Continuous 15-Year Decrease in Incidence and Mortality of Stroke in Finland

Sivenius, Juhani; Tuomilehto, Jaakko; Immonen-Räihä, Pirjo; Kaarisalo, Minna M.; Sarti, Cinzia; Torppa, Jorma; Kuulasmaa, Kari; Mähönen, Markku; Lehtonen, Aapo; Salomaa, Veikko

doi:10.1161/01.str.0000110220.63212.59

Cited by 104 publications

(96 citation statements)

References 47 publications

(38 reference statements)

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“…10 Population-based verification rate (CT, MRI, angiography, or autopsy) for stroke is high (Ͼ98%). 26 Emigration in Finland is so rare in these age groups 27 that probably Ͻ20 (Ͻ0.05%) of our patients may have moved abroad after their stroke and could potentially be lost to follow-up for institutional care. Losses to follow-up for case-fatality are practically 0% because deaths abroad are included in official statistics.…”

Section: Meretoja Et Al Effectiveness Of Stroke Centersmentioning

confidence: 91%

Effectiveness of Primary and Comprehensive Stroke Centers

Meretoja

Roine

Kaste

et al. 2010

Stroke

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126

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Section: Meretoja Et Al Effectiveness Of Stroke Centersmentioning

confidence: 91%

Effectiveness of Primary and Comprehensive Stroke Centers

Meretoja

Roine

Kaste

et al. 2010

Stroke

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“…28 Another small (,10% of population) Finnish study, which was based on a prospective stroke registry FINMONICA and its successor FINSTROKE, reported a steady ESP standardized incidence rate of ;20 per 100,000 person-years for 25-to 74-year-old people between 1988 and 1997. 29 When conducting meta-analyses, pooled studies, or systematic reviews, such inconsistences in Finnish population-based studies lead easily to inaccurate nationwide incidence estimates, as discussed recently. 30 The current study has some strengths in comparison with previous population-based and nationwide epidemiologic studies on SAH.…”

Section: 11mentioning

confidence: 99%

Incidence of subarachnoid hemorrhage is decreasing together with decreasing smoking rates

et al. 2016

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Objective: To determine the nationwide incidence of subarachnoid hemorrhage (SAH) and report nationwide changes in smoking rates between 1998 and 2012 in Finland.Methods: In this register-based study, we utilized the nationwide Causes of Death Register and Hospital Discharge Register in identifying SAH events between 1998 and 2012. Population statistics in Finland, which were obtained through a database of Statistics Finland, were used to calculate crude annual incidence rates of SAH. For the direct age standardization of crude incidence rates, we used the European Standard Population (ESP) 2013. Data on changes in nationwide smoking rates between 1998 and 2012 were extracted from a database of the National Institute for Health and Welfare.Results: For the total of 79,083,579 cumulative person-years, we identified 6,885 people with SAH. Sudden deaths from SAH away from hospitals or in emergency rooms accounted for 1,771 (26%) of the events. Crude nationwide annual incidence rates varied between 6.2 and 10.0 per 100,000 persons, and increased by age particularly in women. Among 70-to 75-year-old women, the incidence of SAH was highest (22.5 per 100,000 persons). The 3-year average of ESP standardized incidence decreased 24% from 11.7 in 1998-2000 to 8.9 per 100,000 persons in 2010-2012. Daily smoking decreased 30% between 1998 and 2012.Conclusions: The incidence of SAH seems to be decreasing. This tendency may be coupled with changes in smoking rates. The incidence of SAH in Finland is similar to other Nordic countries.

