Sex-specific stroke incidence over time in the Greater Cincinnati/Northern Kentucky Stroke Study

Objective:Recent data suggest stroke incidence is decreasing over time, but it is unknown whether incidence is decreasing in women and men to the same extent.Methods:Within our population of 1.3 million, all incident strokes among residents ≥20 years old were ascertained at all hospitals during July 1993–June 1994 and calendar years 1999, 2005, and 2010. A sampling scheme was used to ascertain out-of-hospital cases. Sex-specific incidence rates per 100,000 among black and white participants, age- and race-adjusted, were standardized to the 2000 US Census population. Trends over time by sex were compared; a Bonferroni correction was applied for multiple comparisons.Results:Over the 4 study periods, there were 7,710 incident strokes; 57.2% (n = 4,412) were women. Women were older than men (mean ± SE 72.4 ± 0.34 vs 68.2 ± 0.32, p < 0.001). Incidence of all strokes decreased over time in men (263 [confidence interval 246–281] to 192 [179–205], p < 0.001) but not in women (217 [205–230] to 198 [187–210], p = 0.15). Similar sex differences were seen for ischemic stroke (men, 238 [223–257] to 165 [153–177], p < 0.01; women, 193 [181–205] to 173 [162–184], p = 0.09). Incidence of all strokes and of ischemic strokes was similar between women and men in 2010. Incidence of intracerebral hemorrhage and subarachnoid hemorrhage were stable over time in both sexes.Conclusions:Decreases in stroke incidence over time are driven by a decrease in ischemic stroke in men. Contrary to previous study periods, stroke incidence rates were similar by sex in 2010. Future research is needed to understand why the decrease in ischemic stroke incidence is more pronounced in men.

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Abstract 72: Temporal Trends in Stroke Incidence Over Time by Sex and Age in the Greater Cincinnati Northern Kentucky Stroke Study

Stroke ◽

10.1161/str.51.suppl_1.72 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Tracy E Madsen ◽

Jane C Khoury ◽

Michelle Leppert ◽

Kathleen Alwell ◽

Charles J Moomaw ◽

...

Keyword(s):

Older Adults ◽

Temporal Trends ◽

Age Groups ◽

Incidence Rates ◽

Age Group ◽

Bonferroni Correction ◽

Stroke Incidence ◽

Stroke Study ◽

Trends Over Time ◽

Over Time

Introduction: Data from the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS) through 2010 showed that over time, stroke incidence rates decreased to a greater extent in men than in women. We aimed to determine whether this difference continued through 2015 and whether the differences are driven by particular age groups. Methods: Within the GCNKSS population of 1.3 million, all incident strokes among residents ≥20 years old were ascertained at all local hospitals during 7/93–6/94 and calendar years 1999, 2005, 2010, and 2015. Out-of-hospital cases were sampled. Sex-specific incidence rates per 100,000 were adjusted for age and race, standardized to the 2010 U.S. Census. Trends over time by sex were compared (overall and age-stratified); a Bonferroni correction was applied for multiple comparisons. Results: In total over the five study periods, there were 9721 incident strokes (ischemic, ICH, and SAH); 56.4% were women. Incidence of ischemic strokes decreased from 254 (95%CI 236,272) in 1993/4 to 177 (95%CI 164,189) in 2015 among men (p<.0001 for trend over time) and from 204 (95%CI 192,217) in 1993/4 to 151 (95%CI 141,161) in 2015 among women (p<.0001). Incidence of ICH/ SAH did not change significantly over time in either sex. In age-stratified analyses, among women, incidence of all strokes decreased among older adults (65–84 years) but not in other age categories (Figure). Among men, incidence over time decreased among older adults (65–84 and ≥ 85 years) but increased in young adults (20–44 years). Conclusions: Stroke incidence decreased between the early 1990s and 2015 for both sexes, contrary to previous data on trends through 2010 which demonstrated a significant decrease in men but not women. Temporal changes are being driven by the 65–84 year age group in both men and women, as well as the ≥ 85 age group in men. Future prevention strategies should target young and middle age adults for both sexes as well as those over 85 for women.

