scholarly journals Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study 2017

BMC Medicine ◽  
2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Abolfazl Avan ◽  
Hadi Digaleh ◽  
Mario Di Napoli ◽  
Saverio Stranges ◽  
Reza Behrouz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Stroke Risk ◽  
Global Burden ◽  
Modifiable Risk Factors ◽  
Stroke Mortality ◽  
Stroke Incidence ◽  
Stroke Prevalence ◽  
Incidence And Mortality ◽  
Incidence Prevalence

Abstract Background Socioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden. Methods We extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from 1990 to 2017. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle-, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from 1990 to 2017. Results Despite a growth in crude number of stroke events from 1990 to 2017, there has been an 11.3% decrease in age-standardised stroke incidence rate worldwide (150.5, 95% uncertainty interval [UI] 140.3–161.8 per 100,000 in 2017). This has been accompanied by an overall 3.1% increase in age-standardised stroke prevalence rate (1300.6, UI 1229.0–1374.7 per 100,000 in 2017) and a 33.4% decrease in age-standardised stroke mortality rate (80.5, UI 78.9–82.6 per 100,000 in 2017) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since 2005. Further, there has been almost a 34% reduction in stroke death rate (67.8, UI 64.1–71.1 per 100,000 in 2017) attributable to modifiable risk factors, more prominently in wealthier countries. Conclusions Almost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden; thus, screening of people from low SES at higher stroke risk is crucial.

Abstract WP345: Stroke Risk Factors Screening and Education: A Regional Strategy to Address Stroke Prevalence and Mortality in Eastern North Carolina

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Terry M Congleton ◽  
Cristine W Small ◽  
Susan D Freeman
Keyword(s):  
Risk Factors ◽  
North Carolina ◽  
Stroke Risk ◽  
Stroke Mortality ◽  
Transient Ischemia ◽  
Stroke Risk Factor ◽  
Stroke Risk Factors ◽  
Regional Collaboration ◽  
Stroke Prevalence ◽  
Eastern North Carolina

Background: Eastern North Carolina (ENC) stroke mortality is 12 percent higher than the rest of the state. Often, geographical and sociological barriers prevent people residing in our rural communities from seeking routine health care. Stroke risk factors are known. The purpose of this initiative is to reduce the stroke prevalence and mortality in ENC through community risk factors screening and education. Methods: Medical center volunteers’ staff the screening and volunteer hours are recorded in a community benefit database. Each participant completes a standardized evidenced based assessment. Information collected at each screening includes demographic data, cardiovascular history, knowledge of stroke/transient ischemia signs and symptoms. Clinical metrics obtained are finger stick for random lipid panel and blood glucose, body mass index, hip to waist ratio and carotid bruit screen. Based on the screening results, education, recommendations and referrals are reviewed with every participant. Results: From 2007-2010 the screening volume doubled. In 2011, there was a reduction in screening volume as our system hospitals expanded their community stroke outreach efforts. Approximately 4900 community screenings have been conducted from 2007-2011. Elevated blood pressure and cholesterol respectively are most frequently occurring stroke risks factor found, which is consistent with national trends. Stroke mortality has decreased in the region while transient ischemia attack admissions volume has increased at our certified primary stroke center and regional referral center. Conclusions: In conclusion, primary and secondary prevention through community outreach education, risk factors screening and regional collaboration has made a difference. The region has seen a decrease in stroke prevalence and mortality in ENC. Further reduction is necessary to continue to make an even greater impact. Future directions for the stroke risk factor identification screening is to further integrate community efforts and seeks grant opportunities to establish stroke prevention and management clinics throughout the region.

