Trends of risk profile among middle-aged adults hospitalized for acute ischemic stroke in United States 2006–2017

Background Recent studies reported increasing trends in hospitalization of stroke patients aged 35–64 years. Aim To examine changes in risk factor profiles among patients aged 35–64 years hospitalized with acute ischemic stroke between 2006 and 2017 in the United States. Methods We used data from the National Inpatient Sample of the Healthcare Cost and Utilization Project from 2006 through 2017. Principal ICD-9-CM/ICD-10-CM codes were used to identify acute ischemic stroke hospitalizations, and secondary codes were used to identify the presence of four major stroke risk factors: hypertension, diabetes, lipid disorders, and tobacco use. We used the relative percent change to assess the changes in the prevalence of risk profile between 2006–2007 and 2016–2017 and linear regression models to obtain the p values for the overall trends across six time periods. Results Approximately 1.5 million acute ischemic stroke hospitalizations occurred during 2006–2017. The prevalence of having all four risk factors increased from 4.1% in 2006–2007 to 9.1% in 2016–2017 (relative percent change 122.0%, p < 0.001 for trend), prevalence of any three risk factors increased from 24.5% to 33.8% (relative percent change 38.0%, p < 0.001). Prevalence of only two risk factors decreased from 36.1% to 32.7% (p < 0.001), only one risk factor decreased from 25.2% to 18.1% (p < 0.001), and absence of risk factors decreased from 10.1% to 6.2% (p < 0.001). The most prevalent triad of risk factors was hypertension, diabetes, and lipid disorders (14.3% in 2006–2007 and 19.8% in 2016–2017), and the most common dyad risk factors was hypertension and lipid disorders (12.6% in 2006–2007 and 11.9% in 2016–2017). Conclusions The prevalence of hospitalized acute ischemic stroke patients aged 35–64 years with all four or any three of four major stroke risk factors increased by 122% and 38%, while those with only one risk factor or no risk factor has declined by 28% and 39%, respectively, from 2006 to 2017. Younger adults are increasingly at higher risk for stroke from preventable and treatable risk factors. This growing public health problem will require clinicians, healthcare systems, and public health efforts to implement more effective prevention strategies among this population.

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Circulating miR-155 and JAK2/STAT3 Axis in Acute Ischemic Stroke Patients and Its Relation to Post-Ischemic Inflammation and Associated Ischemic Stroke Risk Factors

International Journal of General Medicine ◽

10.2147/ijgm.s295939 ◽

2021 ◽

Vol Volume 14 ◽

pp. 1469-1484

Author(s):

Noha Adly Sadik ◽

Laila Ahmed Rashed ◽

Mai Ahmed Abd-El Mawla

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Risk ◽

Stroke Patients ◽

Stroke Risk Factors ◽

Ischemic Stroke Risk

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Abstract WP182: Trends in Acute Ischemic Stroke Hospitalizations and Risk Factors Among Young Adults: 12 Years of Nationally Representative Data

Stroke ◽

10.1161/str.48.suppl_1.wp182 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Urvish K Patel ◽

Priti Poojary ◽

Vishal Jani ◽

Mandip S Dhamoon

Keyword(s):

Risk Factors ◽

Older Adults ◽

Young Adults ◽

Ischemic Stroke ◽

Length Of Stay ◽

Acute Ischemic Stroke ◽

Stroke Risk ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Stroke Risk Factors

Background: There is limited recent population-based data of trends in acute ischemic stroke (AIS) hospitalization rates among young adults (YA). Rising prevalence of stroke risk factors may increase stroke rates in YA. We hypothesized that 1) stroke hospitalizations and mortality among YA are increasing over time (2000-2011), 2) besides traditional stroke risk factors, non-traditional factors are associated with stroke in YA, 3) stroke hospitalization among YA is associated with higher mortality, length of stay (LOS), and cost. Methods: In the Nationwide Inpatient Sample database (years 2000-2011), adult hospitalizations for AIS and concurrent diagnoses were identified by ICD-9-CM codes; the analytic cohort constituted all AIS hospitalizations. We performed weighted analysis using chi-square, t-test, and Jonckheere trend test. Multivariable survey regression models evaluated interactions between age group (18-45 vs. >45 years) and traditional and non-traditional risk factors, with outcomes including mortality, LOS, and cost. Models were adjusted for race, sex, Charlson’s Comorbidity Index, primary payer, location and teaching status of hospital, and admission day. Results: Among 5220960 AIS hospitalizations, 231858 (4.4%) were YA. On trend analysis, proportion of YA amongst AIS increased from 3.6% in 2000 to 4.7% in 2011 (p<0.0001) but mortality in YA decreased from 3.7% in 2000 to 2.6% in 2011, compared to 7.1% in 2000 to 4.6% in 2011 (p<0.0001) among older adults. Non-traditional, especially behavioral, risk factors were more common among YA, and LOS and cost were higher (Table). Conclusion: There was a trend for higher proportion of YA among AIS hospitalizations, though there was a decreasing mortality trend over 10 years. Behavioral risk factors were more common among YA, and there was an increased length of stay and cost. AIS in YA may require different preventive approaches compared to AIS among older adults.

