A Prospective Community-Based Study of Stroke in Southern Italy: The Vibo Valentia Incidence of Stroke Study (VISS)

Abstract

Background and Purpose: Data on stroke morbidity are lacking in southern Italy, an area with about 20 million inhabitants and a mean income lower than the rest of the country. Therefore a population-based stroke register was established to determine incidence and case fatality in the Province of Vibo Valentia, Calabria. Methods: The survey was conducted among the 179,186 residents. Standard definitions and multiple case-finding procedures were employed. All identified cases of first-ever stroke were followed at 28 days, 3 and 12 months. The registration started on January 1, 1996, and ended on December 31, 1996. Results: A total of 321 first-ever-in-a-lifetime strokes were identified. The crude annual incidence rate was 1.79 (95% CI 1.60–1.99) per 1,000 inhabitants. Rates age-standardized to the 1996 Italian population and to the standard European population were, respectively, 1.99 (95% CI 1.79–2.20) and 1.36 (95% CI 1.19–1.53) per 1,000 inhabitants. A subtype diagnosis was reached in 96% of patients. The crude annual incidence rates per 1,000 inhabitants were 1.31 for cerebral infarction, 0.35 for intracerebral hemorrhage, 0.06 for subarachnoid hemorrhage, and 0.07 for unspecified stroke. Overall case fatality was 23.7% at 28 days, 27.4% at 3 months and 40.2% at 12 months. Conclusions: This is the first prospective population-based stroke register established in southern Italy. Incidence and case fatality were comparable to those previously reported in northern and central Italy and other industrialized countries. Our estimates are useful for developing management services and allocating resources.

Time trends in outcome of subarachnoid hemorrhage

“…Exclusion of 2 studies 12,14 which did not report 1-month outcomes, and 1 study with an exceptionally low case-fatality rate of 8%, 39 did not substantially alter the results. Eighteen studies including our own 11,13,[21][22][23][24][25][27][28][29][31][32][33]35,37,38 reported the mean age of cases with SAH and proportion of women. After adjustment for age and sex, there was a similar but nonsignificant reduction in case-fatality of 0.9% per annum (Ϫ0.2 to 2.0%, p ϭ 0.10).…”

Hemorrhagic and Ischemic Strokes Compared

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Even in large stroke cohorts absolute numbers of HS are low, rendering statistical validation of differences between the 2 types of stroke difficult. [1][2][3][4][5][6][7][8][9][10][11][12][13] Hence, our knowledge of this issue is still incomplete.…”

Stroke Unit care in Italy. Results from PROSIT (Project on Stroke Services in Italy). A nationwide study

“…Nevertheless, the study demonstrated an overall shortage of stroke unit beds, which was clearer in the central and southern parts of the country. This geographic disparity, documented also by others [15,16], is not related to the variation of the population needs, because the stroke incidence in the south is similar to that of the northern regions [17]. A shortage of acute SU beds is also evident in many European countries where the percent of stroke patients hospitalised in a SU bed ranged from 5% to 40%.…”