Incidence trends of gastroenteropancreatic neuroendocrine tumors in the United States from 1975 to 2012.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 231-231
Author(s):  
Mi Ri Lee ◽  
Cynthia Harris ◽  
Kiwoon Joshua Baeg ◽  
Juan P. Wisnivesky ◽  
Michelle Kang Kim
Keyword(s):  
The United States ◽  
Population Based ◽  
Incidence Rates ◽  
Birth Cohorts ◽  
Annual Percent Change ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Incidence Trends ◽  
The Us ◽  
Population Based Registry ◽  
Adjusted Incidence

231 Background: Although multiple studies document a rise in gastroenteropancreatic neuroendocrine tumor (GEP-NET) incidence over the past several decades, there are limited national data regarding recent trends. Using a population-based registry, we evaluated GEP-NET incidence trends in the US population from 1975-2012 by age and calendar year at diagnosis and year of birth. Methods: GEP-NET cases between 1975-2012 were identified from the most recent version of the Surveillance, Epidemiology, and End Results (SEER) registry based on histologic and site codes. We calculated overall annual incidence, age-adjusted incidence (number of cases per 100,000), annual percent change (APC), and average APC by 5 year age intervals. We also evaluated the incidence rates by age, period, and birth year cohorts. Results: We identified 22,744 patients with GEP-NETs. In adults age 25-39 years, GEP-NET incidence rates declined from the mid 1970s to early 1980s, then increased until 2012 (Table 1). In adults age 40 and older and between ages 15-24 years, incidence rates generally increased continuously from 1975 to 2012. Adults age 40-69 years demonstrated the most rapid increases in average APC, approximately 4-6% per year. Overall incidence rates were highest in adults age 70-84 years. Since the late 1880s, GEP-NET incidence has increased in consecutive birth cohorts. Conclusions: Our study demonstrates that more recent generations have had higher incidence rates than more distant generations. In addition, GEP-NETs are more common among older adults and the number of GEP NETs has increased in past decades. [Table: see text]

scholarly journals Melanoma Incidence Among Non-Hispanic Whites in All 50 US States From 2001 Through 2015

2019 ◽  
Vol 112 (5) ◽  
pp. 533-539 ◽  
Author(s):  
Aaron P Thrift ◽  
Franciska J Gudenkauf
Keyword(s):  
Incidence Rate ◽  
Birth Cohort ◽  
Sun Exposure ◽  
The United States ◽  
Incidence Rates ◽  
Birth Cohorts ◽  
Annual Percent Change ◽  
Incidence Trends ◽  
Percent Change ◽  
Melanoma Incidence

Abstract Background The United States has large regional variation in primary prevention campaigns for skin cancer. We collected data from all 50 states to examine changes in melanoma incidence and performed age-period-cohort analyses to describe the simultaneous effects of age, period, and cohort on incidence rates. Methods Annual melanoma incidence rates for non-Hispanic whites from 2001 to 2015 were extracted from the US Cancer Statistics registry. Secular trends were examined overall and by sex and state. We used joinpoint regression to compute annual percent change and average annual percent change and corresponding 95% confidence intervals (CIs). We also analyzed incidence trends by 5-year age group and birth cohort using incidence rate ratios and age-period-cohort modeling. Results Melanoma incidence increased from 20.7 per 100 000 (95% CI = 20.5 to 20.9) in 2001 to 28.2 per 100 000 (95% CI = 28.0 to 28.5) in 2015, increasing by 3.90% (95% CI = 2.36% to 5.48%) annually between 2001 and 2005 and 1.68% (95% CI = 1.37% to 1.99%) annually from 2005 through 2015. The average annual percent change in melanoma incidence rates were similar for men (2.34%, 95% CI = 1.91 to 2.78) and women (2.25%, 95% CI = 1.60 to 2.91). Age-specific relative risk by birth cohort increased from circa 1921 to 1981 before decreasing. Compared with adults born circa 1956, those born circa 1991 had lower melanoma risk (incidence rate ratio  = 0.85; 95% CI = 0.77 to 0.94). Geographic variation was observed; some states still have melanoma rates trending upwards in all birth cohorts. Conclusions The continued increase in melanoma incidence among non-Hispanic whites, particularly in states where rates continue to rise among recent and current birth cohorts, underscores the need for increased public health campaigns aimed at reducing sun exposure.

