Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry

125

Ischemic strokes account for ≈87% of all types of strokes; the distribution of ischemic stroke subtypes varies in different parts of the world.1 In Asia and South America, small vessel disease is the most prominent ischemic stroke subtype, whereas in Europe and the United States there is regional and ethnic variation in the distribution of stroke subtypes and their risk factors.2 Correctly identifying the cause of stroke is important for selection of the appropriate therapy to best reduce the risk of recurrence. 3 This may be particularly important in patients with minor or moderate stroke/transient ischemic attack (TIA), because they are less disabled, so will have more to lose from a recurrent stroke. With changing patterns of practice, in particular, increasing use of statins in the past decade, the distribution of risk factors and stroke subtypes in this population is expected to change over time. Changes in stroke subtypes resulting from these changes in practice can be expected to lead to changes in how physicians view the likelihood of different causes of stroke among their patients and plan strategies for investigation of their patients.The motivation for this study was the clinical suspicion, on the part of 2 senior stroke neurologists at our center, that cardioembolic strokes seemed to be increasing as a proportion of new patients referred to our local urgent TIA clinic. Our primary objective was to determine secular trends in ischemic stroke subtypes. We hypothesized that with more intensive management of atherosclerotic risk factors, there will have been a decrease in atherosclerotic risk factors and a decrease in large artery atherosclerosis and small vessel disease, and, in consequence, a proportional increase in cardioembolic stroke/TIA. Methods Study Setting and TimelineThis was a retrospective cohort study of patients diagnosed with minor or moderate stroke/TIA at the urgent TIA Clinic at University Hospital, a designated regional stroke hospital in London, Ontario. Based on Census reports from Statistics Canada, 599 538 residents were living in the referral area in 2006, and 619 881 residents were recorded in 2011. According to the 2011 census, 82% of the population of London are white, 2.7% Latin American, 2.6% Arab, 2.4% black, 2.2% South Asian, 2.0% Chinese, 1.9% Aboriginal, 1% Southeast Asian, 0.8% West Asian, 0.8% Korean, 0.6% Filipino, and 0.7% belong to other groups. In the surrounding farming area a higher Background and Purpose-Early diagnosis and treatment of a stroke improves patient outcomes, and knowledge of the cause of the initial event is crucial to identification of the appropriate therapy to maximally reduce risk of recurrence. Assumptions based on historical frequency of ischemic subtypes may need revision if stroke subtypes are changing as a result of recent changes in therapy, such as increased use of statins. Methods-We analyzed secular trends in stroke risk factors and ischemic stroke subtypes among patients with transient ischemic attack or minor or moderate stroke refer...

Section: Bogiatzi Et Al Secular Trends In Stroke Subtypes 3211supporting

confidence: 82%

Secular Trends in Ischemic Stroke Subtypes and Stroke Risk Factors

Bogiatzi

Hackam

McLeod

et al. 2014

125

“…Moreover, the decreased incidence of ICH in elderly men may be associated with the unchanged prevalence of hypertension and the reduced frequency of smoking during 1991 to 2011. 29 Simultaneously, the 12-fold increased prevalence of diabetes mellitus and alcohol consumption and 2-fold increased prevalence of obesity in elderly women contributed partly to the increased incidence of ICH in this study. 29 Previous studies reported that there was a higher proportion of ICH among Chinese than among Caucasians.…”

Section: Discussionmentioning

confidence: 75%

“…29 Simultaneously, the 12-fold increased prevalence of diabetes mellitus and alcohol consumption and 2-fold increased prevalence of obesity in elderly women contributed partly to the increased incidence of ICH in this study. 29 Previous studies reported that there was a higher proportion of ICH among Chinese than among Caucasians. 4,20,21,26 However, we found that the incidence of ICH remained stable in young and middle-aged adults in the present study, but it decreased in those aged at least 65 years.…”

Section: Discussionmentioning

confidence: 75%

“…4,20,21,26 However, we found that the incidence of ICH remained stable in young and middle-aged adults in the present study, but it decreased in those aged at least 65 years. 29 The increased prevalence of hypertension in those aged 35 to 64 years, the lower rate of hypertension control in this low-income population (0.7% in 1991 and 12% in 2011), and the significantly increased prevalence of alcohol consumption in men aged 35 to 44 years over the 24-year study period may partly explain the invariant frequency of ICH in young and middle-aged residents.…”

