Temporal Trends in Ischemic Stroke Rates by Ethnicity, Sex, and Age 2000–2017: The Brain Attack Surveillance in Corpus Christi Project

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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Abstract 87: Eighteen-Year Trends in Ischemic Stroke Rates in a Bi-Ethnic Population

Stroke ◽

10.1161/str.51.suppl_1.87 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Lynda D Lisabeth ◽

Devin Brown ◽

Xingyu Zhang ◽

Sehee Kim ◽

Erin Case ◽

...

Keyword(s):

Ischemic Stroke ◽

Mexican Americans ◽

Ethnic Disparities ◽

Population Based ◽

Rate Difference ◽

Corpus Christi ◽

Interaction Terms ◽

Annual Population ◽

Adjusted Rate ◽

Using Data

Introduction: Elevated stroke rates in Mexican Americans (MA) compared with non-Hispanic whites (NHW) persisted over the first decade of the 21 st century. Our objective was to investigate recent trends in ischemic stroke (IS) rates by ethnicity and age using data from a longstanding population-based study. Methods: ISs were identified in the Brain Attack Surveillance in Corpus Christi (BASIC) Project (2000-2017) and validated by neurologists using a clinical definition. Race-ethnicity was from medical records. Annual population counts from the US Census estimated the at-risk population. Poisson regression was used to model sex-adjusted rate trends by ethnicity and age. Time was modeled using linear and quadratic terms. Ethnic differences were assessed using interaction terms between ethnicity and time. Results: 4,883 ISs were identified (median age 70 (IQR:59-80); 56% MA). Trends varied by ethnicity and age (figure). In those 45-59, rates increased substantially in NHWs (104%; p<0.001 for rate difference 2000-2017) but decreased in MAs (-21.4%; p=0.04 for rate difference 2000-2017) such that, for the first time, rates were higher in NHWs. In those 60-74, rates declined in both ethnic groups through 2010-2011 but then increased and more steeply in NHWs thereafter. In those ≥75, rates declined in MAs, declined sharply in NHWs through 2012 and then increased. Conclusions: New patterns in stroke have emerged. Ethnic disparities have declined as a result of increasing rates in NHWs most notably in midlife. Reasons for increasing rates in recent years are unclear but suggest renewed attention to prevention.

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Time Trends in Incidence and Case Fatality of Ischemic Stroke

Stroke ◽

10.1161/strokeaha.114.008387 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1173-1179 ◽

Cited By ~ 23

Author(s):

Anne Merete Vangen-Lønne ◽

Tom Wilsgaard ◽

Stein Harald Johnsen ◽

Maria Carlsson ◽

Ellisiv B. Mathiesen

Keyword(s):

Ischemic Stroke ◽

Time Trends ◽

Age Groups ◽

Case Fatality ◽

Population Based ◽

Industrialized Countries ◽

Stroke Incidence ◽

Fractional Polynomial ◽

Adjusted Incidence ◽

Age And Sex

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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Temporal Trends in the Incidence of Ischemic Stroke in Young Adults: Dijon Stroke Registry

Neuroepidemiology ◽

10.1159/000516054 ◽

2021 ◽

pp. 1-6

Author(s):

Yannick Béjot ◽

Gauthier Duloquin ◽

Quentin Thomas ◽

Sophie Mohr ◽

Lucie Garnier ◽

...