Sex differences in stroke metrics among Southeast Asian countries: Results from the Global Burden of Disease Study 2015

2019 ◽  
Vol 14 (8) ◽  
pp. 826-834
Author(s):  
Wen Yea Hwong ◽  
Michiel L Bots ◽  
Sharmini Selvarajah ◽  
Sheamini Sivasampu ◽  
Daniel D Reidpath ◽  
...  
Keyword(s):  
Sex Differences ◽  
Ischemic Stroke ◽  
Southeast Asia ◽  
Burden Of Disease ◽  
Global Burden Of Disease ◽  
Global Burden ◽  
Stroke Mortality ◽  
Stroke Incidence ◽  
Incidence And Mortality ◽  
Disease Study

Background Sex differences in cardiovascular diseases generally disadvantage women, particularly within developing regions. Aims This study aims to examine sex-related differences in stroke metrics across Southeast Asia in 2015. Furthermore, relative changes between sexes are compared from 1990 to 2015. Methods Data were sourced from the Global Burden of Disease Study. Incidence and mortality from ischemic and hemorrhagic strokes were explored with the following statistics derived: (1) women-to-men incidence/mortality ratio and (2) relative percentage change in rate. Results Women had lower incidence and mortality from stroke compared to men. Notable findings include higher ischemic stroke incidence for women at 30–34 years in high-income countries (women-to-men ratio: 1.3, 95% CI: 0.1, 16.2 in Brunei and 1.3, 95% CI: 0.5, 3.2 in Singapore) and the largest difference between sexes for ischemic stroke mortality in Vietnam and Myanmar across most ages. Within the last 25 years, greater reductions for ischemic stroke metrics were observed among women compared to men. Nevertheless, women below 40 years in some countries showed an increase in ischemic stroke incidence between 0.5% and 11.4%, whereas in men, a decline from −4.2% to −44.2%. Indonesia reported the largest difference between sexes for ischemic stroke mortality; a reduction for women whereas an increase in men. For hemorrhagic stroke, findings were similar: higher incidence among young women in high-income countries and greater reductions for stroke metrics in women than men over the last 25 years. Conclusions Distinct sex-specific differences observed across Southeast Asia should be accounted in future stroke preventive guidelines.

scholarly journals REGARDS: A Case Study in Aging and Disparities Research, Mentoring, and Data Sharing

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 855-856
Author(s):  
Virginia Howard ◽  
Jennifer Manly ◽  
Maria Glymour
Keyword(s):  
Risk Factors ◽  
Data Sharing ◽  
Racial Differences ◽  
Stroke Risk ◽  
Epidemiologic Studies ◽  
Stroke Incidence ◽  
Stroke Risk Factors ◽  
Incidence And Mortality ◽  
National Cohort ◽  
Ancillary Studies

Abstract Investigators in the NIH-funded REGARDS (REasons for Geographic and Racial Differences in Stroke) project have taken a novel approach to break the paradigm of epidemiologic studies limited to clinic-based convenience samples, by developing a national cohort of 30,239 black and white participants recruited from communities across all lower 48 US states, including 1,855 of the 3,033 counties. Mean age at enrollment (Jan 2003-Oct 2007) was 65.3 years. The four initial aims were to further understanding of: 1) geographic and racial differences in stroke risk factors; 2) geographic and racial differences in stroke incidence and mortality; 3) association of stroke risk factors and stroke risk (incidence and mortality) focusing on effect modification by race or region; and 4) establishment of a repository of serum, plasma, urine and DNA for use in future studies. When the grant was awarded, the study goals were broadened to include longitudinal remote assessment of cognitive function. A second in-home visit was completed May 2013-Dec 2016 including measures of functional status. The cohort is in its 17th year of follow-up. We will detail recruitment and enrollment methods, characteristics of the cohort and status, with brief overview of the biological, medical, psychosocial, environmental, and contextual data collected in the parent study. Speakers will discuss in more detail the stroke and cognitive data, ancillary studies focused on caregiver and heart disease outcomes, and provide examples of national and international mentoring that has leveraged REGARDS data. Finally, we will describe opportunities for additional data sharing and new ancillary studies.