Incidence trends for human papillomavirus-related (HPV-R) and unrelated (HPV-U) head and neck squamous cell carcinomas (HNSCC) in the United States (US)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6001-6001 ◽  
Author(s):  
A. Chaturvedi ◽  
E. Engels ◽  
W. Anderson ◽  
M. Gillison
Keyword(s):  
The United States ◽  
Underlying Disease ◽  
Birth Cohorts ◽  
Anatomic Site ◽  
Annual Percent Change ◽  
Absolute Increase ◽  
Incidence Trends ◽  
The Us ◽  
Smoking Behaviors ◽  
Regional Disease

6001 Background: HNSCC are etiologically heterogeneous, with one subset primarily attributable to HPV and another to tobacco and alcohol. Methods: Data from SEER9 program registries were used to investigate the potential influence of HPV on incidence and survival of HNSCC in the US from 1973–2003. HNSCCs (N=58,158) were classified by anatomic site as potentially HPV-R (base of tongue; tonsil; oropharynx; N=16,712) or HPV-U (lip; tongue; gum; floor of mouth; palate; other mouth; hypopharynx; ill-defined sites of lip, oral cavity, and pharynx; N=41,446). Joinpoint regression was used to assess incidence trends and life-table methods were used to compare survival for HPV-R and HPV-U HNSCCs. Results: For HPV-R HNSCCs, age-adjusted incidence increased significantly from 1973–2003 (annual percent change [APC] = 0.65), particularly among males (APC=1.02), whites (APC=0.89), and younger ages (APCs for 30–39 = 1.46; 40- 49=1.92; 50–59=0.61, and =60= -0.66). By contrast, HPV-U HNSCC incidence was stable from 1973–1983 and then decreased significantly from 1983–2003 (APC= -2.42). Mean age at diagnosis was younger for HPV-R HNSCC than HPV-U (61.1 vs. 64.5 years; p<0.001), and from 1973- 2003, decreased significantly for HPV-R, but increased for HPV-U. Improvements in overall survival (OS) were observed for HPV-R (all stages) and HPV-U (regional and distant) HNSCC treated by radiotherapy (RT) from 1973–2003, but were more marked for HPV-R HNSCC, e.g. absolute increase in two-year OS for regional disease of 24.4% (vs. 5.8% for HPV-U). OS for HPV-R (local and regional) was significantly better than HPV-U HNSCC if treated by RT, but worse if not so treated. Conclusions: The proportion of HNSCC that is potentially HPV- R increased in the US from 1973–2003, particularly among recent birth cohorts, perhaps due to changing sexual and smoking behaviors. Recent improvements in locoregional control with RT-based therapy may be due in part to a gradual shift in the etiology of the underlying disease. No significant financial relationships to disclose.

scholarly journals Changes in the Incidence of Endstage Renal Disease Due to Lupus Nephritis in the United States, 1996–2004

2009 ◽  
Vol 36 (1) ◽  
pp. 63-67 ◽  
Author(s):  
MICHAEL M. WARD
Keyword(s):  
United States ◽  
Lupus Nephritis ◽  
Renal Disease ◽  
The United States ◽  
Population Based ◽  
Incidence Rates ◽  
Endstage Renal Disease ◽  
The Us ◽  
Population Based Registry ◽  
Us Census

ObjectiveTo determine if the incidence of endstage renal disease (ESRD) due to lupus nephritis has decreased from 1996 to 2004.MethodsPatients age 15 years or older with incident ESRD due to lupus nephritis in 1996–2004 and living in one of the 50 United States or the District of Columbia were identified using the US Renal Data System, a national population-based registry of all patients receiving renal replacement therapy for ESRD. Incidence rates were computed for each calendar year, using population estimates of the US census as denominators.ResultsOver the 9-year study period, 9199 new cases of ESRD due to lupus nephritis were observed. Incidence rates, adjusted to the age, sex, and race composition of the US population in 2000, were 4.4 per million in 1996 and 4.9 per million in 2004. Compared to the pooled incidence rate in 1996–1998, the relative risk of ESRD due to lupus nephritis in 1999–2000 was 0.99 (95% CI 0.93–1.06), in 2001–2002 was 0.99 (95% CI 0.92–1.06), and in 2003–2004 was 0.96 (95% CI 0.89–1.02). Findings were similar in analyses stratified by sex, age group, race, and socioeconomic status.ConclusionThere was no decrease in the incidence of ESRD due to lupus nephritis between 1996 and 2004. This may reflect the limits of effectiveness of current treatments, or limitations in access, use, or adherence to treatment.

