ◽

Cited By ~ 94

Author(s):

FLORANNE C. WILSON ◽

MURAT ICEN ◽

CYNTHIA S. CROWSON ◽

MARIAN T. McEVOY ◽

SHERINE E. GABRIEL ◽

...

Keyword(s):

Psoriatic Arthritis ◽

Time Trends ◽

Population Based ◽

Incidence Rates ◽

Population Based Study ◽

Physician Awareness ◽

Adjusted Incidence ◽

Diagnosis Date ◽

Age And Sex

Objective.To determine time trends in incidence, prevalence, and clinical characteristics of psoriatic arthritis (PsA) over a 30-year period.Methods.We identified a population-based incidence cohort of subjects aged 18 years or over who fulfilled ClASsification of Psoriatic ARthritis (CASPAR) criteria for PsA between January 1, 1970, and December 31, 1999, in Olmsted County, Minnesota, USA. PsA incidence date was defined as the diagnosis date of those who fulfilled CASPAR criteria. Age- and sex-specific incidence rates were estimated and age- and sex-adjusted to the 2000 US White population.Results.The PsA incidence cohort comprised 147 adult subjects with a mean age of 42.7 years, and 61% were men. The overall age- and sex-adjusted annual incidence of PsA per 100,000 was 7.2 [95% confidence interval (CI) 6.0, 8.4] with a higher incidence in men (9.1, 95% CI 7.1, 11.0) than women (5.4, 95% CI 4.0, 6.9). The age- and sex-adjusted incidence of PsA per 100,000 increased from 3.6 (95% CI 2.0, 5.2) between 1970 and 1979 to 9.8 (95% CI 7.7, 11.9) between 1990 and 2000 (p for trend < 0.001). The point prevalence per 100,000 was 158 (95% CI 132, 185) in 2000, with a higher prevalence in men (193, 95% CI 150, 237) than women (127, 95% CI 94, 160). At incidence, most PsA subjects had oligoarticular involvement (49%) with enthesopathy (29%).Conclusion.The incidence of PsA has been rising over 30 years in men and women. Reasons for the increase are unknown, but may be related to a true change in incidence or greater physician awareness of the diagnosis.

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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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Incidence of surgery for chronic subdural hematoma in Finland during 1997–2014: a nationwide study

Journal of Neurosurgery ◽

10.3171/2021.3.jns21281 ◽

2021 ◽

pp. 1-8

Author(s):

Pihla Tommiska ◽

Teemu Luostarinen ◽

Jaakko Kaprio ◽

Miikka Korja ◽

Kimmo Lönnrot ◽

...

Keyword(s):

Subdural Hematoma ◽

Negative Binomial ◽

Age Groups ◽

Chronic Subdural Hematoma ◽

Case Fatality ◽

The Elderly ◽

European Standard Population ◽

Adjusted Incidence ◽

Age And Sex

OBJECTIVE The number of surgeries performed for chronic subdural hematoma (CSDH) has increased. However, these changes have been poorly reported. The authors aimed to assess the national incidence of surgeries for CSDH in Finland during an 18-year time period from 1997 to 2014. They hypothesized that the incidence of CSDH surgeries has continued to increase, particularly among the elderly. METHODS A nationwide register-based follow-up study was performed using the Finnish Care Register for Health Care. All adult patients undergoing primary CSDH surgeries during 1997–2014 were included. The study population was followed up from the time of CSDH surgery until death or the end of follow-up on December 31, 2017. The incidences of CSDH surgery per 100,000 person-years were calculated separately in each age group and sex. Age standardization was performed for those 20 years of age and older with weights from the 2013 European Standard Population. Negative binomial regression models were used to assess changes in incidence rate ratios (IRRs) during the study period. RESULTS In total, 9280 patients were identified. The age-standardized incidence of CSDH surgery increased from 12.2 to 16.5 per 100,000 person-years during 1997–2014. The age- and sex-adjusted incidence of CSDH surgery increased by 30% (IRR 1.30, 95% CI 1.20–1.41). The age- and sex-adjusted incidence increased more in the older age groups, with an IRR of 1.24 for those aged 60–69 years, 1.32 for those 70–79 years, 1.46 for those 80–89 years, and 1.85 for those aged 90 years or older. The adjusted incidence did not increase for those aged 18–59 years. The sex difference (2:1 men/women) was consistent throughout the study period, with a higher incidence among men. One year after the primary surgery, 19% of the population had a resurgery, and the 1-year case fatality rate was 15%. The median age of patients increased from 73 to 76 years. CONCLUSIONS During the past 2 decades, the age- and sex-adjusted incidence of CSDH surgery has increased in Finland, with major increases for those aged 60 years or older. This increase is likely to continue in parallel with the aging population and increased life expectancies.