scholarly journals Global Burden, Risk Factors, and Trends of Esophageal Cancer: An Analysis of Cancer Registries from 48 Countries

Cancers ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 141
Author(s):  
Junjie Huang ◽  
Anastasios Koulaouzidis ◽  
Wojciech Marlicz ◽  
Veeleah Lok ◽  
Cedric Chu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
The Netherlands ◽  
Cancer Registries ◽  
Global Burden ◽  
Annual Percent Change ◽  
The United Kingdom ◽  
Incidence And Mortality ◽  
Elevated Cholesterol ◽  
Prevalence Of Obesity

This study aimed to examine the global burden, risk factors, and trends of esophageal cancer based on age, sex, and histological subtype. The data were retrieved from cancer registries database from 48 countries in the period 1980–2017. Temporal patterns of incidence and mortality were evaluated by average annual percent change (AAPC) using joinpoint regression. Associations with risk factors were examined by linear regression. The highest incidence of esophageal cancer was observed in Eastern Asia. The highest incidence of adenocarcinoma (AC) was found in the Netherlands, the United Kingdom, and Ireland. A higher AC/squamous cell carcinoma (SCC) incidence ratio was associated with a higher prevalence of obesity and elevated cholesterol. We observed an incidence increase (including AC and SCC) in some countries, with the Czech Republic (female: AAPC 4.66), Spain (female: 3.41), Norway (male: 3.10), Japan (female: 2.18), Thailand (male: 2.17), the Netherlands (male: 2.11; female: 1.88), and Canada (male: 1.51) showing the most significant increase. Countries with increasing mortality included Thailand (male: 5.24), Austria (female: 3.67), Latvia (male: 2.33), and Portugal (male: 1.12). Although the incidence of esophageal cancer showed an overall decreasing trend, an increasing trend was observed in some countries with high AC/SCC incidence ratios. More preventive measures are needed for these countries.

The Burden of Stroke in Pakistan

2008 ◽  
Vol 3 (4) ◽  
pp. 293-296 ◽  
Author(s):  
Bhojo A. Khealani ◽  
Mohammad Wasay
Keyword(s):  
Risk Factors ◽  
Stroke Risk ◽  
Case Series ◽  
Stroke Care ◽  
Poor Control ◽  
Stroke Incidence ◽  
Treatment Practices ◽  
Stroke Risk Factors ◽  
The Subject ◽  
Artery Disease

Epidemiologic literature on stroke burden, patterns of stroke is almost non existent from Pakistan. However, several hospital-based case series on the subject are available, mainly published in local medical journals. Despite the fact that true stroke incidence and prevalence of stroke in Pakistan is not known, the burden is assumed to be high because of highly prevalent stroke risk factors (hypertension, diabetes mellitus, coronary artery disease, dyslipidemia and smoking) in the community. High burden of these conventional stroke risk factors is further compounded by lack of awareness, poor compliance hence poor control, and inappropriate management/treatment practices. In addition certain risk factors like rheumatic valvular heart disease may be more prevalent in Pakistan. We reviewed the existing literature on stroke risk factors in community, the risk factor prevalence among stroke patients, patterns of stroke, out come of stroke, availability of diagnostic services/facilities related to stroke and resources for stroke care in Pakistan.

Abstract 20: Patterns of Stroke Center Certification and the Impact on Stroke Mortality in Counties of New York State

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Emily Chapman ◽  
Kurt A Yaeger ◽  
J D Mocco
Keyword(s):  
New York ◽  
Socioeconomic Status ◽  
Household Income ◽  
New York State ◽  
Stroke Care ◽  
Stroke Mortality ◽  
Median Household Income ◽  
Stroke Incidence ◽  
York State ◽  
The Relationship