Descriptive epidemiology of pituitary tumors in the United States, 2004–2009

2014 ◽  
Vol 121 (3) ◽  
pp. 527-535 ◽  
Author(s):  
Haley Gittleman ◽  
Quinn T. Ostrom ◽  
Paul D. Farah ◽  
Annie Ondracek ◽  
Yanwen Chen ◽  
...  
Keyword(s):  
United States ◽  
Incidence Rate ◽  
Pituitary Tumors ◽  
The United States ◽  
Population Based ◽  
Incidence Rates ◽  
Annual Incidence ◽  
Annual Incidence Rate ◽  
The Us ◽  
Adjusted Incidence

Object Pituitary tumors are abnormal growths that develop in the pituitary gland. The Central Brain Tumor Registry of the United States (CBTRUS) contains the largest aggregation of population-based data on the incidence of primary CNS tumors in the US. These data were used to determine the incidence of tumors of the pituitary and associated trends between 2004 and 2009. Methods Using incidence data from 49 population-based state cancer registries, 2004–2009, age-adjusted incidence rates per 100,000 population for pituitary tumors with ICD-O-3 (International Classification of Diseases for Oncology, Third Edition) histology codes 8040, 8140, 8146, 8246, 8260, 8270, 8271, 8272, 8280, 8281, 8290, 8300, 8310, 8323, 9492 (site C75.1 only), and 9582 were calculated overall and by patient sex, race, Hispanic ethnicity, and age at diagnosis. Corresponding annual percent change (APC) scores and 95% confidence intervals were also calculated using Joinpoint to characterize trends in incidence rates over time. Diagnostic confirmation by subregion of the US was also examined. Results The overall annual incidence rate increased from 2.52 (95% CI 2.46–2.58) in 2004 to 3.13 (95% CI 3.07–3.20) in 2009. Associated time trend yielded an APC of 4.25% (95% CI 2.91%–5.61%). When stratifying by patient sex, the annual incidence rate increased from 2.42 (95% CI 2.33–2.50) to 2.94 (95% CI 2.85–3.03) in men and 2.70 (95% CI 2.62–2.79) to 3.40 (95% CI 3.31–3.49) in women, with APCs of 4.35% (95% CI 3.21%–5.51%) and 4.34% (95% CI 2.23%–6.49%), respectively. When stratifying by race, the annual incidence rate increased from 2.31 (95% CI 2.25–2.37) to 2.81 (95% CI 2.74–2.88) in whites, 3.99 (95% CI 3.77–4.23) to 5.31 (95% CI 5.06–5.56) in blacks, 1.77 (95% CI 1.26–2.42) to 2.52 (95% CI 1.96–3.19) in American Indians or Alaska Natives, and 1.86 (95% CI 1.62–2.13) to 2.03 (95% CI 1.80–2.28) in Asians or Pacific Islanders, with APCs of 3.91% (95% CI 2.88%–4.95%), 5.25% (95% CI 3.19%–7.36%), 5.31% (95% CI –0.11% to 11.03%), and 2.40% (95% CI –3.20% to 8.31%), respectively. When stratifying by Hispanic ethnicity, the annual incidence rate increased from 2.46 (95% CI 2.40–2.52) to 3.03 (95% CI 2.97–3.10) in non-Hispanics and 3.12 (95% CI 2.91–3.34) to 4.01 (95% CI 3.80–4.24) in Hispanics, with APCs of 4.15% (95% CI 2.67%–5.65%) and 5.01% (95% CI 4.42%–5.60%), respectively. When stratifying by age at diagnosis, the incidence of pituitary tumor was highest for those 65–74 years old and lowest for those 15–24 years old, with corresponding overall age-adjusted incidence rates of 6.39 (95% CI 6.24–6.54) and 1.56 (95% CI 1.51–1.61), respectively. Conclusions In this large patient cohort, the incidence of pituitary tumors reported between 2004 and 2009 was found to increase. Possible explanations for this increase include changes in documentation, changes in the diagnosis and registration of these tumors, improved diagnostics, improved data collection, increased awareness of pituitary diseases among physicians and the public, longer life expectancies, and/or an actual increase in the incidence of these tumors in the US population.

