Background and Purpose-Stroke is the main cause of death in Brazil and no prospective population-based study has been conducted in the country. The purpose of this study was to determine the incidence of stroke, stroke subtypes, case fatality, and prognosis after 1 year of follow-up in the city of Matão, Brazil. Methods-Using overlapping methods of case ascertainment, all stroke cases that occurred in the city of Matão (population, 75 053) from November 1, 2003 to October 31, 2004 were followed-up at 1 month and 1 year after the episode. Standard criteria for population-based stroke studies were followed. Results-Of 141 suspect stroke cases identified, 81 were first-ever-in-a-lifetime strokes. All patients underwent a CT scan. The crude annual incidence rate per 100 000 per year was 108 (95% CI, 85.7-134.1) and the rate adjusted for sex and age to the Segi population was 137 (95% CI, 112.0 to 166.4) per 100 000 inhabitants per year. Ischemic stroke occurred in 69 (85.2%) subjects, intracerebral hemorrhage in 11 (13.6%), and subarachnoid hemorrhage in 1 (1.2%). The 30-day case fatality rate was 18.5 and the 1-year case fatality rate was 30.9%. After 1 year of follow-up, 43% of the patients were independent in activities of daily living, 49.4% had independent gait, and 15.9% had a recurrent stroke. Conclusions-The present results are similar to those obtained in other stroke population-based studies. Future studies in Matão will provide the opportunity to discover ways to decrease the stroke burden in Brazil. (Stroke.

Women are reported to have greater mortality in the short term after stroke than men. In a review of 31 populationbased studies of short-term mortality after stroke, Appelros et al 1 reported that women had a 25% greater risk of 1-month crude mortality than men. It remains unclear what accounts for this disparity and whether these differences persist into the Background-Women are reported to have greater mortality after stroke than men, but the reasons are uncertain. We examined sex differences in mortality at 1 and 5 years after stroke and identified factors contributing to these differences. Methods and Results-Individual participant data for incident strokes were obtained from 13 population-based incidence studies conducted in Europe, Australasia, South America, and the Caribbean between 1987 and 2013. Data on sociodemographics, stroke-related factors, prestroke health, and 1-and 5-year survival were obtained. Poisson modeling was used to estimate the mortality rate ratio (MRR) for women compared with men at 1 year (13 studies) and 5 years (8 studies) after stroke. Studyspecific adjusted MRRs were pooled to create a summary estimate using random-effects meta-analysis. Overall, 16 957 participants with first-ever stroke followed up at 1 year and 13 216 followed up to 5 years were included. Crude pooled mortality was greater for women than men at 1 year (MRR 1.35; 95% confidence interval, 1.24-1.47) and 5 years (MRR 1.24; 95% confidence interval, 1.12-1.38). However, these pooled sex differences were reversed after adjustment for confounding factors (1 year MRR, 0.81; 95% confidence interval, 0.72-0.92 and 5-year MRR, 0.76; 95% confidence interval, 0.65-0.89).Confounding factors included age, prestroke functional limitations, stroke severity, and history of atrial fibrillation. Conclusions-Greater mortality in women is mostly because of age but also stroke severity, atrial fibrillation, and prestroke functional limitations. Lower survival after stroke among the elderly is inevitable, but there may be opportunities for intervention, including better access to evidence-based care for cardiovascular and general health. There have been no studies specifically designed to examine sex differences in long-term mortality after stroke. Identifying factors that explain the sex differences in mortality is important because better understanding could lead to interventions to reduce the disparities.2 In an Australian study, the 36% greater risk of death at 28 days for women compared with men was explained by age, prestroke health, stroke severity, and use of anticoagulants at discharge. 3 After adjustment in that study, women had a 17% lower short-term mortality than men. It is unknown whether these same factors account for the relative sex differences in other geographical regions or in long-term mortality.Our aims were to quantify the relative sex difference in long-term mortality and to identify factors that contribute to the greater mortality of women after stroke using a meta-analysis of pooled individual participant...