Keyword(s):

Young Adults ◽

Sex Differences ◽

Ischemic Stroke ◽

Temporal Trends ◽

Population Based ◽

Incidence Rates ◽

Stroke Incidence ◽

Stroke Registry ◽

Stroke In Young Adults ◽

Stroke In Young

Introduction: Stroke is associated with major consequences in terms of socioeconomic impact and lost disability-adjusted life in young victims, thus justifying a careful surveillance of epidemiological trends. This study aimed to assess changes in the incidence of ischemic stroke in young adults over a long period. Methods: All cases of first-ever ischemic stroke that occurred among adults aged 18–55 years were prospectively recorded using the population-based Dijon Stroke Registry, from 1985 to 2017. Sex-specific annual incidence rates were calculated and were presented according to 6 time periods. Incidence rate ratios (IRRs) were determined to assess sex differences in stroke incidence. Results: Over the whole study period, 4,451 patients suffered a first-ever ischemic stroke. Among these patients, 469 (10.5%) were young adults (median age: 46 years, IQR: 39–50; 53.9% men). Incidence rates rose from the study period 2003 to 2007 compared with previous periods and remained stable thereafter, both in men and women. Hence, incidence per 100,000 per year was globally 11.0 (95% CI: 9.4–12.7) before 2003 and 22.9 (20.3–25.6) thereafter. In individuals aged 18–45 years, incidence rates were 5.4 (4.3–6.9) overall, 4.1 (2.7–6.0) in men, and 6.7 (4.9–9.0) in women, before 2003. After 2003, incidence rates rose to 12.8 (10.7–15.1) overall, 12.0 (9.2–15.4) in men, and 13.6 (10.6–17.0) in women. In this age group, the men/women IRR was 0.78 (95% CI: 0.62–1.26, p = 0.08), although sex differences decreased over time (IRR = 0.62; 95% CI: 0.36–1.02, p = 0.046 before 2003, vs. IRR = 0.88; 95% CI: 0.62–1.26, p = 0.48 after 2003). In individuals aged 45–55 years, incidence rates before 2003 were 47 (37–61) in men and 25 (17–35) in women (IRR = 1.90; 95% CI: 1.24–2.97, p < 0.001), and they increased to 82 (67–100) in men and 46 (35–59) in women (IRR = 1.79; 95% CI: 1.29–2.49, p < 0.001) after 2003. Conclusions: The incidence of ischemic stroke in young adults increased during the early 2000s and remained stable thereafter. These results highlight the priority need for dedicated prevention strategies for the young to reduce the burden of stroke.

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Abstract T P132: Rapid loss of the Mexican American Survival Advantage After Stroke--The BASIC Study

Stroke ◽

10.1161/str.45.suppl_1.tp132 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Lewis B Morgenstern ◽

Brisa N Sánchez ◽

Melinda Smith ◽

Devin Brown ◽

Nelda Garcia ◽

...

Keyword(s):

Ischemic Stroke ◽

Ethnic Differences ◽

Mexican Americans ◽

Mexican American ◽

Population Based ◽

Survival Advantage ◽

Stroke Severity ◽

Basic Study ◽

Entire Study ◽

Corpus Christi

Background/Objective: As a primary, pre-specified objective of the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project we studied trends in mortality following ischemic stroke among Mexican Americans (MAs) and non Hispanic whites (NHWs). MAs were previously found to have lower mortality following stroke than NHWs. Methods: We performed active and passive surveillance, and using source documentation, validated all ischemic stroke cases from January, 2000-December, 2010. Deaths were ascertained from the Texas Department of Health through December 31, 2011. Cumulative 30 day and 1 year mortality adjusted for covariates was estimated using log-binomial models with a linear term for year of stroke onset used to model time trends. Pre-specified adjustment factors were: age, sex, prior stroke or TIA, atrial fibrillation, diabetes, heart disease, hypertension, smoking, high cholesterol and stroke severity. Models used data from the entire study period to estimate adjusted mortality among stroke cases in 2000 and 2010, and to calculate projected ethnic differences. Results: There were 1,822 ischemic strokes among NHWs and 2,211 among MAs. Between 2000 and 2010, 30 day and 1 year mortality declined among NHWs, from 8.6% to 5.9% (p=0.14), and 21.7% to 17.0% (p=0.06), respectively. Among MAs, 30 day mortality remained stagnant at 5.6% (p=0.98), and a slight decline from 18.3% to 16.4% was observed for 1 year mortality (p=0.41). While, the ethnic differences in 30 day (p=0.01) and 1 year (p=0.07) mortality were robust in 2000, they were not so in 2010 (30 day, p=0.76; 1 year p=0.78). See figure. MAs are projected to have higher post-stroke mortality by 2022. Conclusions: Overall, mortality following ischemic stroke has declined in the last decade. However, the survival advantage previously documented among MAs vanished by 2010. Further, faster declines in mortality among NHWs than MAs imply a reversal of the survival advantage by approximately 2022.