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Risk of Ischemic Stroke After Acute Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Graft Surgery

Scientific Reports ◽

10.1038/s41598-020-60854-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

André Åström ◽

Lars Söderström ◽

Thomas Mooe

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ischemic Stroke ◽

Coronary Artery ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Incidence Rates ◽

P2y12 Inhibitors ◽

Over Time

AbstractOnly sparse epidemiological data are available regarding the risk of ischemic stroke (IS) after coronary artery bypass surgery (CABG). Here we aimed to describe the incidence and predictors of IS associated with CABG performed after acute myocardial infarction (AMI), as well as trends over time. We analyzed data for 248,925 unselected AMI patients. We separately analyzed groups of patients who underwent CABG early or late after the index infarction. IS incidence rates per year at risk were 15.8% (95% confidence interval, 14.5–17.1) and 10.9% (10.6–11.2), respectively, among patients with and without CABG in the early cohort, and 4.0% (3.5–4.5) and 2.3% (2.2–2.3), respectively, among patients with and without CABG in the late cohort. Predictors of post-AMI IS included prior IS, CABG, prior atrial fibrillation, prior hemorrhagic stroke, heart failure during hospitalization, older age, diabetes mellitus, and hypertension. Reduced IS risk was associated with use of statins and P2Y12 inhibitors. IS incidence markedly decreased among patients who did not undergo CABG, while no such reduction over time occurred among those who underwent CABG. This emphasizes the need to optimize modifiable risk factors and to consistently use treatments that may reduce IS risk among CABG patients.

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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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Abstract T MP66: Injury to the Head or Neck Increases Risk of Ischemic Stroke Three-fold After Trauma.

Stroke ◽

10.1161/str.45.suppl_1.tmp66 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Christine K Fox ◽

Adam L Numis ◽

Steve Sidney ◽

Heather J Fullerton

Keyword(s):

Ischemic Stroke ◽

Traumatic Injury ◽

Young Patients ◽

Risk Groups ◽

Population Based ◽

Incidence Rates ◽

Neck Injury ◽

Diagnostic Code ◽

Stroke Incidence ◽

Diagnostic Codes

Background: Over 2 million people under age 50 are seen in a U.S. emergency room monthly for non-fatal injuries. Our objective was to measure ischemic stroke incidence after traumatic injury in young patients and identify stroke risk factors. Methods: We performed a population-based study of ischemic stroke after trauma among people <50 years old in a Northern Californian integrated health care system. We electronically identified a cohort of patients with diagnostic codes for trauma (ICD-9 800-959.9) in emergency and inpatient encounters from 1997-2011, then identified ischemic stroke outcomes within 4 weeks. To determine stroke, we required an ICD-9 stroke code (433-438) plus a radiology report of brain imaging containing a keyword: stroke, infarct#, thromb#, ischemi#, lacun#, or dissect#. A neurologist reviewed the reports to exclude those inconsistent with ischemic stroke. We obtained clinical data such as injury type from electronic databases to calculate stratified incidence rates and risk ratios. Results: From 1.5 million trauma encounters, we identified 197 ischemic strokes. The 4-week stroke incidence after any traumatic injury was 0.013% (95% CI 0.011, 0.015). Patients with stroke had a mean age of 37.7 years (SD 12.2) versus 24.0 years (SD 13.8) in those without stroke (P<0.0001). Patients with injury to the head or neck were more likely to have a stroke compared to those with other types of injuries (Table). The 4-week stroke incidence after head or neck injury was 0.07% (95% CI 0.05, 0.09) among adults and 0.005% (95% CI 0.001, 0.01) among children (P<0.0001). Of the 197 stroke cases, 16% (95% CI 11, 22) had a diagnostic code for cranio-cervical dissection. Conclusions: A 4-week stroke incidence of 0.013% suggests that 260 young people have an ischemic stroke after a traumatic injury every month in the U.S. Further research is needed to identify the highest risk groups, such as those with head or neck injury, and opportunities for stroke prevention.

