Temporal trends in stroke incidence and case-fatality rates in Arcadia, Greece: A sequential, prospective, population-based study

Karantali, Eleni; Vemmos, Konstantinos; Tsampalas, Evangelos; Xynos, Konstantinos; Karachalia, Persefoni; Lambrou, Dimitris; Angeloglou, Stella; Kazakou, Maria; Karagianni, Aikaterini; Aravantinou-Fatorou, Konstantina; Karakatsani, Eleftheria; Bots, Michiel L.; Karamatzianni, Georgia; Bellos, Stavros; Ntiloudis, Romanos; Lypiridou, Maria; Gamvoula, Anastasia; Georgiopoulos, Georgios; Ajdini, Erold; Gatselis, Nikolaos; Makaritsis, Konstantinos; Korompoki, Eleni; Ntaios, George

doi:10.1177/1747493021995594

Cited by 6 publications

(5 citation statements)

References 37 publications

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“…Our search of databases and other sources (eFigure 2 in the Supplement) identified 29 221 records, with 463 potentially relevant full-text articles assessed after screening of titles and abstracts. Of these, 49 eligible published studies (eFigure 2 and eTable 3 in the Supplement) reported some data on temporal trend in incidence of stroke at younger ages with ascertainment until at least 1990. The addition of our own data resulted in 50 studies (Table 1 and eTable 4 in the Supplement; 20 prospective population-based studies and 30 based on routinely collected administrative data).…”

Section: Resultsmentioning

confidence: 99%

Diverging Temporal Trends in Stroke Incidence in Younger vs Older People

Scott

Rothwell

2022

JAMA Neurol

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ImportanceOverall stroke incidence is falling in high-income countries, but data on time trends in incidence of young stroke (ie, stroke in individuals younger than 55 years) are conflicting. An age-specific divergence in incidence, with less favorable trends at younger vs older ages, might be a more consistent underlying finding across studies.ObjectiveTo compare temporal trends in incidence of stroke at younger vs older ages in high-income countries.Data SourcesPubMed and EMBASE were searched from inception to February 2022. One additional population-based study (Oxford Vascular Study) was also included.Study SelectionStudies reporting age-specific stroke incidence in high-income countries at more than 1 time point.Data Extraction and SynthesisFor all retrieved studies, 2 authors independently reviewed the full text against the inclusion criteria to establish their eligibility. Meta-analysis was performed with the inverse variance–weighted random-effects model. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed.Main Outcomes and MeasuresThe main outcome was age-specific divergence (&lt;55 vs ≥55 years) in temporal trends in stroke incidence (relative temporal rate ratio [RTTR]) in studies extending to at least 2000. RTTRs were calculated for each study and pooled by random-effects meta-analysis, with stratification by administrative vs prospective population-based methodology, sex, stroke subtype (ischemic vs intracerebral hemorrhage vs subarachnoid hemorrhage) and geographical region.ResultsAmong 50 studies in 20 countries, 26 (13 prospective population-based and 13 administrative studies) reported data allowing calculation of the RTTR for stroke incidence at younger vs older ages across 2 or more periods, the latest extending beyond 2000. Reported trends in absolute incidence of young individuals with stroke were heterogeneous, but all studies showed a less favorable trend in incidence at younger vs older ages (pooled RTTR = 1.57 [95% CI, 1.42-1.74]). The overall RTTR was consistent by stroke subtype (ischemic, 1.62 [95% CI, 1.44-1.83]; intracerebral hemorrhage, 1.32 [95% CI, 0.91-1.92]; subarachnoid hemorrhage, 1.54 [95% CI, 1.00-2.35]); and by sex (men, 1.46 [95% CI, 1.34-1.60]; women, 1.41 [95% CI, 1.28-1.55]) but was greater in studies reporting trends solely after 2000 (1.51 [95% CI, 1.30-1.70]) vs solely before (1.18 [95% CI, 1.12-1.24]) and was highest in population-based studies in which the most recent reported period of ascertainment started after 2010 (1.87 [95% CI, 1.55-2.27]).Conclusions and RelevanceTemporal trends in stroke incidence are diverging by age in high-income countries, with less favorable trends at younger vs older ages, highlighting the urgent need to better understand etiology and prevention of stroke at younger ages.

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Section: Resultsmentioning

confidence: 99%

Diverging Temporal Trends in Stroke Incidence in Younger vs Older People

Scott

Rothwell

2022

JAMA Neurol

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“…29 Contrasting our findings, data from the Arcadia Stroke Registry in Greece show stable rates already from 1993 to 2016. 30 Data from Auckland, New Zealand 31 and Dijon, France 10 imply increasing incidence rates in young adults. Notably, authors of the Dijon Stroke Registry reported an increase in the incidence of first-ever AIS in 18-to 55-year-old adults from 1985 to 2007, but thereafter, the rates remained stable International Journal of Stroke, 18 (4) until the end of the study in 2017.…”

