Trends in stroke incidence, mortality and case fatality rates in Joinville, Brazil: 1995-2006

Abstract

Background: Studying stroke rates in a whole community is a rational way to assess the quality of patient care and primary prevention. However, there are few studies of trends in stroke rates worldwide and none in Brazil. Objective: Established study methods were used to define the rates for first ever stroke in a defined population in Brazil compared with similar data obtained and published in 1995. Methods: All stroke cases occurring in the city of Joinville during 2005-2006 were prospectively ascertained. Crude incidence and mortality rates were determined, and age adjusted rates and 30 day case fatality were calculated and compared with the 1995 data. Results: Of the 1323 stroke cases registered, 759 were first ever strokes. The incidence rate per 100 000 was 105.4 (95% CI 98.0 to 113.2), mortality rate was 23.9 (95% CI 20.4 to 27.8) and the 30 day case fatality was 19.1%. Compared with the 1995 data, we found that the incidence had decreased by 27%, mortality decreased by 37% and the 30 day case fatality decreased by 28%. Conclusions: Using defined criteria we showed that in an industrial southern Brazilian city, stroke rates are similar to those from developed countries. A significant decrease in stroke rates over the past decade was also found, suggesting an improvement in primary prevention and inpatient care of stroke patients in Joinville.It is currently not clear if stroke rates are changing in different parts of the world. The incidence of total stroke in Latin American and Caribbean countries other than Brazil has been found to be between 135 and 151 per 100 000 population in well designed community based studies.1 Only three population based epidemiological studies have been carried out in Brazilian communities where the rates have ranged from 137 to 168 per 100 000 population.2-4 However, those studies were conducted in different decades and in distinct regions, which complicates the interpretation of trends in rates. There have been no comparative studies in which the same population base was analysed at two different time points.A recent study demonstrated a decrease in stroke mortality rates over the past two decades for all Brazilian regions, 5 but it is not clear if this is the result of a decreasing incidence or better health care and management of these patients.Our aim was to determine the incidence, mortality rates and case fatality of stroke in the city of Joinville and compare our results with a prospective, population based study on first ever stroke carried out in 1995 in the same city using similar methods. 3 METHODS Study populationIn the year 2000 census, the population of the city of Joinville was 429 604 inhabitants, and the projection for the year 2005 was 487 047 inhabitants. 6 The city has four general hospitals and one public institutional care facility, totalling 840 beds. All of the hospitals, with the exception of the public institutional care facility, have CT services available on a 24 h basis.

Infectious disease is the most common cause of death among stroke patients: two-years of follow-up

“…In Brazil, the results seem to vary slightly, depending on other factors such as the sample size and the region where the study was conducted, varying from 5 to 24.6% 4,11,12 . These data confirm a global trend of a significant reduction in the death rates related to disease 13 .…”

Incidence and functional outcome of atrial fibrillation and non-atrial fibrillation- related cardioembolic stroke in Joinville, Brazil: a population-based study

“…The Joinville Stroke Registry is an ongoing population-based stroke data bank, which started in 2005, and has been supported by law since 2013 11 . The methods for stroke ascertainment in our registry have previously been published 12 . In brief, we used multiple overlapping sources of ascertainment according to the World Health Organization STEPS criteria 13 .…”

“…All patients underwent at least one brain CT and transthoracic echocardiogram. Stroke diagnosis followed established diagnostic criteria 1,12,14 . The pathophysiological diagnosis of stroke was based on the criteria described in the Trial of ORG 10127 in the Acute Stroke Treatment (TOAST) study 15 .…”

“…The major strength of this study is the population-based design 12 . To define the final ischemic stroke subtype (TOAST classification), all CE stroke patients had cranial CT, ECG and echocardiogram; and more than 80% had carotid ultrasound.…”

Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke

“…In more recent years, improvements in acute stroke care and prevention have led to a decrease in stroke mortality and stroke incidence 15,16,17 .…”