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Abstract P602: Stroke Risk Factors Among the Young Over Time in the GCNKSS

Stroke ◽

10.1161/str.52.suppl_1.p602 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Tracy E Madsen ◽

Jane C Khoury ◽

Kathleen S Alwell ◽

Opeolu M Adeoye ◽

Felipe De Los Rios La Rosa ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Large Population ◽

High Cholesterol ◽

Stroke Incidence ◽

Stroke Risk Factors ◽

Obesity And Diabetes ◽

Trends Over Time ◽

Over Time

Background: Data from the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS) have demonstrated stable or increasing stroke incidence rates in young adults with differences by sex and race, suggesting the need for targeted approaches to stroke prevention in the young. We aimed to describe trends over time in prevalence of stroke risk factors among adults ages 20-54 with stroke by sex and race. Methods: Cases of incident stroke (IS, ICH, SAH) occurring in those 20-54 years old and living in a 5-county area of southern Ohio/northern Kentucky were ascertained during 5 study periods (1993-1994, 1999, 2005, 2010, 2015). All physician-adjudicated inpatient events and a sampling of outpatient events were included, excluding nursing home events. Data on risk factors (hypertension, diabetes, obesity (BMI≥30), and high cholesterol) diagnosed prior to stroke were abstracted from medical records, and prevalence of each risk factor was reported over time in race/sex groups. Trends over time were examined using the Cochran-Armitage test. Results: Over the 5 study periods, 1204 incident strokes were included; 49% were women, 33% were black, and mean age was 46 (SD 7) years. Premorbid hypertension increased over time in Black women (48% in 1993/4 to 76% in 2015, p=0.005) but not in any other race/sex group (all p>0.05). Premorbid high cholesterol increased significantly in all race/sex groups (Figure, all p<0.05) except for White men (p=0.06). There were no significant trends over time in pre-stroke diagnoses of diabetes or obesity in any of the race/sex groups (Figure). Conclusions: Among patients aged 20-54 with incident stroke in a large population-based study, the change in the prevalence of hypertension and high cholesterol differed by sex and race, while obesity and diabetes were stable over time in all race/sex groups. Future research is needed to address risk factor control at a population level and to understand the role of undiagnosed pre-stroke risk factors in the young.

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25-Year Trends in Stage-Specific Incidence Rates for Bladder Cancer in a Large Statewide Registry

Bladder Cancer ◽

10.3233/blc-200310 ◽

2020 ◽

Vol 6 (4) ◽

pp. 445-451

Author(s):

Justin Loloi ◽

Yu-Kuan Lin ◽

Fabian Camacho ◽

Eugene Lengerich ◽

Jay D. Raman

Keyword(s):

Bladder Cancer ◽

Hot Spots ◽

Incidence Rates ◽

The State ◽

Distant Disease ◽

Percent Change ◽

The Past ◽

Study Interval ◽

Trends Over Time ◽

Over Time

BACKGROUND: Bladder cancer (BC) is a common genitourinary malignancy with over 80,000 new cases diagnosed annually and over 17,000 associated deaths. OBJECTIVE: We review 25-years of BC incidence (1993-2017) within the state of Pennsylvania to better define incidence, geographic distribution, and trends over time. METHODS: The Pennsylvania Cancer Registry was reviewed for statewide and component county age-adjusted BC incidence rates and stage distribution. Chloropleth maps plotting statewide and county-specific incidence rates across time were created using the GeoDa statistical package. RESULTS: 93,476 cases of BC were recorded in Pennsylvania from 1993 to 2017. Age-adjusted annual rates of BC over the study interval were stable at 24.5 patients per 100,000 (range, 22.7–25.6). However, annual rates of distant disease increased from 0.5 to 1.1 patients per 100,000 (p < 0.001) with an average percent change increase of 6.6% over the study interval. The annual percent distribution of distant disease doubled from 2.3% to 5.1% (p < 0.001) with a greater increase in women compared to men. Chloropleth maps highlighted growing “hot spots” of bladder cancer incidence in the northwestern, northeastern, and southeastern portions of the state. CONCLUSIONS: While BC incidence in the state of Pennsylvania has remained relatively stable over the past 25 years, a concerning increase in distant disease was observed. Geospatial investigation implicates higher risk regions. Further studies are necessary to delineate the underlying etiologies for these observations.