scholarly journals Colorectal cancer in Porto Alegre and Fortaleza, Brazil: incidence trends and distribution pattern from 1990 to 1999

2009 ◽  
Vol 25 (5) ◽  
pp. 1046-1053 ◽  
Author(s):  
Rejane de Souza Reis ◽  
Marceli de Oliveira Santos ◽  
Katia Vergetti Bloch
Keyword(s):  
Colorectal Cancer ◽  
Cancer Registries ◽  
Developed Countries ◽  
Population Based ◽  
Incidence Rates ◽  
Lifestyle Changes ◽  
Porto Alegre ◽  
Annual Percent Change ◽  
Incidence Trends ◽  
Adjusted Incidence

The aim of this study was to describe the incidence distribution of colorectal cancer in Fortaleza, Ceará State, and Porto Alegre, Rio Grande do Sul State, Brazil, and the time trend in the disease from 1990 to 1999. Mean annual age-adjusted incidence rates and estimated annual percent change were calculated by gender, using population-based cancer registries. EAPC showed an increase in the rates in Porto Alegre and Fortaleza for men, +4.2% (p = 0.14) and +9.3% (p < 0.001), and women, +4.6% (p = 0.11) and +5.3% (p = 0.15), respectively. The mean adjusted incidence rates were three times higher in Porto Alegre than in Fortaleza both for men (25.1 vs. 8.6/100 thousand) and women (19.9 vs. 7.1/100 thousand). This rise in incidence rates may be due to early cancer detection strategies, lifestyle changes, and alterations in the population age structure. A population profile similar to that of developed countries may explain the higher incidence rates in Porto Alegre. However, Fortaleza showed the largest increases during the period studied.

scholarly journals Trends in the Incidence of Pancreatic Adenocarcinoma in All 50 United States Examined Through an Age-Period-Cohort Analysis

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Wilson L da Costa ◽  
Abiodun O Oluyomi ◽  
Aaron P Thrift
Keyword(s):  
United States ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Cohort Analysis ◽  
The United States ◽  
Incidence Rates ◽  
Ductal Adenocarcinoma ◽  
Birth Cohorts ◽  
Men And Women ◽  
Cancer Statistics ◽  
Incidence Trends

Abstract Background Pancreatic ductal adenocarcinoma is a major contributor to cancer-related mortality in the United States. We aimed to investigate trends in incidence rates from all 50 states from 2001 to 2016, overall and by race, sex, and state and using age-period-cohort analyses. Methods Age-adjusted incidence rates and trends in adults aged 35 years and older were calculated using data from the US Cancer Statistics registry. We used joinpoint regression to compute annual percent changes (APC) and average annual percent changes. We also analyzed incidence trends by age groups and birth cohorts through age-period-cohort modeling. Results Age-standardized incidence rates increased by 1.23% (95% confidence interval [CI] = 0.92% to 1.54%) annually between 2001 and 2008 but were stable between 2008 and 2016 (APC = 0.11%, 95% CI = -0.13% to 0.35%). APCs and inflection points were no different for men and women. Rates increased statistically significantly among non-Hispanic whites (NHW) and non-Hispanic blacks between 2001 and 2007 and between 2001 and 2008, respectively, but, in later years, rates increased slowly among NHWs (APC = 0.36%, 95% CI = 0.12% to 0.60%), and were stable among non-Hispanic blacks (APC = -0.40%, 95% CI = -0.89% to 0.10%). The number of states with age-standardized incidence rates no less than 20.4 per 100 000 increased from 16 in 2001–2003 to 40 by 2015–2016. We found a strong birth cohort effect in both men and women and increasing rates among successive birth cohorts of NHWs. Conclusions The incidence of pancreatic ductal adenocarcinoma has consistently increased in the United States, albeit at slower rates recently. We observed notable increases among NHWs and in some states in the central and southern part of the country.