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A population-based analysis in 375,233 cases of heart failure stages A, B and C. Real world epidemiology of prevalence and temporal trends in South-European populations

European Heart Journal ◽

10.1093/ehjci/ehaa946.0960 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Jimenez ◽

M Cainzos-Achirica ◽

D Monterde ◽

L Garcia-Eroles ◽

C Enjuanes ◽

...

Keyword(s):

Heart Failure ◽

Chronic Conditions ◽

Temporal Trends ◽

Population Level ◽

Population Based ◽

Relative Increase ◽

Funding Source ◽

Private Company ◽

Healthcare Database ◽

Evolutionary Changes

Abstract Background Prevalence of congestive heart failure (CHF) and predisposing conditions has described previously. Most of these studies evaluated centre-European or north-American populations. However, the prevalence and evolutionary changes of Heart Failure stages A, B and C has not been fully elucidated in Mediterranean cohorts. Purpose To estimate the prevalence of CHF (HF Stage C) and four additional key chronic cardiovascular, metabolic and renal conditions predisposing to the development of CHF (HF Stages A and B) at a population level in a south-European healthcare area. We analysed the evolutionary changes in the prevalence in these five conditions. Methods In a healthcare area of 1,3Millions inhabitants, we extracted health related information of all individuals ≥55 years old. We analysed data of 375,233 individuals included in the population-based healthcare database of a public Institute of Health between 2015 and 2017. The conditions of interest were CHF, chronic kidney disease (CKD), diabetes mellitus (DM), ischemic heart disease (IHD) and hypertension (HTN). Results The prevalence of chronic conditions was high, particularly of HTN (48.2–48.9%) and DM individuals (14.6–14.8%). The other conditions were less frequent, with prevalence around 2–4% for IHD, 5–9% for CKD and 2–4% for CHF (Table). However, the less frequent conditions had a striking upward trend with over 1,500 new prevalent cases per year between 2015 and 2017 for CHF (45% relative increase), more than 2,500 new prevalent cases for IHD (67% relative increase) and more than 4,000 new prevalent cases per year for CKD (44% relative increase). Conclusion In this south European cohort, there were a high prevalence of HTN and DM as risk factors and a significant trend of increasing prevalence in high cost chronic conditions such as CHF, IHD and CKD. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The present study was funded by an unrestricted research grant from Vifor Pharma.

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Disparities in the Use of Intravenous t-PA among Ischemic Stroke Patients: Population-based Recent Temporal Trends

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2019.01.013 ◽

2019 ◽

Vol 28 (5) ◽

pp. 1243-1251 ◽

Cited By ~ 1

Author(s):

Mohammad A. Faysel ◽

Jonathan Singer ◽

Caroline Cummings ◽

Dimitre G. Stefanov ◽

Steven R. Levine

Keyword(s):

Ischemic Stroke ◽

Temporal Trends ◽

Population Based ◽

Stroke Patients

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Abstract WP165: Mexican Americans Receive Less Intensive Stroke Rehabilitation Than non Hispanic Whites

Stroke ◽

10.1161/str.48.suppl_1.wp165 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lewis B Morgenstern ◽

Emma Sais ◽

Michael Fuentes ◽

Nneka Ifejika ◽

Xiaqing Jiang ◽

...