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Time Trends in Incidence of Pathological and Etiological Stroke Subtypes during 16 Years: The Erlangen Stroke Project

Neuroepidemiology ◽

10.1159/000371353 ◽

2015 ◽

Vol 44 (1) ◽

pp. 24-29 ◽

Cited By ~ 22

Author(s):

Peter L. Kolominsky-Rabas ◽

Silke Wiedmann ◽

Michael Weingärtner ◽

Thomas G. Liman ◽

Matthias Endres ◽

...

Keyword(s):

Ischemic Stroke ◽

Time Trends ◽

Population Based ◽

Large Artery ◽

Total Study Population ◽

Stroke Incidence ◽

Stroke Subtypes ◽

Background Population ◽

Small Artery Occlusion ◽

Study Population

Background: Population-based data, which continuously monitors time trends in stroke epidemiology are limited. We investigated the incidence of pathological and etiological stroke subtypes over a 16 year time period. Methods: Data were collected within the Erlangen Stroke Project (ESPro), a prospective, population-based stroke register in Germany covering a total study population of 105,164 inhabitants (2010). Etiology of ischemic stroke was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results: Between January 1995 and December 2010, 3,243 patients with first-ever stroke were documented. The median age was 75 and 55% were females. The total stroke incidence decreased over the 16 year study period in men (Incidence Rate Ratio 1995-1996 vs. 2009-2010 (IRR) 0.78; 95% CI 0.58-0.90) but not in women. Among stroke subtypes, a decrease in ischemic stroke incidence (IRR 0.73; 95% CI 0.57-0.93) and of large artery atherosclerotic stroke (IRR 0.27; 95% CI 0.12-0.59) was found in men and an increase of stroke due to small artery occlusion in women (IRR 2.33; 95% CI 1.39-3.90). Conclusions: Variations in time trends of pathological and etiological stroke subtypes were found between men and women that might be linked to gender differences in the development of major vascular risk factors in the study population.

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Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-06326-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Melissa C. MacKinnon ◽

Scott A. McEwen ◽

David L. Pearl ◽

Outi Lyytikäinen ◽

Gunnar Jacobsson ◽

...

Keyword(s):

Escherichia Coli ◽

Mortality Rate ◽

Case Fatality ◽

Population Based ◽

Day Case ◽

Fatality Risk ◽

E Coli ◽

Factors Associated ◽

Case Fatality Risk ◽

Age And Sex

Abstract Background Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. Methods During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion. Results From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female. Conclusions In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.

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Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20150081 ◽

2015 ◽

Vol 73 (8) ◽

pp. 648-654 ◽

Cited By ~ 8

Author(s):

Marcos C. Lange ◽

Norberto L. Cabral ◽

Carla H. C. Moro ◽

Alexandre L. Longo ◽

Anderson R. Gonçalves ◽

...

Keyword(s):

Ischemic Stroke ◽

Population Based ◽

Large Artery ◽

Vessel Occlusion ◽

Population Based Study ◽

Incidence And Mortality ◽

One Year ◽

Undetermined Etiology ◽

And Control ◽

Adjusted Incidence

Aims To measure the incidence and mortality rates of ischemic stroke (IS) subtypes in Joinville, Brazil. Methods All first-ever IS patients that occurred in Joinville from January 2005 to December 2006 were identified. The IS subtypes were classified by the TOAST criteria, and the patients were followed-up for one year after IS onset. Results The age-adjusted incidence per 100,000 inhabitants was 26 (17-39) for large-artery atherosclerosis (LAA), 17 (11-27) for cardioembolic (CE), 29 (20-41) for small vessel occlusion (SVO), 2 (0.6-7) for stroke of other determined etiology (OTH) and 30 (20-43) for stroke of undetermined etiology (UND). The 1-year mortality rate per 100,000 inhabitants was 5 (2-11) for LAA, 6 (3-13) for CE, 1 (0.1-6) for SVO, 0.2 (0-0.9) for OTH and 9 (4-17) for UND. Conclusion In the population of Joinville, the incidences of IS subtypes were similar to those found in other populations. These findings highlight the importance of better detection and control of atherosclerotic risk factors.

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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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