Chronic myeloid leukemia incidence trends among Caucasians in the United States.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e17005-e17005
Author(s):  
Rakesh Mandal ◽  
Binay Kumar Shah
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Incidence Rate ◽  
Myeloid Leukemia ◽  
Age Groups ◽  
The United States ◽  
Incidence Rates ◽  
Background Information ◽  
Incidence Trends ◽  
Caucasian Women ◽  
Adjusted Incidence

e17005 Background: Information on trend of Chronic Myeloid Leukemia (CML) incidence rate is scant. This study was conducted to evaluate the time trends of CML incidence rates among Caucasians in the U.S. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) Program to extract annual age-adjusted incidence rates of CML from 1973-2008 for <60yr and >60yr age groups classified by gender. Trends of incidence rates were evaluated using the National Cancer Institute’s Joinpoint Regression Program (v 3.5.2). The maximum number of joinpoints used was 4. The annual percentage change (APC %) for the final selected joinpoint model for each cohort is shown in the table. Results: The annual age-adjusted CML incidence rates for 1973 vs. 2008 were 0.72/0.67, 5.67/4.47, 0.93/0.67, and 10.5/8.5 per 100,000 population for the 4 cohorts: women (<60yr, >60yr) and men (<60yr, >60yr), respectively. Among Caucasian women (>60yr), the incidence rate decreased significantly from 5.58/100,000 in 2001 to 4.47/100,000 in 2008 (APC= -3.08, CI -5.8 to -0.3, p = 0.004). The incidence trend from 1973-2001 was stable for this cohort (APC=0.1, CI -0.3 to 0.5). The incidence trends among women <60yr, men <60yr, and men >60yr were stable from 1973-2008. Conclusions: The annual age-adjusted incidence rates of chronic myeloid leukemia among older (>60 year) Caucasian women has declined sharply from 2001-2008. The rate change is unexplained. It may help generate hypotheses regarding risk factors for CML. [Table: see text]

scholarly journals Incidence trends, rates, and ethnic variations of primary CNS tumors in Texas from 1995 to 2013

2017 ◽  
Vol 5 (3) ◽  
pp. 154-160 ◽  
Author(s):  
Solomon N Ambe ◽  
Kristopher A Lyon ◽  
Damir Nizamutdinov ◽  
Ekokobe Fonkem
Keyword(s):  
United States ◽  
American Indians ◽  
Large Population ◽  
Ethnic Disparities ◽  
The United States ◽  
Incidence Rates ◽  
Cns Tumors ◽  
Annual Percent Change ◽  
Incidence Trends ◽  
Percent Change

Abstract Background Although rare, primary central nervous system (CNS) tumors are associated with significant morbidity and mortality. Texas is a representative sample of the United States population given its large population, ethnic disparities, geographic variations, and socio-economic differences. This study used Texas data to determine if variations in incidence trends and rates exist among different ethnicities in Texas. Methods Data from the Texas Cancer Registry from 1995 to 2013 were examined. Joinpoint Regression Program software was used to obtain the incidence trends and SEER*Stat software was used to produce average annual age-adjusted incidence rates for both nonmalignant and malignant tumors in Texas from 2009 to 2013. Results The incidence trend of malignant primary CNS tumors in whites was stable from 1995 to 2002, after which the annual percent change decreased by 0.99% through 2013 (95% CI, -1.4, -0.5; P = .04). Blacks and Asian/Pacific Islanders showed unchanged incidence trends from 1995 to 2013. Hispanics had an annual percent change of -0.83 (95% CI, -1.4, -0.2; P = .009) per year from 1995 through 2013. From 2009 to 2013, the incidence rates of nonmalignant and malignant primary CNS tumors were highest among blacks, followed by whites, Hispanics, Asians, and American Indians/Alaskan Natives. Conclusions Consistent with the 2016 Central Brain Tumor Registry of the United States report, the black population in Texas showed the highest total incidence of CNS tumors of any other race studied. Many factors have been proposed to account for the observed differences in incidence rate including geography, socioeconomic factors, and poverty factors, although the evidence for these external factors is lacking.

scholarly journals Contemporary incidence and mortality rates of kidney cancer in the United States

