National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014

Abstract

Background and Purpose— Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, <65 years old), an increase in the incidence of ischemic stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. Methods— Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. Results— From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients <65 years old and decreased by 1.5% in those aged ≥65 years. The rate of patients hospitalized for hemorrhagic stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. Conclusions— An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management.

Changes in survival and characteristics among older stroke unit patients—1994 versus 2012

“…Our main finding of unchanged survival appears surprising given the general decrease in stroke mortality worldwide (Feigin et al, ); however, secular trends in stroke case fatality within different populations are inconsistent, with some studies reporting decreasing fatality (Arboix et al, ; Feigin et al, ; Lee et al, ; Nimptsch & Mansky, ), while others report stable rates (Carrera et al, ; Feigin et al, ; Fuentes et al, ; Rothwell et al, ). The majority of studies on survival after stroke include nonhospitalized strokes (Feigin et al, ; Lecoffre et al, ; Lee et al, ; Numminen et al, ; Rothwell et al, ; Wieberdink et al, ), or strokes treated in hospital but not necessarily on an SU (Appelros et al, ; Arboix et al, ; Carrera et al, ; Nimptsch & Mansky, ). All of the patients in the present study received treatment on a comprehensive SU with consistent protocols, where the main treatment advance, thrombolysis, while improving outcomes for survivors, has not been shown to better survival (Wardlaw, Murray, Berge, & Zoppo, )—and this was also observed in our population by a nonsignificant HR in the adjusted Cox regression model (Supporting Information Table S1).…”

“…Existing studies reporting trends in stroke risk factors or outcomes include either both hospitalized and nonhospitalized patients (Feigin et al, ; Feigin, Lawes, Bennett, Barker‐Collo, & Parag, ; Lecoffre et al, ; Lee, Shafe, & Cowie, ; Numminen, Kaste, Aho, Waltimo, & Kotila, ; Rothwell et al, ; Wieberdink, Ikram, Hofman, Koudstaal, & Breteler, ), or patients treated in hospital, but not necessarily on an SU (Appelros et al, ; Arboix et al, ; Carrera, Maeder‐Ingvar, Rossetti, Devuyst, & Bogousslavsky, ; Nimptsch & Mansky, ). Several do not examine changes in survival outcomes (Bembenek et al, ; Lecoffre et al, ; Teuschl et al, ; Wieberdink et al, ), and none of these papers report on long‐term survival. We were interested in whether there have been changes in survival among patients receiving SU treatment specifically.…”

Income inequalities in stroke incidence and mortality: Trends in stroke-free and stroke-affected life years based on German health insurance data

“…This applies also to Germany, where the majority of studies reported declining or constant incidence rates over time [16][17][18]. Due to improvements in treatment and rehabilitation mortality after stroke has declined continuously over the last decades, thus leading to prolonged survival after stroke incidence [3,[19][20][21][22]. Because of these mortality declines, stable proportions of lifetime prevalence have been reported for Germany despite decreasing or constant rates of stroke incidence [23].…”

The peripheral immune response after stroke—A double edge sword for blood‐brain barrier integrity

“…Ischemic stroke is one of the most common neurological disorders and a major cause of disability and death with limited transitional success of mounting stroke researches, posing an economic and societal burden . Under normal condition, the brain is under continuous immune surveillance and regulation.…”