Section: Discussionmentioning

confidence: 99%

“…Contrasting our findings, data from the Arcadia Stroke Registry in Greece show stable rates already from 1993 to 2016. 30…”

Section: Discussionmentioning

confidence: 99%

Declining first-ever stroke incidence rates in 15- to 54-year-old residents of Tartu, Estonia, from 1991 to 2017

Kõrv

Vibo

Kõrv

2022

International Journal of Stroke

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Background Having a stroke at a young age has a huge socioeconomic impact. Data on the trends of stroke incidence in young adults from prospective population-based studies is scarce. Aims The aim of the current study was to analyze the trends in stroke incidence in 15-54-year-old residents of Tartu, Estonia from 1991 to 2017. Methods Three population-based studies with identical study protocols determining the incidence of first-ever stroke have previously been conducted in Tartu, Estonia (1991 to 1993, 2001 to 2003 and 2013 to 2017). All residents of Tartu with first-ever stroke (ischemic stroke, spontaneous intracerebral hemorrhage, subarachnoid hemorrhage) who were hospitalized to the Department of Neurology, Tartu University Hospital in respective study periods were included prospectively. Overlapping data sources for case ascertainment were used to include both hospitalized and non-hospitalized cases. Trends in first-ever stroke incidence in 15–54-year-old residents of Tartu were calculated and compared using rate ratio (RR). Results Altogether 259 strokes were identified. From 1991 to 2017 the proportion of women increased from 38.3% to 43.6%. Mean age at onset in women decreased from 46.9 (standard deviation (SD) 7.3) to 42.6 (SD 8.9). Overall crude incidence rates per 100 000 decreased significantly from 1991 to 2003 (from 57.2 (95% confidence interval (CI) 46.9-69.1) to 35.7 (95% CI 25.7- 48.3)); RR 0.62 (95% CI 0.44-0.89). While also present in women, the decrease was most notable in 45–54-year-old men (RR 0.55 (95% CI 0.30-0.99)). In 35-44-year-old men the incidence rates decreased significantly from 2001 to 2017 (RR 0.37 (95% CI 0.14-0.99)). Conclusions The overall first-ever stroke incidence rates decreased from 1991 to 2003 and remained stable thereafter.

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“…The burden of stroke in the last decade in Greece fluctuates widely across different regions with an annual stroke incidence ranging from 117 to 534 cases per 100,000 inhabitants [2][3][4]. Despite almost 35,000 patients suffering and 16,000 dying from stroke annually in Greece [1,5], the management in the acute phase of stroke remains heterogeneous.…”

Section: Introductionmentioning

confidence: 99%

Quality Indicators and Clinical Outcomes of Acute Stroke: Results from a Prospective Multicenter Registry in Greece (SUN4P)

Korompoki,

Ntaios,

Tountopoulou

et al. 2024

JCM

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Aim: The Stroke Units Necessity for Patients (SUN4P) project aims to provide essential data on stroke healthcare in Greece. Herein, we present results on established quality indicators and outcomes after first-ever stroke occurrences. Methods: This prospective multicenter study included consecutive patients admitted to nine hospitals across Greece in 2019–2021. Descriptive statistics were used to present patients’ characteristics, key performance measures and stroke outcomes. Results: Among 892 patients, 755 had ischemic stroke (IS) (mean age 75.6 ± 13.6, 48.7% males) and 137 had hemorrhagic stroke (HS) (mean age 75.8 ± 13.2, 57.7% males). Of those, 15.4% of IS and 8% of HS patients were treated in the acute stroke unit (ASU) and 20.7% and 33.8% were admitted to the intensive care unit (ICU) or high-dependency unit (HDU), respectively. A total of 35 (4.6%) out of 125 eligible patients received intravenous alteplase with a door-to needle time of 60 min (21–90). The time to first scan for IS patients was 60 min (31–105) with 53.2% undergoing a CT scan within 60 min post presentation. Furthermore, 94.4% were discharged on antiplatelets, 69.8% on lipid-lowering therapy and 61.6% on antihypertensives. Oral anticoagulants (OAC) were initiated in 73.2% of the 153 IS patients with atrial fibrillation (AF). Among the 687 IS patients who survived, 85.4% were discharged home, 12% were transferred to rehabilitation centers, 1.2% to nursing homes and 1.3% to another hospital. Conclusions: The SUN4P Registry is the first study to provide data from a prospectively collected cohort of consecutive patients from nine representative national hospitals. It represents an important step in the evaluation and improvement of the quality of acute stroke care in Greece.

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Temporal trends in stroke incidence and case-fatality rates in Arcadia, Greece: A sequential, prospective, population-based study

Cited by 6 publications

References 37 publications

Diverging Temporal Trends in Stroke Incidence in Younger vs Older People

Diverging Temporal Trends in Stroke Incidence in Younger vs Older People

Declining first-ever stroke incidence rates in 15- to 54-year-old residents of Tartu, Estonia, from 1991 to 2017

Quality Indicators and Clinical Outcomes of Acute Stroke: Results from a Prospective Multicenter Registry in Greece (SUN4P)

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