Incidence, Event Rates, and Early Outcome of Stroke in Dublin, Ireland

Abstract

Background and Purpose-The World Health Organization has emphasized the importance of international populationbased data for unbiased surveillance of stroke incidence and outcome. To date, few such studies have been conducted using recommended gold-standard ascertainment methods. We conducted a large, population-based stroke study in Dublin, Ireland. Methods-Using gold-standard ascertainment methods, individuals with stroke and transient ischemic attack occurring over a 12-month period (December 1, 2005-November 30, 2006 in North Dublin were identified. Disability was assessed using the modified Rankin score and stroke severity (Ͻ72 hours) by the National Institutes of Health Stroke Scale. Stroke-related deaths were confirmed by review of medical files, death certificates, pathology, and coroner's records. Crude and standardized (to European and World Health Organization standard populations) rates of incidence, risk factors, severity, and early outcome (mortality, case-fatality, disability) were calculated, assuming a Poisson distribution for the number of events. Results-Seven hundred one patients with new stroke or transient ischemic attack were ascertained (485 first-ever stroke patients, 83 recurrent stroke patients, 133 first-ever transient ischemic attack patients). Crude frequency rates (all rates per 1000 person-years) were: 1.65 (95% CI, 1.5-1.79; first-ever stroke), 0.28 (95% CI, 0.22-0.35; recurrent stroke), and 0.45 (95% CI, 0.37-0.53; first-ever transient ischemic attack). Age-adjusted stroke rates were higher than those in 9 other recent population-based samples from high-income countries. High rates of subtype-specific risk factors were observed (atrial fibrillation, 31.3% and smoking, 29.1% in ischemic stroke; warfarin use, 21.2% in primary intracerebral hemorrhage; smoking, 53.9% in subarachnoid hemorrhage; PϽ0.01 for all compared with other subtypes). Compared with recent studies, 28-day case-fatality rates for primary intracerebral hemorrhage (41%; 95% CI, 29.2%-54.1%) and subarachnoid hemorrhage (46%; 95% CI, 28.8%-64.5%) were greater in Dublin. Conclusions-Using gold-standard methods for case ascertainment, we found high incidence rates of stroke in Dublin compared with those in similar high-income countries; this is likely explained in part by high rates of subtype-specific risk factors. (Stroke. 2012;43:2042-2047.)Key Words: acute stroke Ⅲ cerebrovascular disease Ⅲ epidemiology Ⅲ health policy Ⅲ outcomes C ardiovascular diseases are the leading cause of death globally, with almost 6 million deaths attributable to stroke in 2005. 1 Stroke incidence rates are increasing rapidly in lowand middle-income countries, whereas substantial increases in the absolute numbers of individuals affected by stroke are projected in high-income countries, because of lifestyle changes and increasing population life-expectancy. [2][3][4] To develop policy, health-service, and public health measures to address the challenge of increasing global stroke frequency, the World Health Organization has emphasized the ...

Adelaide Stroke Incidence Study

“…7 Retrospective data were collected in 28 events in which no examination was possible. The median NIHSS was 6 (interquartile range, [2][3][4][5][6][7][8][9][10][11][12][13][14]. Neuroimaging was performed in 301 strokes (95% of total), including 229 (96%) of patients with first-ever stroke.…”

Changes in Functional Outcome Over the First Year After Stroke

“…In 2010, the number of stroke survivors was estimated to 33 million, illustrating the effect of stroke on society. [1][2][3] There are many reports on short-term survival and functional outcome after stroke, [4][5][6][7] and assessment of outcomes at 3 months is common standard in acute stroke trials. Few studies have assessed functional outcome in the longer term, and in particular, longitudinal studies with multiple assessment points are scarce.…”

Perfil Social e Funcional dos Usuários da Estratégia Saúde da Família com Acidente Vascular Encefálico

“…No presente estudo, observou-se predominância de indivíduos analfabetos, residentes em casa própria e que a principal fonte de renda era a aposentadoria. Cavalcante et al, encontraram em sua amostra de pacientes com AVE, uma escolaridade média de 4,3 anos e renda de 513 reais 8 . Enquanto isso, no município de Vassouras -RJ, 61% da amostra com AVC avaliada era composta por aposentados, 70% residentes em zona urbana, 46% com grau de escolaridade até a 4º série e 26% de analfabetos 5 .…”

“…Por se tratar de uma das principais causas de morbi-mortalidade no mundo, além de proporcionar incapacidades motoras e cognitivas, o AVE é uma doença comum e de grande impacto na saúde pública [2][3][4] . No Brasil, o AVE ainda é uma das principais causas de morte 4,6 , onde as projeções para o ano de 2015 e 2030 expressam números alarmantes, com expectativa de 18 e 23 milhões de novos casos no mundo As crescentes mudanças no estilo e expectativa de vida associadas com o aumento dos fatores de risco para as doenças cerebrovasculares podem servir como justificativa para a grande incidência do AVE 8,9 . O conhecimento e percepção dos fatores de risco são medidas essenciais para se obter um maior controle da doença e melhor adesão a medidas preventivas.Dentre os principais fatores de risco que podem aumentar a propensão ao AVE, destacam-se os altos perfis lipídicos, diabetes mellitus, sobrepeso e obesidade, além do tabagismo e sedentarismo 10 .…”

“…O conhecimento e percepção dos fatores de risco são medidas essenciais para se obter um maior controle da doença e melhor adesão a medidas preventivas.Dentre os principais fatores de risco que podem aumentar a propensão ao AVE, destacam-se os altos perfis lipídicos, diabetes mellitus, sobrepeso e obesidade, além do tabagismo e sedentarismo 10 . Um estudo realizado em Fortaleza-CE mostrou que 77,2% dos pacientes com AVE eram hipertensos, 23,5% diabéticos, 3,9% tabagistas e 21,2% etilistas 8 . Além disso, os principais dados sobre epidemiologia e fatores de risco associados ao AVE são baseados principalmente em estudos norte-americanos ou europeus e existe uma escassez de resultados dessa patologia em países em desenvolvimento.…”