Introduction: To establish a statewide stroke system in March 2019, New York State (NYS) created the Stroke Designation Program. Stroke centers (SCs) must be certified by a state-approved certifying organization (CO), which is tasked with initial designation and ongoing re-certification. Previous research has found an association at the national level between socioeconomic status and access to higher levels of acute stroke care. Objective: This study characterizes the relationship between socioeconomic status of NYS populations and stroke care level access by comparing median household income and wealth in counties with and without certified SCs. Methods: Population and median household income from the U.S. Census (2010), stroke epidemiological data from the Center for Disease Control, and Area Deprivation Index (ADI) data (ranked within NYS) from the Neighborhood Atlas, a project that quantifies disadvantage by census tract, were collected and averaged for each county. Income has been used to assess local wealth and ADI to analyze community health risks. Certification data were mined from quality check databases for The Joint Commission and Det Norske Veritas, the most commonly used COs. Student’s t-tests compared income and ADI in counties with at least one certified SC to those without. Linear regression characterized the relationship between income and ADI with number of certified SCs, stroke incidence and stroke mortality. Results: All 62 counties in NYS were investigated to yield 40 certified SCs. Counties with at least one certified SC had a significantly higher income ($68,183.63 vs. $57,155.12; p=0.03) and lower ADI (5.90 vs. 7.37; p=0.004) compared to counties with no certified SC. Higher income (p<0.001) and lower ADI (p<0.001) were also associated with more certified SCs. Counties with fewer certified SCs had significantly higher stroke mortality (p<0.001) despite having similar stroke incidence. Conclusion: Socioeconomic heterogeneity in NYS counties is correlated to differential access to certified SCs and quality stroke care, as fewer centers are found in lower-income and disadvantaged communities. Although populations with less access experience stroke at similar rates, this study finds higher death rates in these counties.

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.

Neighborhood Socioeconomic Status and Stroke Incidence: A Systematic Review

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011892
Author(s):  
Yeonwoo Kim ◽  
Erica Twardzik ◽  
Suzanne E. Judd ◽  
Natalie Colabianchi
Keyword(s):  
United States ◽  
Systematic Review ◽  
Socioeconomic Status ◽  
Stroke Risk ◽  
Keyword Search ◽  
The United States ◽  
Stroke Incidence ◽  
Neighborhood Socioeconomic Status ◽  
Modifiable Factors ◽  
The Impact

ObjectiveTo summarize overall patterns of the impact of neighborhood socioeconomic status (nSES) on incidence stroke and uncover potential gaps in the literature, we conducted a systematic review of studies examining the association between nSES and incident stroke, independent of individual socioeconomic status (SES).MethodsFour electronic databases and reference lists of included articles were searched, and corresponding authors were contacted to locate additional studies. A keyword search strategy included the three broad domains of neighborhood, SES, and stroke. Eight studies met our inclusion criteria (e.g., nSES as an exposure, individual SES as a covariate, and incident stroke as an outcome). We coded study methodology and findings across the eight studies.ResultsThe results provide evidence for the overall nSES and incident stroke association in Sweden and Japan, but not within the United States. Findings were inconclusive when examining the nSES-incident stroke association stratified by race. We found evidence for the mediating role of biological factors in the nSES-incident stroke association.ConclusionsHigher neighborhood disadvantage was found to be associated with higher stroke risk, but it was not significant in all the studies. The relationship between nSES and stroke risk within different racial groups in the United States was inconclusive. Inconsistencies may be driven by differences in covariate adjustment (e.g., individual-level sociodemographic characteristics, neighborhood-level racial composition). Additional research is needed to investigate potential intermediate and modifiable factors of the nSES and incident stroke association, which could serve as intervention points.

scholarly journals FAKTOR-FAKTOR RISIKO STROKE PADA PENYAKIT GINJAL KRONIK STADIUM V YANG MENJALANI HEMODIALISIS

2018 ◽  
Vol 35 (2) ◽  
Author(s):  
Susanti Dwi Ariani ◽  
Dodik Tugasworo ◽  
Maria Imakulata Widiastuti Samekto
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Kidney Disease ◽  
Case Group ◽  
Chi Square ◽  
Stroke Incidence ◽  
Incidence And Mortality