Keyword(s):

Mexican Americans ◽

Stroke Rehabilitation ◽

Inpatient Rehabilitation ◽

Population Based ◽

Cognitive Outcomes ◽

Rehabilitation Services ◽

Population Based Study ◽

Corpus Christi ◽

Home Based ◽

Chi Squared

Background: Mexican Americans (MAs) have worse neurologic, functional and cognitive outcomes after stroke than non Hispanic whites (NHWs). Stroke rehabilitation is important for outcome. In a population-based study, we sought to determine if allocation of stroke rehabilitation services differed by ethnicity. Methods: Consecutive stroke patients were identified for a three month time period as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, Texas, USA. Cases were validated by physicians using source documentation. Patients were followed prospectively for three months following stroke to determine self-reported rehabilitation services. Descriptive statistics were used to describe the study population. Ethnic comparisons of rehabilitation services were made using chi-squared or Fisher’s exact tests. Results: Seventy-two subjects (50 MA, 22 NHW) were followed. Mean age, NHW-69 (sd-13), MA-66 (sd-11) years, sex (NHW 55% male, MA 50% male) and median presenting NIHSS (NHW-2.5, MA-3.0) did not differ significantly. There were no ethnic differences in the proportion of patients who were discharged home without rehabilitation services (p=0.9). Among those who received rehabilitation (n=48), the figure shows the distribution of the first place for services. NHWs were more likely to be discharged to inpatient rehabilitation (73%) compared with MAs (30%), p=0.016. MAs (51%) were much more likely to be receive home rehabilitation services compared with NHWs (0%) (p=0.0017). Conclusions: In this population-based study, MAs were more likely to receive home-based rehabilitation while NHWs more likely to get inpatient rehabilitation. This disparity may, in part, explain the worse stroke outcome in MAs.

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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 TP182: Stroke Outcome in Mexican American Immigrants and Non-Immigrants

Stroke ◽

10.1161/str.51.suppl_1.tp182 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Lewis B Morgenstern ◽

Lynda Lisabeth ◽

River Gibbs ◽

Sehee Kim ◽

Charles Agyemang

Keyword(s):

Mexican Americans ◽

Mexican American ◽

Population Based ◽

Cognitive Outcome ◽

Stroke Outcome ◽

Linear Regression Models ◽

Corpus Christi ◽

Project Outcomes ◽

Stroke Study ◽

The U.S

Background/Objective: We studied the association of being born outside of the U.S. (immigrant) or born in the U.S. (non-immigrant) with 90 day post-stroke outcomes in a population-based stroke study in Texas. Methods: Stroke cases from 2008-2016 were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project. Outcomes among survivors included ADL/IADL score (higher scores worse) for functional assessment, 3MSE (cognition, lower scores worse), and NIHSS Score (neurologic, higher scores worse). Weighted linear regression models were used to assess the effect of immigration status on the outcomes. Analysis was completed using multiple imputation and inverse probability weighting to account for differential attrition. Results: Of 935 Mexican Americans available for analysis, 83 were immigrants and 852 were non-immigrants. Immigrants had resided in the U.S. on average 47 years. Immigrants were significantly older (69 vs. 66 years), more likely male (60% vs. 49%), more likely to have atrial fibrillation and have less education than non-immigrants (all p<0.05). No differences in hypertension, diabetes, cholesterol, insurance, smoking or other comorbidities existed. The Table provides the data from the fully adjusted models. Immigrants had better functional outcome (mean difference (MD) = -0.22; p=0.02), and no difference for neurologic outcome (MD= -0.15; p=0.15). There was an association of worse cognitive outcome in immigrants (MD= -5.25; p=0.009), however, the association was explained by attenuated after the adjustment for the lower educational attainment in immigrants (MD= -0.79; p=0.64). Conclusions: In this community, there was no evidence of worse stroke outcome among Mexican American immigrants, who had lived in the U.S. for decades, compared with non-immigrants. Further studies of more recent immigrant populations are warranted.

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