Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study)

Rothwell, P M; Coull, A J; Giles, M.F.; Howard, S C; Silver, L E; Bull, Linda; Gutnikov, Sergei A.; Edwards, Phil; Mant, David; Sackley, Catherine; Farmer, Andrew; Sandercock, P.; Dennis, Saya; Warlow, C P; Bamford, J.; Anslow, Philip

doi:10.1016/s0140-6736(04)16405-2

Cited by 988 publications

(886 citation statements)

References 41 publications

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“…Our data using supporting evidence to confirm diagnosis among 80% of patients with a stroke code also agree with that of a previous GPRD cerebrovascular disease validation study [34]. We have also compared our rates of stroke in the comparison group without diabetes with that of the Oxford Vascular Study [36], and those in the diabetes group with those published by McAlpine et al [37], and the findings are remarkably consistent. Thus although we acknowledge that a database study such as this is limited in as far as the study population is not a true inception cohort, we believe that the data from this study are reliable and can be generalised to the UK.…”

Section: Discussionsupporting

confidence: 89%

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

et al. 2006

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Aims/hypothesis Risk estimates for stroke in patients with diabetes vary. We sought to obtain reliable risk estimates for stroke and the association with diabetes, comorbidity and lifestyle in a large cohort of type 2 diabetic patients in the UK. Materials and methods Using the General Practice Research Database, we identified all patients who had type 2 diabetes and were aged 35 to 89 years on 1 January 1992. We also identified five comparison subjects without diabetes and of the same age and sex. Hazard ratios (HRs) for stroke between January 1992 and October 1999 were calculated, and the association with age, sex, body mass index, smoking, hypertension, atrial fibrillation and duration of diabetes was investigated. Results The absolute rate of stroke was 11.91 per 1,000 person-years (95% CI 11.41-12.43) in people with diabetes (n=41,799) and 5.55 per 1,000 person-years (95% CI 5.40-5.70) in the comparison group (n=202,733). The ageadjusted HR for stroke in type 2 diabetic compared with non-diabetic subjects was 2.19 (95% CI 2.09-2.32) overall, 2.08 (95% CI 1.94-2.24) in men and 2.32 (95% CI 2.16-2.49) in women. The increase in risk attributable to diabetes was highest among young women (HR 8.18; 95% CI 4.31-15.51) and decreased with age. No investigated comorbidity or lifestyle characteristic emerged as a major contributor to risk of stroke. Conclusions/interpretation This study provides risk estimates for stroke for an unselected population from UK general practice. Patients with type 2 diabetes were at an increased risk of stroke, which decreased with age and was higher in women. Additional risk factors for stroke in type 2 diabetic patients included duration of diabetes, smoking, obesity, atrial fibrillation and hypertension.

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Section: Discussionsupporting

confidence: 89%

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

et al. 2006

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“…In general, the trends in stroke incidence and mortality rates have decreased in the recent decades for high-income countries such as the U.S., the United Kingdom, and Canada [83][84][85][86]. Analyses from the Framingham Study revealed a decrease in stroke incidence for the past 50 years, although the lifetime risk of stroke did not decrease to the same degree [86]; this may reflect both an improvement in risk factor control, as well as an improvement in life expectancy.…”

Section: Trends In Strokementioning

confidence: 99%

“…Analyses from the Framingham Study revealed a decrease in stroke incidence for the past 50 years, although the lifetime risk of stroke did not decrease to the same degree [86]; this may reflect both an improvement in risk factor control, as well as an improvement in life expectancy. Population-based studies in Oxfordshire (United Kingdom) showed a major reduction in age-and genderspecific stroke incidence for the past 20 years [85]. This decline was found to be associated with an increased use of preventative treatment and better control of vascular risk factors, including hypertension, hyperlipidemia, and smoking.…”

Section: Trends In Strokementioning

confidence: 99%

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

2011

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Stroke is the fourth killer and number one cause of adult disability in the United States. The estimated direct and indirect costs of stroke care in this country are $68.9 billion for 2009. The prevalence of stroke and its cost will undoubtedly rise as the aging population increases. In addition, stroke incidence and mortality are increasing in less developed countries in which the lifestyles and population restructuring are rapidly changing. More population-based research to assess incidence, risk factors, and outcomes are needed in these countries. Epidemiologic studies can help identify groups of individuals or regions at higher risk for stroke. They can also help us better understand the natural history of certain conditions and therefore push the direction of therapeutic investigations. Furthermore, the study of trends across different time periods and different populations can help investigators evaluate the effects of stroke care programs and treatment options.

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“…With an aging population and a decline in mortality after stroke,4 the rates of poststroke cognitive impairment will increase. Despite being as common as other neurological deficits, such as motor and sensory, cognitive impairment is often overlooked in the follow‐up of stroke survivors unless they have progressed to dementia 5.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Effect of Stroke on Cognition: A Systematic Review

Tang

Amiesimaka

Harrison

et al. 2018

JAHA

144

114

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BackgroundStroke is associated with an increased risk of dementia; however, the impact of stroke on cognition has been found to be variable, such that stroke survivors can show decline, remain stable, or revert to baseline cognitive functioning. Knowing the natural history of cognitive impairment after stroke is important for intervention. The aim of this systematic review is to investigate the longitudinal course of cognitive function in stroke survivors.Methods and ResultsThree electronic databases (Medline, Embase, PsycINFO) were searched using OvidSP from inception to July 15, 2016. Longitudinal studies with ≥2 time points of cognitive assessment after stroke were included. In total, 5952 articles were retrieved and 14 were included. There was a trend toward significant deterioration in cognitive test scores in stroke survivors (8 studies). Cognitive stability (3 studies) and improvement (3 studies) were also demonstrated, although follow‐up time tended to be shorter in these studies. Variables associated with impairment included age, ethnicity, premorbid cognitive performance, depression, stroke location, and history of previous stroke. Associations with APOE*E4 (apolipoprotein E with the E4 allele) allele status and sex were mixed.ConclusionsStroke is associated with an increased risk of cognitive decline, but cognitive decline is not a consequence. Factors associated with decline, such as sociodemographic status, health‐related comorbidity, stroke history, and clinical features could be used in models to predict future risk of dementia after stroke. A risk model approach could identify patients at greatest risk for timely intervention to reduce the frequency or delay the onset of poststroke cognitive impairment and dementia.

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Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study)

Cited by 988 publications

References 41 publications

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

Longitudinal Effect of Stroke on Cognition: A Systematic Review

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