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Incidence, recurrence, and long-term survival of ischemic stroke subtypes: A population-based study in the Middle East

International Journal of Stroke ◽

10.1177/1747493016684843 ◽

2017 ◽

Vol 12 (8) ◽

pp. 835-843 ◽

Cited By ~ 15

Author(s):

Hamidreza Saber ◽

Amanda G Thrift ◽

Moira K Kapral ◽

Ashkan Shoamanesh ◽

Amin Amiri ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle East ◽

Incidence Study ◽

Incidence Rates ◽

Large Artery ◽

Small Artery ◽

Community Based ◽

Stroke Incidence ◽

Stroke Subtypes ◽

Artery Disease

Background Incidence, risk factors, case fatality and survival rates of ischemic stroke subtypes are unknown in the Middle East due to the lack of community-based incidence stroke studies in this region. Aim To characterize ischemic stroke subtypes in a Middle Eastern population. Methods The Mashad Stroke Incidence Study is a community-based study that prospectively ascertained all cases of stroke among the 450,229 inhabitants of Mashhad, Iran between 2006 and 2007. We identified 512 cases of first-ever ischemic stroke [264 men (mean age 65.5 ± 14.4) and 248 women (mean age 64.14 ± 14.5)]. Subtypes of ischemic stroke were classified according to the TOAST criteria. Incidence rates were age standardized to the WHO and European populations. Results The proportion of stroke subtypes was distributed as follows: 14.1% large artery disease, 15% cardioembolic, 22.5% small artery disease, 43.9% undetermined and 4.5% other. The greatest overall incidence rates were attributed to undetermined infarction (49.97/100,000) followed by small artery disease (25.54/100,000). Prevalence of hypertension, diabetes and atrial fibrillation differed among ischemic stroke subtypes. Overall, there were 268 (52.34%) deaths and 73 (14.25%) recurrent strokes at five years after incident ischemic stroke, with the greatest risk of recurrence seen in the large artery disease (35.6%) and cardioembolic (35.5%) subgroups. Survival was similar in men and women for each stroke subtype. Conclusions We observed markedly greater incidence rates of ischemic stroke subtypes than in other countries within the Mashad Stroke Incidence Study after age standardization. Our findings should be considered when planning prevention and stroke care services in this region.

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Increasing Prevalence and Stable Incidence Rates of Inflammatory Bowel Disease Among First Nations: Population-Based Evidence From a Western Canadian Province

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab096 ◽

2021 ◽

Author(s):

Juan Nicolás Peña-Sánchez ◽

Jessica Amankwah Osei ◽

Jose Diego Marques Santos ◽

Derek Jennings ◽

Mustafa Andkhoie ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

First Nations ◽

Indigenous Peoples ◽

Bowel Disease ◽

Population Based ◽

Incidence Rates ◽

Canadian Province ◽

Trends Over Time ◽

Inflammatory Bowel ◽

Over Time

Abstract Background There is limited to no evidence of the prevalence and incidence rates of inflammatory bowel disease (IBD) among Indigenous peoples. In partnership with Indigenous patients and family advocates, we aimed to estimate the prevalence, incidence, and trends over time of IBD among First Nations (FNs) since 1999 in the Western Canadian province of Saskatchewan. Methods We conducted a retrospective population-based study linking provincial administrative health data from the 1999-2000 to 2016-2017 fiscal years. An IBD case definition requiring multiple health care contacts was used. The prevalence and incidence data were modeled using generalized linear models and a negative binomial distribution. Models considered the effect of age groups, sex, diagnosis type (ulcerative colitis [UC], Crohn disease [CD]), and fiscal years to estimate prevalence and incidence rates and trends over time. Results The prevalence of IBD among FNs increased from 64/100,000 (95% confidence interval [CI], 62-66) in 1999-2000 to 142/100,000 (95% CI, 140-144) people in 2016-2017, with an annual average increase of 4.2% (95% CI, 3.2%-5.2%). Similarly, the prevalence of UC and CD, respectively, increased by 3.4% (95% CI, 2.3%-4.6%) and 4.1% (95% CI, 3.3%-4.9%) per year. In contrast, the incidence rates of IBD, UC, and CD among FNs depicted stable trends over time; no statistically significant changes were observed in the annual change trend tests. The ratio of UC to CD was 1.71. Conclusions We provided population-based evidence of the increasing prevalence and stable incidence rates of IBD among FNs. Further studies are needed in other regions to continue understanding the patterns of IBD among Indigenous peoples.