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Abstract WP236: The Urban-Rural Divide: Risk Factor Prevalence in Ischemic Stroke Patients Across Two Decades

Stroke ◽

10.1161/str.51.suppl_1.wp236 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Dinesh V Jillella ◽

Sara Crawford ◽

Anne S Tang ◽

Rocio Lopez ◽

Ken Uchino

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Regression Models ◽

Stroke Risk ◽

Stroke Patients ◽

Stroke Risk Factor ◽

Risk Factor Prevalence ◽

Urban Rural ◽

Artery Disease

Introduction: Regional disparities exist in stroke incidence and stroke related mortality in the United States. We aimed to elucidate the stroke risk factor prevalence trends based on urban versus rural location. Methods: From the National Inpatient Sample database the comorbid stroke risk factors were collected among hospitalized ischemic stroke patients during 2000-2016. Crude and age-and sex-standardized prevalence estimates were calculated for each risk factor during the time periods 2000-2008 and 2009-2016. We compared risk factor prevalence over the defined time periods using regression models, and differences in risk factor trends based on patient location categorized as urban (metropolitan with population of ≥ 1 million) and rural (neither micropolitan or metropolitan) using interaction terms in the regression models. Results: Stroke risk factor prevalence significantly increased from 2000-2008 to 2009-2016. When stratified based on patient location, most risk factors increased in both urban and rural groups. In the crude model, the urban to rural trend difference across 2000-08 and 2009-16 was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0008), diabetes mellitus (p<0.0001), coronary artery disease (p<0.0001), smoking (p<0.0001) and alcohol (p=0.02). With age and sex standardization, the urban to rural trend difference was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0007), coronary artery disease (p=0.01) and smoking (p<0.0001). Conclusion: The prevalence of vascular risk factors among ischemic stroke patients has increased over the last two decades. There exists an urban-rural divide, with rural patients showing larger increases in prevalence of several risk factors compared to urban patients.

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Abstract P604: Incidentally-Discovered Asymptomatic Ischemic Lesions Identified Using Natural Language Processing Are Strong Risk Markers for Future Ischemic Stroke

Stroke ◽

10.1161/str.52.suppl_1.p604 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

David M Kent ◽

Lester Y Leung ◽

Yichen Zhou ◽

Patrick H Luetmer ◽

David F Kallmes ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Natural Language Processing ◽

Natural Language ◽

Language Processing ◽

Stroke Risk ◽

Risk Markers ◽

Stroke Risk Factors ◽

Over Time ◽

Major Stroke

Background: White matter disease (WMD) and silent brain infarction (SBI) are known to be risk markers for stroke. Nevertheless, the predictive value of these changes when seen incidentally on routinely-obtained neuroimages is unknown. Methods: In this retrospective cohort study, Kaiser Permanente-Southern California health plan enrollees aged ≥ 50 years old with a brain CT or MRI scan between 2009-2019 and without a prior history of ischemic stroke, transient ischemic attack, or dementia were identified. Natural language processing (NLP) was used to identify patients with SBI and WMD on the index neuroimaging report. We used Cox proportional hazards to estimate the risk of future ischemic stroke associated with the presence of SBI and of WMD, controlling for major stroke risk factors. Results: Among 262,875 individuals receiving brain neuroimaging, 13,154 (5.0%) and 78,330 (29.8%) had SBI and WMD, respectively. The Table below summarizes the crude stroke incidence rates. The crude hazard ratio (HR) was 3.40 (95% CI 3.25-3.56) for SBI and 2.63 (95% CI 2.54-2.71) for WMD. In the multivariable model controlling for all major stroke risk factors, the effect of SBI was found to be stronger in younger versus older patients and for MRI- versus CT-discovered lesions. With MRI, the average adjusted HR over time was 2.95 (95% CI 2.53-3.44) for those < age 65 and 2.15 (95% CI 1.91-2.41) for those ≥ age 65. With CT scan, the average adjusted HR over time was 2.48 (95%CI 2.19-2.81) for those < age 65 and 1.81 (95% CI 1.71-1.91) for those ≥ age 65. The adjusted HR associated with a finding of WMD was 1.76 (95% CI 1.69-1.82) and was not modified by age or imaging modality. The effect of SBI decreased gradually over time, while the effect of WMD remained constant. Conclusion: Incidentally-discovered SBI and WMD are common in patients ≥ age 50 and are associated with substantial increases in the risk of subsequent symptomatic stroke. The findings may represent an opportunity for stroke prevention.