2014 ◽  
Vol 8 (7-8) ◽  
pp. 247 ◽  
Author(s):  
Giorgio Gandaglia ◽  
Praful Ravi ◽  
Firas Abdollah ◽  
Abd-El-Rahman M. Abd-El-Barr ◽  
Andreas Becker ◽  
...  
Keyword(s):  
Kidney Cancer ◽  
The United States ◽  
Mortality Rates ◽  
Incidence Rates ◽  
Short Term ◽  
Annual Percent Change ◽  
Cancer Specific Survival ◽  
Incidence And Mortality ◽  
Short Term Mortality ◽  
Adjusted Incidence

Introduction: This is a timely update of incidence and mortality for renal cell carcinoma (RCC) in the United States.Methods: Relying on the Surveillance, Epidemiology, and End Results (SEER) database, we computed age-adjusted incidence, mortality rates and 5-year cancer-specific survival (CSS) for patients with histologically confirmed kidney cancer between 1975 and 2009. Long-term (1975–2009) and short-term (2000–2009) trends were examined by joinpoint analysis, and quantified using the annual percent change (APC). The reported findings were stratified according to disease stage.Results: Age-adjusted incidence rates of RCC increased by +2.76%/year between 1975 and 2009 (from 6.5 to 17.1/100 000 person years, p < 0.001), and by +2.85%/year between 2000 and 2009 (p < 0.001). For the same time points, the corresponding APC for the incidence of localized stage were +4.55%/year (from 3.0 to 12.2/100 000 person years, p < 0.001), and +4.42%/year (p < 0.001), respectively. The incidence rates of regional stage increased by +0.88%/year between 1975 and 2009 (p < 0.001), but stabilized in recent years (2000–2009: +0.56%/year, p = 0.4). Incidence rates of distant stage remained unchanged in long- and short-term trends. Overall mortality rates increased by +1.72%/year between 1975 and 2009 (from 1.2 to 5.0/100 000 person-years, P<0.001), but stabilized between 1994 and 2004 (p = 0.1). Short-term mortality rates increased in a significant fashion by +3.14%/year only for localized stage (p < 0.001).Interpretation: In contemporary years, there is a persisting upward trend in incidence and mortality of localized RCC.

scholarly journals Incidence of Silent Stroke in the United States

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 363-363
Author(s):  
Megan C Leary ◽  
Jeffrey L Saver
Keyword(s):  
United States ◽  
Stroke Prevention ◽  
The United States ◽  
Population Based ◽  
Incidence Rates ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Stroke Incidence ◽  
Age Cohorts ◽  
The Us

P134 Background: Recent estimates of stroke incidence in the US range from 715,000–750,000 annually. These estimates, however, do not reflect silent infarcts and hemorrhages. Since population-based studies have found that prevalence of silent stroke is 10–20 times that of symptomatic, estimates of stroke incidence based solely on symptomatic events may substantially underestimate the annual burden of stroke. Silent strokes contribute to vascular dementia, gait impairment, and other major adverse patient outcomes. Methods: Incidence of silent infarcts for different age strata were derived from two US population-based studies of the prevalence of silent infarct-like lesions on MRI, Atherosclerosis Risk In Communities and Cardiovascular Health Study. Prevalence observations in these studies and age-specific death rates from the US Census Bureau were inputted to calculate silent infarct incidence (method of Leske et al). Similarly, incidence rates of silent hemorrhage at differing ages were extrapolated from population-based prevalence observations employing MR GRE imaging in the Austrian Stroke Prevention Study. Age-specific incidence rates were projected onto age cohorts in the 1998 US population to calculate annual burden of silent stroke. Results: Derived incidence rates per 100,000 of silent infarct ranged from 6400 in the age 50–59 strata to 16400 at ages 75–79. Extrapolated incidence rates of silent hemorrhage ranged from 230 in the age 30–39 strata to 7360 at ages > 80. Incidence rates of both subclinical infarcts and hemorrhage increased exponentially with age. Overall estimated annual US occurrence of silent infarct was 9,039,000, and of silent hemorrhage 2,130,000. Conclusion: In 1998, nearly 12 million strokes occurred in the United States, of which ∼750,000 were symptomatic and over 11 million were subclinical. Among the silent strokes, ∼81% were infarcts and ∼19% hemorrhages. These findings demonstrate that the annual burden of stroke is substantially higher than suggested by estimates based solely on clinically manifest events, and suggest that greater research and clinical resources should be allocated to stroke prevention and treatment.

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