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Background Women have worse outcomes after stroke than men, and this may be partly explained by stroke severity. We examined factors contributing to sex differences in severity of acute stroke assessed by the National Institutes of Health Stroke Scale. Methods and Results We pooled individual participant data with National Institutes of Health Stroke Scale assessment (N=6343) from 8 population‐based stroke incidence studies (1996–2014), forming part of INSTRUCT (International Stroke Outcomes Study). Information on sociodemographics, stroke‐related clinical factors, comorbidities, and pre‐stroke function were obtained. Within each study, relative risk regression using log‐binominal modeling was used to estimate the female:male relative risk ( RR ) of more severe stroke (National Institutes of Health Stroke Scale>7) stratified by stroke type (ischemic stroke and intracerebral hemorrhage). Study‐specific unadjusted and adjusted RR s, controlling for confounding variables, were pooled using random‐effects meta‐analysis. National Institutes of Health Stroke Scale data were recorded in 5326 (96%) of 5570 cases with ischemic stroke and 773 (90%) of 855 participants with intracerebral hemorrhage. The pooled unadjusted female:male RR for severe ischemic stroke was 1.35 (95% CI 1.24–1.46). The sex difference in severity was attenuated after adjustment for age, pre‐stroke dependency, and atrial fibrillation but remained statistically significant (pooled RR adjusted 1.20, 95% CI 1.10–1.30). There was no sex difference in severity for intracerebral hemorrhage ( RR crude 1.08, 95% CI 0.97–1.21; RR adjusted 1.08, 95% CI 0.96–1.20). Conclusions Although women presented with more severe ischemic stroke than men, much although not all of the difference was explained by pre‐stroke factors. Sex differences could potentially be ameliorated by strategies to improve pre‐stroke health in the elderly, the majority of whom are women. Further research on the potential biological origin of sex differences in stroke severity may also be warranted.

Worse outcomes after stroke among women were explained mostly by age, stroke severity, and prestroke dependency, suggesting these potential targets to improve the outcomes after stroke in women.

Inpatient rehabilitation has been traditionally employed in developed countries, while in developing countries, outpatient rehabilitation is the rule. The purpose of this study was to compare the patterns of recovery of upper extremity (UE) function, global impairment and independence in activities of daily living (ADL) during the first month after ischemic stroke in inpatient (United States) and outpatient (Brazil) rehabilitation settings.This is a prospective cohort comparison study. Twenty patients from each country were selected using identical inclusion criteria.The study measures employed were the UE portion of the Fugl-Meyer scale, the Action Research Arm test, the National Institutes of Health Stroke Scale and Barthel Index. Changes from baseline to the end of treatment, efficiency and effectiveness of each treatment were compared.Both populations exhibited significant improvement between the first and second evaluations in the four outcome scales (p<0.0001). There were no differences between the two rehabilitation settings on any of the four dependent measures (p>0.05).Substantially different treatment approaches after ischemic stroke led to similar results in UE function, global impairment and ADL. Further studies in larger populations should be performed in order to confirm the present results.

<b><i>Background:</i></b> Stroke population-based studies in the same setting comparing time trends of rates are a gold standard method to determine the primary prevention status of stroke. Twelve years ago, we measured the stroke incidence and mortality in Matão city, Southeast of Brazil. <b><i>Objective:</i></b> This second Matão stroke registry study aimed to determine the time trends in the incidence, mortality, case fatality, and functional status of patients with stroke. <b><i>Methods:</i></b> This was a prospective, population-based study known as the Matão Preventing Stroke (MAPS). We determined all incident stroke events that occurred between August 1, 2015, and July 31, 2016. Between the periods of November 1, 2003, to October 31, 2004, and August 1, 2015, to July 31, 2016, the rates were age adjusted to the Brazilian and world population. Functional status was measured by Barthel scale 1 year after the index event. <b><i>Results:</i></b> We registered 81 cases of incident stroke. Demographic and cardiovascular risk factors were similar in both periods. The mean age increased by 9%, from 65.2 (95% CI 62.6–67.8) to 71.0 (95% CI 68.1–73.8) years. Between 2003–2004 and 2015–2016, the age-adjusted incidence decreased by 39% (incidence rate ratio [IRR] 0.61; 95% CI 0.46–0.79) and mortality by 50% (IRR 0.50; 95% CI 0.31–0.94). The 1-year case fatality was 26%; approximately 56% of the patients were functionally independent, while 7% had a recurrent stroke. Compared with the results of our first registry study, these outcomes did not differ significantly. <b><i>Conclusion:</i></b> Our findings agree with those of previous studies, showing a decline in the incidence and mortality of stroke in Brazil. Improvements in local public health care might explain these declines.

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