The Third Stroke Registry in Tartu, Estonia

Background and Purpose— Seldom studies are available on trends in stroke incidence in blacks. We aimed to evaluate whether stroke risk prevention policies modified first-ever stroke incidence and outcomes in the black Afro-Caribbean population of Martinique. Methods— Etude Réalisée en Martinique et Centrée sur l’Incidence des Accidents Vasculaires Cérébraux (ERMANCIA) I and II are 2 sequential prospective population-based epidemiological studies. There have assessed temporal trends in first-ever stroke incidence, risk factors, pathological types, and early outcomes in the black Afro-Caribbean population of Martinique comparing two 12-month periods (1998–1999 and 2011–2012). Crude and age-standardized incidence and 30-day outcomes for stroke in the 2 study periods were compared using Poisson regression. Results— We identified 580 and 544 first-ever strokes in the 2 studies. World age-standardized incidence rates decreased by 30.6% in overall (111 [95% confidence interval, 102–120] versus 77 [95% confidence interval, 70–84]). Rate decline was greater in women than in men (34% versus 26%) particularly in women aged 65 to 74 years (−69%) and 75 to 84 years (−43%). Frequencies of hypertension and diabetes mellitus were unchanged, whereas dyslipidemia, smoking, and atrial fibrillation significantly increased. Only ischemic stroke types showed significant rate reduction in overall and in women, incidence rate ratio (95% confidence intervals) of 0.69 (0.50–0.97) and 0.61 (0.42–0.88), respectively. The overall 30-day case-fatality ratio remained stable (19.3%/17.6%), whereas a better 30-day outcome was found (modified Rankin Score, ≤2 in 47%/37.6%; P =0.03). Conclusions— Over 13 years, there has been a significant decrease (30.6%) in the age-specific first-ever stroke incidence in our Afro-Carribean population. Although prevention policies seem effective, we need to focus on new risk factors limitation and on male population adherence to prevention program.

Section: Discussionsupporting

confidence: 90%

Section: Strokementioning

confidence: 99%

Trends in Incidence and Early Outcomes in a Black Afro-Caribbean Population From 1999 to 2012

Olindo

Chausson

Mejdoubi

et al. 2014

“…Regarding data from Eastern Europe, incidence rates are similar to those from Tartu 14,15 In all comparisons, the different study periods need to be observed.…”

Section: Discussionmentioning

confidence: 88%

Stroke Incidence and Survival in Ludwigshafen am Rhein, Germany

Palm

Urbanek

Rose

et al. 2010

Background and Purpose-Considerable locoregional differences in stroke incidence exist even within countries. Based on data from a statewide stroke care quality monitoring project, we hypothesized a high stroke incidence mainly among younger age groups in the industrial city of Ludwigshafen am Rhein, Germany. To test this hypothesis and to provide data on stroke incidence and case-fatality rates, a population-based stroke register was initiated. were identified. The crude annual incidence rate per 1000 for first-ever stroke was 2.16 (95% CI 2.10 to 2.32). After age adjustment to the European population, incidence for first-ever stroke was 1.46 (95% CI 1.35 to 1.57; men: 1.63; 95% CI 1.46 to 1.81; women: 1.29; 95% CI 1.15 to 1.43). Crude annual incidence rates per 1000 were 1.86 for ischemic stroke, 0.19 for intracerebral hemorrhage, 0.05 for subarachnoid hemorrhage, and 0.05 for undetermined stroke. Case-fatality rates for first-ever stroke were 13.6%, 16.4%, and 23.2% at Days 28, 90, and 365, respectively. Conclusions-High crude incidence rates in our study reflect the rising burden of stroke in our aging population. Methods-TheAge-adjusted incidence rates were somewhat higher than those reported by recent studies from Western Europe, mainly due to higher incidence in subjects Ͻ65 years. (Stroke.

“…67,68 Although one study found that mean age at first stroke increased among women, and was unchanged among men, 20 many studies have shown a trend toward higher age in both sexes with time. 24,39,67 Some studies have shown an unchanged mean age, 30,32 and one study even a declining age at first-ever stroke. 66 …”

Section: Secular Trendsmentioning

confidence: 98%

Sex Differences in Stroke Epidemiology

Appelros

Stegmayr²,

Terént³

2009

865

621

Background and Purpose-Epidemiological studies, mainly based on Western European surveys, have shown that stroke is more common in men than in women. In recent years, sex-specific data on stroke incidence, prevalence, subtypes, severity and case-fatality have become available from other parts of the world. The purpose of this article is to give a worldwide review on sex differences in stroke epidemiology. Methods-We searched PubMed, tables-of-contents, review articles, and reference lists for community-based studies including information on sex differences. In some areas, such as secular trends, ischemic subtypes and stroke severity, noncommunity-based studies were also reviewed. Male/female ratios were calculated. Results-We found 98 articles that contained relevant sex-specific information, including 59 incidence studies from 19 countries and 5 continents. The mean age at first-ever stroke was 68.6 years among men, and 72.9 years among women. Male stroke incidence rate was 33% higher and stroke prevalence was 41% higher than the female, with large variations between age bands and between populations. The incidence rates of brain infarction and intracerebral hemorrhage were higher among men, whereas the rate of subarachnoidal hemorrhage was higher among women, although this difference was not statistically significant. Stroke tended to be more severe in women, with a 1-month case fatality of 24.7% compared with 19.7% for men. Conclusions-Worldwide, stroke is more common among men, but women are more severely ill. The mismatch between the sexes is larger than previously described.