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Incidence of Stroke and Ischemic Stroke Subtypes: A Community-Based Study in Brno, Czech Republic

Cerebrovascular Diseases ◽

10.1159/000512180 ◽

2020 ◽

pp. 1-8

Author(s):

Petra Sedova ◽

Robert D. Brown ◽

Miroslav Zvolsky ◽

Silvia Belaskova ◽

Michaela Volna ◽

...

Keyword(s):

Ischemic Stroke ◽

Czech Republic ◽

Epidemiological Data ◽

Incidence Rates ◽

National Registry ◽

World Health ◽

Large Artery ◽

Stroke Incidence ◽

European Standard Population ◽

Stroke Diagnosis

Background: There are few contemporary epidemiological data on stroke for Central Europe. We performed a population-based study evaluating the incidence of stroke, stroke types, and ischemic stroke (IS) subtypes in Brno, the second biggest city in the Czech Republic (CR). Methods: Using the National Registry of Hospitalized Patients, and hospital databases, we identified all patients hospitalized with a stroke diagnosis in Brno hospitals in 2011. For Brno residents with validated stroke diagnosis, we calculated (a) the overall incidence of hospitalized stroke, (b) incidence rates for IS, subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), and (c) incidence rates for IS subtypes. We calculated the average annual age- and sex-standardized incidence (European Standard Population and World Health Organization), to compare our results with other studies. Results: The overall crude incidence of stroke in Brno was 213/100,000 population. The incidence of stroke for stroke types were as follows: SAH, 6.9; ICH, 26.4; and IS, 180 cases per 100,000 population, respectively. The WHO-standardized annual stroke incidence was 107 for all strokes and 88 for IS, 14.4 for ICH, and 5 for SAH. For IS subtypes, the WHO-standardized incidence was large artery atherosclerosis 25.8, cardioembolism 27.8, lacunar 21.6, other determined etiology 6.2, and undetermined etiology 6.5 cases per 100,000 population. Conclusions: The stroke incidence is lower than that previously reported for the CR and Eastern Europe probably reflecting socioeconomic changes in post-communistic countries in the region. These findings could contribute to stroke prevention strategies and influence health policies.

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Abstract WMP51: Ischemic Stroke Rates in Those With Diabetes in the Black and White Population: An Update

Stroke ◽

10.1161/str.51.suppl_1.wmp51 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jane C Khoury ◽

Tracy Madsen ◽

Kathleen Alwell ◽

Charles J Moomaw ◽

Heidi Sucharew ◽

...

Keyword(s):

Local Population ◽

Age Groups ◽

Black Population ◽

Census Bureau ◽

Incidence Rates ◽

Black And White ◽

Increased Risk ◽

Diagnosed Diabetes ◽

Glycemic Monitoring ◽

Us Census

Background: We previously reported an increased incidence of stroke in the population with diabetes. This was particularly pronounced in those under 65 years of age. With guidelines now including glycemic monitoring during hospitalization, we examined incidence attributable to diabetes in 2010 and 2015. Methods: Ischemic strokes in the 5-county Greater Cincinnati/Northern Kentucky region were ascertained, then physician verified, at all 15 area hospitals using ICD-9 codes 430 to 436 or ICD10 codes I60 to I68. First ever ischemic strokes in patients aged 20 years and older were included in this analysis. Population age-specific rates of diabetes were estimated using the 2009-2010 and 2015-2016 NHANES databases, then applied to local population numbers, extracted from the US Census Bureau website, to estimate the denominator for calculation of incidence rates. Incidence rates were adjusted by age race and sex, as appropriate, to the 2010 US population. Diabetes was defined as reported in the electronic medical record or glycohemoglobin A1c &gt 6.4% during hospitalization. Results: There were a total of 4141 ischemic strokes; 55% female and 22% black. Stroke rates continue to be substantially higher in those with diagnosed diabetes, than those without diabetes overall and for those less than 65 years in both time periods, as well as those 65 years and older except for the black population in 2010. Racial disparities continue in both the less than 65 and 65 years and older age groups. Stroke rates were higher for Blacks in the less than 65 year age group for those both with and without diabetes; with risk ratios ranging from 1.3 to 2.7. Of note the stroke rate has decreased between 2010 and 2015 for those with diabetes <65 years of age. (Table) Conclusions: The population with diabetes continues to be at increased risk of stroke, especially in those less than 65 years of age and those of black race.

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