From Data to Action: Neuroepidemiology Informs Implementation Research for Global Stroke Prevention and Treatment

Abstract

As a scientific field of study, neuroepidemiology encompasses more than just the descriptive study of the frequency, distribution, determinants and outcomes of neurologic diseases in populations. It also includes experimental aspects that span the full spectrum of clinical and population science research. As such, neuroepidemiology has a strong potential to inform implementation research for global stroke prevention and treatment. This review begins with an overview of the progress that has been made in descriptive and experimental neuroepidemiology over the past quarter century with emphasis on standards for evidence generation, critical appraisal of that evidence and impact on clinical and public health practice at the national, regional and global levels. Specific advances made in high-income countries as well as in low- and middle-income countries are presented. Gaps in implementation as well as evidence gaps in stroke research, stroke burden, clinical outcomes and disparities between developed and developing countries are then described. The continuing need for high quality neuroepidemiologic data in low- and middle-income countries is highlighted. Additionally, persisting disparities in stroke burden and care by sex, race, ethnicity, income and socioeconomic status are discussed. The crucial role that national stroke registries have played in neuroepidemiologic research is also addressed. Opportunities presented by new directions in comparative effectiveness and implementation research are discussed as avenues for turning neuroepidemiological insights into action to maximize health impact and to guide further biomedical research on neurological diseases.

Association of High Serum Levels of Growth Factors with Good Outcome in Ischemic Stroke: a Multicenter Study

“…Improvement of the management of stroke patients, especially in developed countries, has contributed to the reduction in mortality and morbidity rates observed in recent decades. However, the incidence of stroke has not followed this same trend showing a continuous increase in developed countries [1]. Besides, the demographic change expected in Europe for the next 50 years suggests that this situation will become worse [2].…”

The Global Burden of Stroke

“…In order to maximize individual and population health impact, Mensah et al [8] suggest the need to embrace rigorous evidence synthesis and new directions in comparative effectiveness and implementation research in stroke. The atlas by Feigin et al [9] paints a picture of a continuing epidemic of stroke in spite of the remarkable declines seen for age-standardized incidence rates, prevalence, mortality rates, and DALYs over the period from 1990 to 2013.…”

National Stroke Registry Programme in India for Surveillance and Research: Design and Methodology

“…These 28 registries in 26 countries used web-based systems for data collection (57%) and data linkage (25%) and usually had waiver of patient consent (70%) for data collection [24]. Thus, registries are recognized as methods for disease surveillance globally [25], and they achieve coverage of all health facilities when it is mandatory and are linked to continuous process of quality improvement of services and guide health policy development [26].…”