Does the incidence, severity, or case fatality of stroke vary in southern England?

Abstract

Study objectives-To determine differences in incidence and case fatality of stroke in district health authorities with differing standardised mortality ratios (SMR) for stroke im residents aged under 65 years in whom death from stroke is considered 'avoidable'. Design-Registration of first ever strokes in three district health authorities. Patients were assessed and followed up over one year by one of three observers. Measurements and main results-Age specific incidence rates and survival time from stroke to death. Severity was assessed in terms ofthe level of consciousness and the presence of speech, urinary, and motor impairment within the first 24 hours of the stroke.Altogether 386 strokes were registered. There was a significant difference in the incidence rate between district health authorities in those aged under 65 (p<0.01). The overall case fatality was 26% at three weeks with no significant difference between the districts. Poor survival was associated jointly with increased age and with coma, incontinence, and swallowing impairment in the first 24 hours after a stroke.Conclusions-The SMRs for stroke in those aged under 65 in these three health districts reflect the incidence ofstroke. Case fatality at three weeks does not vary between these districts and consequently would not be a sensitive indicator ofthe quality ofcare. This also suggests that differences in services between the districts did not lead to changes in prognosis. In districts with high SMRs for stroke there is a need for further study and reduction of risk factors, thereby reducing the incidence and burden of stroke locally. This study provides a framework for assessing the needs for stroke prevention and treatment in both rural and urban areas without an elaborate protocol and detailed neurological assessment. Jf Epidemiol Community Health 1993; 47: 139-143 Stroke is one of the commonest causes of physical disability and death in adults' 2 but for someone

Risk Factors for Myocardial Infarction Case Fatality and Stroke Case Fatality in Type 2 Diabetes

“…First, for compatibility with the existing risk engine equations, variables were constrained to age at diagnosis of diabetes, time to event, sex, ethnic group, smoking, HbA 1c , sBP, and lipid ratio (total cholesterol:HDL cholesterol). Second, to minimize the risk of type I error, variables were tested at the 0.5% rather than 5% significance level, except where the literature already strongly supported a variable as a case fatality risk factor: for MI, age (5, [27][28][29], and previous MI (30,31) and for stroke, age (32)(33)(34)(35)(36)(37), sex (37,38 -41), and previous stroke (39,40). Tests were carried out for interactions between all variables that were found significant.…”

Western and Central Europe

“…The data items collected on stroke at the time of maximum impairment have been used in many previous registers [13][14][15] and are considered robust for stroke research, although between-center, interobserver studies have not been undertaken. The level of detail decided on was a balance between those factors known to predict outcome 21 and the feasibility of data collection in 12 centers across Europe in a routine manner.…”

“…Data collection related to first-ever stroke admissions according to the World Health Organization definition. 13 Stroke-specific data questionnaires were developed, and well-validated case mix variables were collected by dedicated data collectors in each center 10 ; these were developed from previous register questionnaires formulated by participants 14,15 and were in agreement with those used by the MONICA Stroke Study. 3 Baseline information used for these analyses included demographic factors (ie, age, sex, prestroke modified Rankin score, 16 living condition before stroke); case mix, including risk factors at the time of maximum impairment within the first 7 days (level of consciousness subsequently dichotomized into 2 categories of coma or noncoma, 17 site of plegia/paresis, speech or swallowing problems as a result of stroke, incontinence [including catheterization]); type of stroke (cerebral infarction or hemorrhage, subarachnoid hemorrhage); use of hospital resources (type of bed, eg, medical, neurological, intensive care, surgery, rehabilitation, private, other; length of stay in acute hospital wards); use of major diagnostic tests (brain imaging, angiography, carotid Doppler); and major therapeutic interventions (neurosurgery).…”

“…Data were prospectively collected by dedicated personnel in each center using a standardized questionnaire determined at the beginning of the project 11 on the basis of previously published register questionnaires. 14,15 There was regular 6-month feedback with centers at meetings to discuss problems with data collection and interpretation of questions, and a manual was written to aid standardization. The centers were self-selected and contained physicians or researchers with an interest in stroke.…”

“…A manual of definitions was distributed to all centers. The clinical data items were routinely collected in the centers and have been collected for population studies in Europe previously [13][14][15] ; they consist of clinical assessments undertaken at bedside in each center. Issues regarding data collection, interpretation, and quality were discussed at the site visits and at 6 monthly meetings of the group during the 3 years of the project.…”