High Altitude Is Associated With Lower Stroke-Related Mortality: A 17-Year Nationwide Population-Based Analysis From Ecuador

2021 ◽  
Author(s):  
Esteban Ortiz-Prado ◽  
Patricio. S Espinosa ◽  
Alfredo Borrero ◽  
Simone P. Cordovez ◽  
Jorge E. Vasconez ◽  
...  
Keyword(s):  
High Altitude ◽  
Protective Factor ◽  
Hospital Admissions ◽  
Population Based ◽  
Incidence Rates ◽  
Stroke Incidence ◽  
Hypoxia Exposure ◽  
Admission Rates ◽  
Disability Adjusted Life ◽  
Life Years

Abstract Background: Globally, more than 5.7% of the population reside above 1,500 m of elevation. It has been hypothesized that acute short-term hypoxia exposure could increase the risk of developing a stroke. Studies assessing the effect of altitude on stroke have provided conflicting results, some analysis suggest that long-term chronic exposure could be associated with reduced mortality and lower stroke incidence rates. Methods:An ecological analysis of all stroke hospital admissions, mortality rates and disability adjusted life years in Ecuador was performed from 2001-2017. The cases and population at risk were categorized in low (<1,500 m), moderate (1,500-2,500 m), high (2,500-3,500 m) and very high altitude (3,500-5,500 m) according to place of residence. The derived crude and direct standardized age-sex adjusted mortality and hospital admission rates were calculated. Results: A total of 38,201 deaths and 75,893 stroke-related hospital admissions were reported. High-altitude populations (HAP) had lower stroke mortality in men (RR: 0.91 [0.88 - 0.95]) and women (RR: 0.83 [0.79 - 0.86]). In addition, HAP had a significant lower risk of getting admitted to the hospital when compared with the low altitude group in men (RR: 0.55 [CI95% 0.54 - 0.56]) and women (RR: 0.65 [CI95% [0.64 - 0.66]). Conclusions: This is the first epidemiological study that aims to elucidate the association between stroke and altitude using four different elevation ranges. Our findings suggest that living at higher elevations offers a reduction or the risk of dying due to stroke as well as a reduction in the probability of being admitted to the hospital. Nevertheless, this protective factor has the stronger effect between 2,000 m to 3,500 m.

scholarly journals Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador

2021 ◽  
Vol 12 ◽  
Author(s):  
Esteban Ortiz-Prado ◽  
Patricio S. Espinosa ◽  
Alfredo Borrero ◽  
Simone P. Cordovez ◽  
Jorge E. Vasconez ◽  
...  
Keyword(s):  
High Altitude ◽  
Protective Factor ◽  
Hospital Admissions ◽  
Population Based ◽  
Incidence Rates ◽  
Stroke Incidence ◽  
Hypoxia Exposure ◽  
Admission Rates ◽  
Disability Adjusted Life ◽  
Life Years

Introduction: Worldwide, more than 5.7% of the population reside above 1,500 m of elevation. It has been hypothesized that acute short-term hypoxia exposure could increase the risk of developing a stroke. Studies assessing the effect of altitude on stroke have provided conflicting results, some analyses suggest that long-term chronic exposure could be associated with reduced mortality and lower stroke incidence rates.Methods: An ecological analysis of all stroke hospital admissions, mortality rates, and disability-adjusted life years in Ecuador was performed from 2001 to 2017. The cases and population at risk were categorized in low (&lt;1,500 m), moderate (1,500–2,500 m), high (2,500–3,500 m), and very high altitude (3,500–5,500 m) according to the place of residence. The derived crude and direct standardized age-sex adjusted mortality and hospital admission rates were calculated.Results: A total of 38,201 deaths and 75,893 stroke-related hospital admissions were reported. High altitude populations (HAP) had lower stroke mortality in men [OR: 0.91 (0.88–0.95)] and women [OR: 0.83 (0.79–0.86)]. In addition, HAP had a significant lower risk of getting admitted to the hospital when compared with the low altitude group in men [OR: 0.55 (CI 95% 0.54–0.56)] and women [OR: 0.65 (CI 95% 0.64–0.66)].Conclusion: This is the first epidemiological study that aims to elucidate the association between stroke and altitude using four different elevation ranges. Our findings suggest that living at higher elevations offers a reduction or the risk of dying due to stroke as well as a reduction in the probability of being admitted to the hospital. Nevertheless, this protective factor has a stronger effect between 2,000 and 3,500 m.