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“…4 Two cohorts excluded patients admitted later than 24 hours after symptom onset, 21,23 2 excluded patients with prior stroke, 5,26 1 excluded patients "diagnosed with amyloid angiopathy," 20 and 1 excluded patients with multiple ICH, prior ICH, pre-ICH disability, or need for surgery. 30 We contacted study authors to request cohort data excluding patients taking anticoagulation and ultimately received data from 23 cohorts that specifically excluded patients on anticoagulation, [1][2][3][4][5]8,9,11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] while one cohort included patients on anticoagulation, 10 and one cohort included patients on anticoagulation but controlled for its use in the multivariable model of mortality. 12 There was no evidence of publication bias in the 10 previously published studies ( p ϭ 0.34 for mortality and p ϭ 0.54 for poor outcome, by Egger's test) or when considering all 25 studies ( p ϭ 0.24 for mortality and p ϭ 0.49 for poor outcome) (figure 1).…”

Section: -11mentioning

confidence: 99%

“…[2][3][4]8,11,[13][14][15][16]18,[20][21][22][23][24]26,27 All models adjusted for age, 6 adjusted for premorbid disability, 4,13,15,16,18,27 and 1 adjusted for sex and diabetes. 3 The pooled univariate OR for poor functional outcome was 1.29 (95% CI 1.09 to 1.53, p ϭ 0.002) (figure 3).…”

Section: -11mentioning

confidence: 99%

“…Data from an additional 15 cohorts were obtained by these methods. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] In many cases, authors contributed more patients than described in the original cohort, which was allowed as long as these patients were collected and characterized according to the same published methods. Study quality was evaluated using the same criteria cited above.…”

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Prior antiplatelet therapy and outcome following intracerebral hemorrhage

Béjot²,

et al. 2010

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Objectives: Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and metaanalysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH. Methods:The Medline and Embase databases were searched in February 2008 using relevant key words, limited to human studies in the English language. Cohort studies of consecutive patients with ICH reporting mortality or functional outcome according to pre-ICH APT use were identified. Of 2,873 studies screened, 10 were judged to meet inclusion criteria by consensus of 2 authors. Additionally, we solicited unpublished data from all authors of cohort studies with Ͼ100 patients published within the last 10 years, and received data from 15 more studies. Univariate and multivariable-adjusted odds ratios (ORs) for mortality and poor functional outcome were abstracted as available and pooled using a random effects model. Results:We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished). Pre-ICH APT users had increased mortality in both univariate (OR 1.41, 95% confidence interval [CI] 1.21 to 1.64) and multivariable-adjusted (OR 1.27, 95% CI 1.10 to 1.47) pooled analyses. By contrast, the pooled OR for poor functional outcome was no longer significant when using multivariable-adjusted estimates (univariate OR 1.29, 95% CI 1.09 to 1.53; multivariable-adjusted OR 1.10, 95% CI 0.93 to 1.29). Conclusions:In cohort studies, APT use at the time of ICH compared to no APT use was independently associated with increased mortality but not with poor functional outcome. Neurology GLOSSARYAPT ϭ antiplatelet therapy; CI ϭ confidence interval; GOS ϭ Glasgow Outcome Scale; ICH ϭ intracerebral hemorrhage; mRS ϭ modified Rankin Scale; OR ϭ odds ratio.Aspirin or other antiplatelet therapy (APT) could worsen outcome from intracerebral hemorrhage (ICH) by promoting bleeding. Published observational studies of outcomes in pre-ICH APT users have yielded conflicting results, however. Some suggest an increased risk of poor outcome 1-3 while others suggest no increased risk. 4,5 If prior APT worsens outcome, then restoration of normal platelet function could be a therapeutic target.We hypothesized that pre-ICH APT use would be associated with increased mortality and functional impairment following ICH, and tested this hypothesis by performing a systematic review of the literature. To reduce the likelihood of publication bias, we additionally requested information from established cohort studies that had not previously published on the association between pre-ICH APT and clinical outcomes.METHODS Search strategy, selection criteria, and data abstraction. Using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) criteria as a guide, 6 we searched for studies describing mortality or functional outcome of consecutive adults with spontaneous ICH by APT use, ex...

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Continuous 15-Year Decrease in Incidence and Mortality of Stroke in Finland

Cited by 104 publications

References 47 publications

Effectiveness of Primary and Comprehensive Stroke Centers

Effectiveness of Primary and Comprehensive Stroke Centers

Incidence of subarachnoid hemorrhage is decreasing together with decreasing smoking rates

Prior antiplatelet therapy and outcome following intracerebral hemorrhage

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