"EMMA Study: a Brazilian community-based cohort study of stroke mortality and morbidity"

Abstract

CONTEXT AND OBJECTIVE: Stroke has a high burden of disability and mortality. The aim here was to evaluate epidemiology, risk factors and prognosis for stroke in the EMMA Study (Study of Stroke Mortality and Morbidity). DESIGN AND SETTINGS: Prospective community-based cohort carried out in Hospital Universitário, University of São Paulo, 2006-2014. METHODS: Stroke data based on fatal and non-fatal events were assessed, including sociodemographic data, mortality and predictors, which were evaluated by means of logistic regression and survival analyses. RESULTS: Stroke subtype was better defined in the hospital setting than in the local community. In the hospital phase, around 70% were first events and the ischemic subtype. Among cerebrovascular risk factors, the frequency of alcohol intake was higher in hemorrhagic stroke (HS) than in ischemic stroke (IS) cases (35.4% versus 12.3%, P < 0.001). Low education was associated with higher risk of death, particularly after six months among IS cases (odds ratio, OR, 4.31; 95% confidence interval, CI, 1.34-13.91). The risk of death due to hemorrhagic stroke was greater than for ischemic stroke and reached its maximum 10 days after the event (OR: 3.31; 95% CI: 1.55-7.05). Four-year survival analysis on 665 cases of first stroke (82.6% ischemic and 17.4% hemorrhagic) showed an overall survival rate of 48%. At four years, the highest risks of death were in relation to ischemic stroke and illiteracy (hazard ratio

Frequência de afasia e perfil de usuários em hospital público municipal de referência

“…Regarding the clinical profile of the group studied, ischemic stroke was the most frequent type, mirroring findings reported in the literature (25)(26)(27)(28) showing this stroke subtype accounts for 70-80% of cases. The CT topodiagnostic findings for brain lesions disclosed a mixed pattern in all groups, involving cortical and/or subcortical lesions in lobes of both left and right hemispheres (Chart 1).…”

Clinical characterization, disability, and mortality in people with strokes during 90 days

“…People without employment and residents of the state capital were more prevalent, results that coincide with those of the study carried out in Roraima (8) but were not identified in the investigations in Salvador (16,18) . Diverging from the present study, investigations in the Southeast region showed a predominance of males in a study carried out in the Triângulo Mineiro (15) and females in a study in São Paulo (28) ; in relation to race/color, the majority of white participants were found in both. Some international articles showed a higher mean age and a predominance of males (9,(29)(30)(31) , however, like the studies from the South of the country, they did not assess the level of education or income of the samples, making the comparison between these variables unfeasible.…”

Doença cerebrovascular no Brasil de 1990 a 2015: Global Burden of Disease 2015

“…In fact, there is a direct relation of cerebrovascular disease with the worst indicators of social and economic development, as already observed in other evaluations of the disease in Brazil. Social differentiation would not only induce a higher incidence of cerebrovascular disease: even in conditions of appropriate medical care to the acute event, subsequent mortality is related to socioeconomic indicators, such as a lower level of formal education, which represented a risk factor for worse survival at long term, as demonstrated in the Stroke Mortality and Morbidity Study (EMMA) in São Paulo 23 .…”