scholarly journals Antidepressants and public health in Iceland

2004 ◽  
Vol 184 (2) ◽  
pp. 157-162 ◽  
Author(s):  
Tómas Helgason ◽  
Helgi Tómasson ◽  
Tómas Zoëga
Keyword(s):  
Public Health ◽  
Depressive Disorders ◽  
Hospital Admissions ◽  
Adult Population ◽  
Health Impact ◽  
The Public ◽  
Admission Rates ◽  
Outpatient Visits ◽  
Disability Adjusted Life ◽  
Life Years

BackgroundMajor depressive disorder is the second leading cause of disability-adjusted life-years in developed regions of the world and antidepressants are the third-ranking therapy class worldwide.AimsTo test the public health impact of the escalating sales of antidepressants.MethodNationwide data from Iceland are used as an example to study the effect of sales of antidepressants on suicide, disability, hospital admissions and outpatient visits.ResultsSales of antidepressants increased from 8.4 daily defined doses per 1000 inhabitants per day in 1975 to 72.7 in 2000, which is a user prevalence of 8.7% for the adult population. Suicide rates fluctuated during 1950–2000 but did not show any definite trend. Rates for outpatient visits increased slightly over the period 1989–2000 and admission rates increased even more. The prevalence of disability due to depressive and anxiety disorders has not decreased over the past 25 years.ConclusionsThe dramatic increase in the sales of antidepressants has not had any marked impact on the selected public health measures. Obviously, better treatment for depressive disorders is still needed in order to reduce the burden caused by them.

scholarly journals National record-linkage study of hospital admissions for schizophrenia in childhood and adolescence in England

2021 ◽  
Author(s):  
Olena Seminog ◽  
Uy Hoang ◽  
Michael Goldacre ◽  
Anthony James
Keyword(s):  
Hospital Admissions ◽  
Population Based ◽  
Linkage Study ◽  
Incidence Rates ◽  
Childhood And Adolescence ◽  
Childhood Onset ◽  
Affective Psychosis ◽  
Health Service Provision ◽  
Childhood Onset Schizophrenia ◽  
Icd 10

Abstract Background There is a lack of information on changes in hospital admission rates for childhood-onset schizophrenia (COS), or on patient characteristics, to inform clinical research and health service provision. Aims To report age- and sex-specific incidence rates of hospital admissions and day patient care for schizophrenia (ICD-10 F20) and non-affective psychosis (ICD-10 F20-29), by year of occurrence and age, in childhood and adolescence. Methods Population-based study using person-linked data for England (available 2001–2016); time-periods in single years and 4-year groups. Results Hospitalised incidence for schizophrenia increased with increasing age, from 0.03 (95% confidence interval (CI) 0.02–0.05) and 0.01 (0–0.01) per 100,000 in, respectively, males and females aged 5–12 years, to 3.67 (3.44–3.91) in males and 1.58 (1.43–1.75) in females aged 13–17 years. There was no gender difference in hospitalised incidence rates in children aged 5–12, but in 13–17 years old, there was a male excess. Rates for schizophrenia were stable over time in 5–12 years old. In ages 13–17, rates for schizophrenia decreased between 2001–2004 and 2013–2016 in males, from 6.65 (6.04–7.31) down to 1.40 (1.13–1.73), and in females from 2.42 (2.05–2.83) to 1.18 (0.92–1.48). The hospitalisation rates for schizophrenia and non-affective psychosis, combined, in 13–17 years old decreased in males from 14.20 (13.30–15.14) in 2001–2004 to 10.77 (9.97–11.60) in 2013–2016, but increased in females from 7.49 (6.83–8.20) to 10.16 (9.38–11.00). Conclusions The study confirms that childhood-onset schizophrenia is extremely rare, with only 32 cases identified over a 15-year period in the whole of England. The incidence of schizophrenia and non-affective psychosis increased substantially in adolescence; however, the marked reduction in the proportion of those diagnosed with schizophrenia in this age group suggests a possible change in diagnostic practice.

