Ascertaining the true incidence of stroke: experience from the Perth Community Stroke Study, 1989–1990

Abstract

ObjectiveTo determine the age and sex specific incidence, and case fatality of stroke in Perth, Western Australia. Design and settingA population‐based descriptive epidemiological study. SubjectsAll residents of a geographically defined segment of the Perth metropolitan area (population 138 708) who had a stroke or transient ischaemic attack between 20 February 1989 and 19 August 1990, Inclusive. Main outcome measuresDefinite acute “first‐ever‐in‐a‐lifetime” (first‐ever) and recurrent stroke classified according to standard definitions and criteria. ResultsDuring the 18‐month study period, 536 stroke events occurred among 492 patients, 69% of which were first‐ever strokes. The crude annual event rate for all strokes was 258 (95% confidence interval 231–285) per 100 000, and the overall case fatality at 28 days was 24% (95% CI, 20%–28%). The crude annual incidence for first‐ever strokes was 178 (95% CI, 156–200) per 100 000; 189 (95% CI, 157–221) per 100 000 in males and 166 (95% CI, 136–196) per 100 000 in females. The corresponding rates, age‐adjusted to the “world” population, were 132 (95% CI, 109–155) for males and 77 (95% CI, 60–94) for females. ConclusionsIn contrast to mortality rates for Ischaemic heart disease, the incidence of stroke in Australia appears little different from that for several other Western countries. For both mates and females the incidence of stroke rises exponentially with increasing age. Although the sex‐dependent difference in the risk of stroke is greatest in middle age, males are at greater risk of stroke even among the most elderly. To determine the incidence of stroke accurately, population‐based studies of stroke need exhaustive and overlapping sources of case ascertainment. If only cases admitted to hospital had been used, we would have underestimated the rate of stroke among the most elderly by almost 40%. We estimate that approximately 37 000 people, about 50% of whom are over the age of 75, suffer a stroke each year in Australia.

Myocardial Infarction After Intravitreal Vascular Endothelial Growth Factor Inhibitors

“…The 12-month rate for MI, stroke, and GI bleed was low in all exposure groups, consistent with rates in the general population for $50-year-olds (MI: 1.1/100 person-years, 28 stroke: 0.2/100 person-years, 29 GI bleeds: 0.1/100 personyears). 30 We observed no significant differences in the rates of MI, stroke, or GI bleeding between patients treated with bevacizumab or ranibizumab (1.6 and 2.1 events/100 persons, respectively).…”

Stroke epidemiology studies have underestimated the frequency of intracerebral haemorrhage

“…2). Information on timing of scanning was documented in a number of different ways; one study gave a value for the mean time interval from stroke to scanning for those patients who underwent neuroimaging [9]; two studies gave the median time interval from symptoms to scanning [42,7]; but the majority of studies simply documented the proportion of patients scanned within a certain time interval, which ranged from seven days [20,12,3], to 21 days [11] and 30 days [25,4,1,29,34]. No study explicitly stated exactly what proportion of patients were scanned and when (i. e. percent within one week, or two weeks, or three weeks after stroke) making it impossible to estimate what proportion were scanned outside the time when CT would have distinguished infarct from haemorrhage reliably.…”

“…Increasing use of magnetic resonance imaging has revealed that it is not uncommon to find evidence of old, apparently asymptomatic small haemorrhages in the brains of elderly patients [27,13] so older patients might also have more small symptomatic PICH. Thus it may be that older people are particularly at risk of PICH, and thus there may be a higher proportion of PICH in this Oxford [4] 1988 Rapidity of death, too ill to transfer, refusal, 65 % of those not scanned > 75 years Malmo [20] 1992 'Mean age of those examined by CT less than those not' Perth [1] 1993 Rapidity of death, too ill, too frail, refusal, 81 % of those not scanned > 75 years Brisbane [33] 1995 'coma, lack of facility, too sick, age of the patient, attitude of the physicians' L'Aquila [7] 1997 Very early death, refusal, exclusive home care of very old patients, equipment breakdown Tartu [26] 1997 'Of the 24 % with no subtype (i. e. no scan), 76 % treated at home Erlangen [25] 1998…”

Orchiectomy or testosterone receptor blockade reduces intestinal mucosal damage caused by ischemia-reperfusion insult

“…Although many studies have emphasized the beneficial effects of estrogen in gender differences in I/R injury [5,6], some others have implicated male sexual hormones [7][8][9]. Androgen hormone deficiency and blockade improves survival in male rodents in systemic inflammatory conditions [3,20]. Park et al shown that the presence of testosterone, rather than the absence of estrogen, appears to be more relevant to the gender difference in susceptibility to kidney I/R injury.…”

“…Men are at a relatively increased risk of cardiovascular and neurological disorders when compared premenopausal women [3,4]. In general, the gender disparity has been interpreted primarily as reflecting estrogen-mediated protection against pathological conditions [5,6].…”