RISK FACTORS OF STROKE IN STAGE V CHRONIC KIDNEY DISEASE WHO UNDERWENT HEMODIALYSISABSTRACTIntroduction: Chronic kidney disease (CKD) and end-stage renal disease are associated with a significantly in- creased risk of stroke. Incidence and mortality of stroke in CKD patients is higher rather than among the general popula- tion. Stroke in hemodialysis patients is also associated with high mortality.Aims: To analyze risk factors that have a relationship with the occurrence of stroke in patients with stage V CKD who underwent hemodialysis in Dr. Kariadi Hospital, Semarang.Method: A case control with retrospective cohort study of patients diagnosed with stage V CKD undergoing hemo- dialysis in Dr. Kariadi Hospital, Semarang, from March 2016 to August 2017. Subject was divided into case group, who experienced stroke, and control group, who did not experience stroke. Bivariate analysis was performed with Chi-square test, multivariate analysis with logistic regression test and rasio Odds.Results: There were 140 subjects with stage V CKD, 70 subjects in each groups. In case group, 85.7% experienced ischemic stroke while the rest hemorrhagic stroke. The duration of hemodialysis was related to the incidence of stroke. In multivariate analysis, patients with diabetes mellitus were more likely to have a stroke by 0.14 times compared to patients who did not have diabetes mellitus, and patients who underwent hemodialysis >12 months, were more likely to have a stroke 4.05 times greater than patients who underwent hemodialysis <12 months.Discussion: There is a relationship between diabetes mellitus and duration of hemodialysis with the occurrence of ischemic stroke, in stage V CKD patients who underwent hemodialysis.Keywords: Chronic kidney disease, hemodialysis, strokeABSTRAKPendahuluan: Penyakit ginjal kronik (PGK) dan penyakit ginjal stadium akhir terkait dengan peningkatan risiko yang signifikan dari stroke. Insiden dan mortalitas stroke pada pasien PGK lebih tinggi dibandingkan populasi umum. Stroke pada pasien dialisis juga dihubungkan dengan mortalitas yang tinggi.Tujuan: Untuk menganalisis faktor-faktor risiko yang memengaruhi terjadinya stroke pada pasien dengan PGK stadium V yang menjalani hemodialisis (HD) di RSUP Dr. Kariadi, Semarang.Metode: Penelitian kasus kontrol dengan pendekatan kohort retrospektif terhadap pasien penyakit ginjal kronik stadium V yang menjalani HD di RSUP Dr. Kariadi, Semarang dari bulan Maret 2016 hingga Agustus 2017. Subjek dibagi ke dalam kelompok kasus, yaitu yang mengalami stroke dan kelompok kontrol yang tidak mengalami stroke. Dilakukan analisis bivariat dengan uji Chi-square dan analisis multivariat dengan uji regresi logistik serta rasio Odds.Hasil: Didapatkan 140 subjek dengan PGK stadium V yang masing-masing kelompok terdiri dari 70 orang. Pada kelompok kasus, sebanyak 85,7% adalah stroke iskemik dan sisanya stroke hemoragik. Lama HD berhubungan dengan kejadian stroke. Pada uji multivariat, subjek yang menderita diabetes melitus (DM) berisiko mengalami stroke sebesar 0,14 kali dibandingkan yang tidak DM dan subjek yang menjalani HD >12 bulan berisiko mengalami stroke 4,05 kali lebih besar dibandingkan yang menjalani HD <12 bulan.Diskusi: Terdapat pengaruh faktor risiko DM dan lama hemodialisis terhadap kejadian stroke iskemik pada pasien PGK stadium V yang menjalani HD.Kata kunci: Hemodialisis, penyakit ginjal kronik, stroke

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