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Gambaran Gangguan Tidur pada Pasien Pasca Stroke Iskemik

Jurnal Ilmu Kesehatan Indonesia ◽

10.25077/jikesi.v1i3.75 ◽

2021 ◽

Vol 1 (3) ◽

pp. 336-342

Author(s):

Alya Ramadhini ◽

Yuliarni Syafrita ◽

Russilawati Russilawati

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Sleep Disorders ◽

Sleep Disorder ◽

Restless Legs Syndrome ◽

Stroke Risk ◽

Stroke Patients ◽

Cross Sectional ◽

Restless Legs ◽

Stroke Risk Factors

Background : Sleep disorder is common to be the complication in stroke patients and can be a risk factor for stroke. Sleep disorder in stroke patients decrease the quality of life. Objective : The purpose of this study was to find out the prevalence of sleep disorders in a post-ischemic stroke patient and the association between sleep disorders and stroke risk factors. Methods: A cross-sectional study was conducted on post-ischemic stroke at the neurology outpatient clinic of Ibnu Sina Islamic Hospital Padang. Information about stroke risk factors is obtained through patient data and guided questionnaires. Types of sleep disorders were assessed through the 2005 Specialized Center of Research Sleep Questionnaire. Results: We found out there were 57 post-ischemic stroke patients, in which 37 post-ischemic stroke patients (64.9%) had sleep disorder incidences, such as apnea, restless legs syndrome, insomnia, and narcolepsy (38.6%, 36.8%, 35.1%, and 15.8%; respectively). There was an association between age and insomnia (p = 0.034,CI = 95%). On the other hand, there was no association between other risk factors (gender, diabetes mellitus, dyslipidemia, heart disease, obesity, smoking, and alcohol consumption) and insomnia, apnea, narcolepsy, and restless legs syndrome. Conclusions : The conclusion of this study was more than half post-ischemic stroke patients have sleep disorder with the most common were apnea. There was an association between age and insomnia. Keywords: sleep disorder, apnea, ischemic stroke

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Determination of Prothrombotic Gene Polymorphisms and Stroke Risk Factors in Young Ischemic Stroke Patients

Sakarya Medical Journal ◽

10.5505/sakaryamj.2014.99810 ◽

2014 ◽

Vol 4 (3) ◽

pp. 119-124

Author(s):

Recep Demir ◽

Omer Atis ◽

Lutfi Ozel ◽

Hasan Dogan ◽

Gokhan Ozdemir ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Gene Polymorphisms ◽

Stroke Risk ◽

Stroke Patients ◽

Stroke Risk Factors ◽

Young Ischemic Stroke

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Abstract WMP54: Estimates of the U.S. Burden of Pregnancy-Associated Stroke Attributable to Common Vascular Risk Factors

Stroke ◽

10.1161/str.51.suppl_1.wmp54 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Abhinaba Chatterjee ◽

Neal S Parikh ◽

Babak B Navi ◽

Hooman Kamel

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Pregnant Women ◽

Stroke Risk ◽

Hypertensive Disorders Of Pregnancy ◽

Stroke Risk Factors ◽

Hypertensive Disorders ◽

The U.S ◽

In Pregnancy

Background: The incidence of pregnancy-associated stroke may be increasing. The degree to which this increase is associated with increases in common stroke risk factors is uncertain. Methods: We used the National Inpatient Sample (NIS) and National Health and Nutrition Examination Survey (NHANES) to estimate the change between 1999 through 2014 in the prevalence of common stroke risk factors among women 12-45 years of age. These risk factors were hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, or eclampsia), which was ascertained using NIS, and diabetes mellitus, obesity, and smoking, which were ascertained using NHANES. We extracted previously published relative risk estimates for the association between each risk factor and ischemic stroke in pregnant women. Using these estimates, we calculated the attributable risk and expected number of ischemic strokes among pregnant women with each risk factor. We used the NIS to estimate the trend in ischemic strokes documented during a hospitalization for labor and delivery, and modeled trends in such strokes attributable to changes in the prevalence of each stroke risk factor over time. Results: The rate of ischemic stroke increased from 7.7 (95% CI, 5.0-10.5) per 100,000 deliveries in 1999-2000 to 12.7 (95% CI, 9.5-15.9) per 100,000 deliveries in 2013-2014 (Fig). Based on changes in the prevalence of hypertensive disorders of pregnancy, diabetes, obesity, and smoking between 1999 and 2014, the expected increase in pregnancy-associated stroke attributable to these risk factors would be approximately 10%, in contrast to the nearly 65% relative increase in strokes documented during pregnancy hospitalizations during this period. Conclusions: Changes in the prevalence of common stroke risk factors explain a small fraction of the apparent increase in pregnancy-associated stroke in the U.S. during the past 2 decades.

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