The national burden of cerebrovascular diseases in Spain: A population-based study using disability-adjusted life years

2015 ◽  
Vol 144 (8) ◽  
pp. 353-359 ◽  
Author(s):  
Ferrán Catalá-López ◽  
Nerea Fernández de Larrea-Baz ◽  
Consuelo Morant-Ginestar ◽  
Elena Álvarez-Martín ◽  
Jaime Díaz-Guzmán ◽  
...  
Keyword(s):  
Population Based ◽  
Cerebrovascular Diseases ◽  
Disability Adjusted Life Years ◽  
Population Based Study ◽  
Disability Adjusted Life ◽  
Life Years ◽  
National Burden

scholarly journals Global Burden of Stroke

2018 ◽  
Vol 38 (02) ◽  
pp. 208-211 ◽  
Author(s):  
Mira Katan ◽  
Andreas Luft
Keyword(s):  
Hemorrhagic Stroke ◽  
Middle Income ◽  
Stroke Incidence ◽  
Middle Income Countries ◽  
The Past ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Incidence And Mortality ◽  
Geographical Regions ◽  
Life Years Lost

AbstractStroke is the second leading cause of death and a major cause of disability worldwide. Its incidence is increasing because the population ages. In addition, more young people are affected by stroke in low- and middle-income countries. Ischemic stroke is more frequent but hemorrhagic stroke is responsible for more deaths and disability-adjusted life-years lost. Incidence and mortality of stroke differ between countries, geographical regions, and ethnic groups. In high-income countries mainly, improvements in prevention, acute treatment, and neurorehabilitation have led to a substantial decrease in the burden of stroke over the past 30 years. This article reviews the epidemiological and clinical data concerning stroke incidence and burden around the globe.

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

Stroke ◽  
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.

Abstract P287: Sex Differences in Stroke Incidence: The REGARDS Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Virginia J Howard ◽  
Suzanne E Judd ◽  
Abraham J Letter ◽  
Dawn O Kleindorfer ◽  
Leslie A McClure ◽  
...  
Keyword(s):  
Sex Differences ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Population Based ◽  
Incidence Rates ◽  
National Data ◽  
Stroke Incidence ◽  
The Difference ◽  
Regards Study

Background: There are strikingly few national data available to describe sex differences in age-specific stroke incidence. Methods: REGARDS is a national, population-based, longitudinal study of black and white participants aged > 45 years old, with oversampling of blacks and residents of the stroke belt. Between 2003 and 2007, 30,239 participants were enrolled and examined; follow-up is every 6 months by telephone for self- or proxy-reported stroke, with retrieval and adjudication of medical records by physicians. This analysis included 27,756 participants with follow up data who had no physician-diagnosed stroke at baseline. Stroke incidence rates were calculated as the number of stroke events divided by the person-years at risk with 95% confidence limits. Proportional hazards models were used to assess the race-specific association of sex with stroke risk by age strata (<65, 65–74, and 75+) after adjustment for socioeconomic factors, and Framingham stroke risk factors. Results: There were 613 incident strokes events over 135,551 person-years of follow-up. Stroke incidence rates increased with age (from 237/100,000 to 1003/100,000), and were higher in men than women in both blacks and whites (left panel of figure). After multivariable adjustment, men had higher risk than women at younger ages (<75) but for the 65–75 age group, the difference is larger for blacks than whites (right panel of figure). Discussion: These national data confirm the patterns in male/female stroke risk observed in the Greater Cincinnati/Northern Kentucky Stroke Study, with smaller sex differences at older ages, and for men, larger excess risk in whites than blacks.

Risk factor intervention at the population level

ESC CardioMed ◽  
2018 ◽  
pp. 873-882
Author(s):  
Eva Prescott ◽  
Torben Jørgensen ◽  
Maja-Lisa Løchen ◽  
Jonathan Pearson-Stuttard ◽  
Simon Capewell
Keyword(s):  
Cardiovascular Health ◽  
Environmental Changes ◽  
Population Level ◽  
Population Based ◽  
Entire Life ◽  
Individual Level ◽  
Convenience Stores ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Unhealthy Diet

Great health benefits can be achieved if preventive efforts are focused on whole populations rather than mainly on high-risk individuals. Tobacco smoking, unhealthy diet, physical inactivity, alcohol abuse, and air pollution are responsible for a large proportion of global deaths and loss of disability-adjusted life years and there are documented effects of interventions at the population level on all of these factors. Population-based strategies include fiscal measures (i.e. taxation and subsidies), international, national, and regional policy regulations and legislation (e.g. smoke-free policies, rules for marketing, food production), and environmental changes (e.g. access to recreational areas, convenience stores), and have the advantages of addressing cardiovascular health over the entire life course, reducing health inequalities and saving costs when compared to individual-level interventions.