Section: Discussionmentioning

confidence: 99%

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Increased Stroke Burdens Among the Low-Income Young and Middle Aged in Rural China

Ning

Sun

Jiang

et al. 2017

Background and Purpose-Although stroke in the young and middle aged accounts for 31% of all strokes in China, the disease burden is unknown. We aimed to determine the secular trends in stroke incidence and the transition of subtypes in rural China over a 24-year period. Methods-In 1992, 14 920 residents were recruited to participate in the Tianjin Brain Study. Stroke events and all deaths were registered annually. We assessed the trends in incidence of first-ever stroke, including intracerebral hemorrhage and ischemic stroke, among adults aged 35 to 64 years during 1992 to 1999, 2000 to 2007, and 2008 to 2015. The annual proportion of change in stroke incidence was evaluated from 1992 to 2015. Results-The age-standardized incidence of first-ever stroke per 100 000 person-years increased significantly, from 122 in 1992 to 1999, to 215.8 in 2000 to 2007, to 471.8 in 2008 to 2015. The incidence of first-ever stroke increased annually by 11.9% overall (12.4% in men, 9.0% in women, 8.7% for intracerebral hemorrhage, and 10.7% for ischemic stroke; P<0.001). The greatest increases were observed in adults aged 55 to 64 years, with an annual increase of 11.6% for ischemic stroke (10.8% in men and 6.9% in women). However, the proportion of intracerebral hemorrhage has not changed over the past 24 years. Conclusions-In contrast with that in developed countries, the burden of stroke in China originates primarily from young and middle-aged adults. Thus, control of risk factors in this population is required to reduce the future burden of stroke in China.

“…18 However, several studies have shown that the incidence of first-ever stroke in young and middle-aged adults increased in different races over the last 2 decades. 19,20 Authoritative statistics indicated that the mean age of people with stroke significantly increased from 73.9 years in 1990 to 74.5 years in 2010 in high-income countries and from 68.8 years in 1990 to 69.4 years in 2010 in low-income and middle-income countries. 3 Contrary to these previous studies, we found a dramatic increase in the incidence of first-ever stroke and a striking decrease in the mean age of stroke patients from 1992 to 2014 among a low-income population in China.…”

Section: Discussionmentioning

confidence: 99%

Trends in Age of First-Ever Stroke Following Increased Incidence and Life Expectancy in a Low-Income Chinese Population

Wang

Bai

Shi

et al. 2016

Background and Purpose-We investigated secular trends in the age of stroke onset and stroke incidence in a low-income population in rural China. Methods-The study population was recruited from a population-based stroke surveillance study conducted in a township in Tianjin, China, from 1992 to 2014. The trends in mean age and incidence of first-ever stroke were assessed by sex and stroke subtype. Risk factor surveys were conducted in the same population in both 1991 and 2011. Results-A total of 1053 patients experienced first-ever stroke from 1992 to 2014. The mean age of stroke onset in men significantly decreased by 0.28 years annually overall, by 0.56 years for intracerebral hemorrhage, and by 0.22 years for ischemic stroke (P<0.05). However, a similar trend was not observed in women. The age-standardized first-ever stroke incidence in the same population significantly increased across sex and stroke subtypes, increased by 6.3% overall, 5.5% for men, 7.9% for women, 4.6% for intracerebral hemorrhage, and 7.3% for ischemic stroke (P<0.05) during 1992 to 2014. Concurrently, the prevalence of hypertension, diabetes mellitus, obesity, current smoking, and alcohol consumption increased significantly in young and middle-aged adults from 1991 to 2011. Conclusions-The age of stroke onset tends to be younger among low-income population in China after the dramatic increased incidence of stroke during the gradual extension of life expectancy of population in China. These findings suggested that stroke burden will continue to increase in the long time, unless the risk factors in low-income populations are effectively controlled. (Stroke. 2016;47:929-935.