Impact of the Ageing Population on the Burden of Stroke: The Dijon Stroke Registry

Abstract

Background: We aimed to evaluate the impact of the ageing population on temporal trends in burden of stroke and to provide projections for the coming years. Methods: Stroke cases (ischemic strokes, spontaneous intracerebral hemorrhages, or undetermined strokes) were prospectively identified between 1987 and 2015 in Dijon, France, using a population-based registry. Age-standardized incidence rates of first-ever and recurrent stroke were calculated, and their temporal trends were assessed using age- and sex-adjusted annual incidence rate ratios (RR). Results: The population of Dijon increased by 3.8% over time, with an increase by 28% in the number of residents aged ≥75 years. We recorded 5,899 strokes including 5,101 patients with a first-ever event. Incidence of first-ever stroke was stable both in people < 75 and ≥75 years old, but an increase in standardized incidence rates of total strokes was noted due to a rise in the incidence of recurrent stroke (from 4.7/100,000/year in 1987–1994 to 12.3/100,000/year in 2009–2015 in people < 75 years old, RR 1.036; p < 0.001; from 74/100,000/year in 1987–1994 to 200/100,000/year in 2009–2015 in people ≥75 years, RR 1.040; p < 0.001). The absolute number of first-ever strokes increased by 43%, and that of total stroke events rose by 58% over time, with a more pronounced increase in people ≥75 years old (+47 and +65% respectively). The annual number of patients who survived > 90 days after a first-ever stroke increased by 90%. According to demographic projections, the total number of strokes will increase by 55% (+65% patients ≥75 years, and +25% patients < 75 years) by 2,030 in Dijon. Conclusions: Ageing and growth of the population led to a rise in the absolute number of strokes, especially in the elderly, that is expected to increase dramatically in the coming years. Improved stroke care was accompanied with an increase in stroke survivors that contributed to a rise in recurrent events. Urgent action is needed to meet this epidemiological challenge.

Prognosis of Cryptogenic Stroke With Patent Foramen Ovale at Older Ages and Implications for Trials

“…This finding suggests that the increase in stroke risk with age in our main analysis of PFO cohorts is not simply due to the increase in the background vascular risk burden with age. 21 The choice of a different age threshold of 65 years (as opposed to 60 years used in PFO trials) for our analysis of risk for PFO vs no PFO was related to the age thresholds reported in the studies included in the analysis. 9 , 23 , 24 …”

“…We estimated the projected sample size for trials of PFO closure vs medical treatment only after cryptogenic TIA/stroke in patients aged 60 years or older with 80% power to detect either a 66% risk reduction for the interventional closure arm, which was expected on the basis of trials predominantly on antiplatelet treatment in the younger population, or a more conservative 33% reduction to allow for the higher background risk of stroke in the older population or a comparison with anticoagulation. 21 …”

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

“…266 A study from the Dijon Stroke Registry reported an increase in recurrent strokes due to improved stroke care and more stroke survivors with longer survival, which is relevant with populations ageing in industrialized countries. 270 On the other hand, a Swedish study found a reduction in incidence of both first and recurrent stroke, concluding that there were no indications of an increased stroke burden. 269 More studies are needed on this matter.…”

“…Still, studies on stroke recurrence trends differ on whether recurrence rates are declining in industrialized countries. 168,265,266 Some studies from selected populations indicate a decline in recurrence rates, 175,[267][268][269] other have reported an increase in incidence, 263,270 but a recent metaanalysis estimated the annual recurrent stroke risk to be ≈4.26% without any observable decline over time. 266 A study from the Dijon Stroke Registry reported an increase in recurrent strokes due to improved stroke care and more stroke survivors with longer survival, which is relevant with populations ageing in industrialized countries.…”

Management of antithrombotic agents and current issues in patients undergoing endoscopic submucosal dissection

“…As the population ages and the risk of thromboembolic disease increases, the number of patients who require antithrombotic therapy also increases. 15,16 Moreover, various antithrombotic medications, including aspirin, nonsteroidal anti-inflammatory drugs, adenosine diphosphate receptor/P2Y 12 inhibitors, glycoprotein IIb/IIIa inhibitors, prostacyclin, thromboxane inhibitors, phosphodiesterase inhibitors, vitamin K antagonists, heparin, and non-vitamin K-dependent oral anticoagulants (NOAC), are available. 17 To cope with these changes, many clinical studies are being conducted and sev-eral global guidelines are being updated.…”