scholarly journals Geospatial and seasonal variation of bronchiolitis in England: a cohort study using hospital episode statistics

Thorax ◽  
2020 ◽  
Vol 75 (3) ◽  
pp. 262-268 ◽  
Author(s):  
Kate Marie Lewis ◽  
Bianca De Stavola ◽  
Pia Hardelid
Keyword(s):  
Hospital Admissions ◽  
Warning System ◽  
Incidence Rates ◽  
Demographic Characteristics ◽  
North West ◽  
Admission Rates ◽  
The North ◽  
Public Health Messages ◽  
Low Levels ◽  
English National Health

BackgroundRates of hospital admissions for bronchiolitis vary seasonally and geographically across England; however, seasonal differences by area remain unexplored. We sought to describe spatial variation in the seasonality of hospital admissions for bronchiolitis and its association with local demographic characteristics.MethodsSingleton children born in English National Health Service hospitals between 2011 and 2016 (n=3 727 013) were followed up for 1 year. Poisson regression models with harmonic functions to model seasonal variations were used to calculate weekly incidence rates and peak timing of bronchiolitis admissions across English regions and clinical commissioning groups (CCGs). Linear regression was used to estimate the joint association of population density and deprivation with incidence and peak timing of bronchiolitis admissions at the CCG level.ResultsBronchiolitis admission rates ranged from 30.9 per 1000 infant-years (95% CI 30.4 to 31.3) in London to 68.7 per 1000 (95% CI 67.9 to 69.5) in the North West. Across CCGs, there was a 5.3-fold variation in incidence rates and the epidemic peak ranged from week 49.3 to 52.2. Admission rates were positively associated with area-level deprivation. CCGs with earlier peak epidemics had higher population densities, and both high and low levels of deprivation were associated with earlier peak timing.ConclusionsApproximately one quarter of the variation in admission rates and two-fifths of the variation in peak timing of hospital admissions for bronchiolitis were explained by local demographic characteristics. Implementation of an early warning system could help to prepare hospitals for peak activity and to time public health messages.

Secular Trends of Stroke Epidemiology in Örebro, Sweden, 2017 Compared to the Trends in 1999: A Population-Based Study

2019 ◽  
Vol 48 (3-6) ◽  
pp. 149-156 ◽  
Author(s):  
Peter Appelros
Keyword(s):  
Length Of Stay ◽  
Incidence Study ◽  
Large Population ◽  
Case Fatality ◽  
Population Based ◽  
Incidence Rates ◽  
European Population ◽  
Stroke Severity ◽  
Stroke Incidence ◽  
Preventive Medication

Background and Purpose: A stroke incidence study in ­Örebro, situated in Southern Sweden, that was carried out in 1999 showed high incidence rates. Since then, in many Western countries, declining incidence rates have been observed. The main purpose of this study is to examine whether there have been any changes in stroke incidence in the city of ­Örebro between 1999 and 2017. Secondary purposes are to show trends in stroke severity, length of stay and case fatality (CF). Methods: The criterion of an “ideal” stroke incidence study was used in both the 1999 and the present investigation. These criteria include uniform diagnostics, case ascertainment including strokes managed outside the hospital, and the use of several overlapping sources, prospective design, well-defined denominator, and a large population. Results: The overall stroke incidence rate of first ever stroke (adjusted to the 2013 European population) dropped from 346/100,000 (95% CI 314–380) to 168/100,000 (95% CI 148–190). Stroke severity declined from a median of 6 to 4 points on the National Institute of Health Stroke scale. CF within 28 days also declined from 19 to 16% (n.s.). Median length-of-stay in hospital was 16 days in 1999, and 10 days in 2017. Twenty-one per cent of all kinds of stroke were recurrent (not included in the above results). Conclusions: During the years between 1999 and 2017, there have been reductions in stroke incidence, severity and mortality. The explanation is most likely to be found in the prevalence of risk factors and how they are treated. The use of antihypertensives and statins has increased, corresponding to lower levels of blood pressure and cholesterol in the population. The use of anticoagulants in patients with atrial fibrillation has increased. Cigarette smoking has decreased. These are encouraging results that show that preventive medication and public health measures work in practice.

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