Incidence rates of stroke in the eighties: the end of the decline in stroke?

Kuller, Lewis H.

doi:10.1161/01.str.20.7.841

Cited by 15 publications

(4 citation statements)

References 8 publications

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“…19 It has been suggested that the improved survival of coronary heart disease patients has resulted in a group at increased risk for stroke, which might account for the increase in stroke incidence in Rochester in the years 198O-1984. 20 Whether this explanation applies in Framingham is unclear. The complete picture is undoubtedly related to the interplay of a number of factors, including the following: an increase in patients susceptible to stroke, resulting from improved survival of coronary disease patients; a decline in the incidence of severe stroke; decreased stroke case-fatality rates resulting from improvements in medical care; increased awareness of transient neurologic symptoms as harbingers of stroke; and improved technology resulting in increased diagnostic sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Secular trends in stroke incidence and mortality. The Framingham Study.

Wolf

D’Agostino

O’Neal

et al. 1992

Stroke

294

162

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Background:The reduction in US stroke mortality has been attributed to declining stroke incidence. However, evidence is accumulating of a trend in declining stroke severity.Methods: We examined secular trends in stroke incidence, prevalence, and fatality in Framingham Study subjects aged 55-64 years in three successive decades beginning in 1953, 1963, and 1973.Results: No significant decline in overall stroke and transient ischemic attack incidence or prevalence occurred. In women, but not men, incidence of completed ischemic stroke declined significantly. Stroke severity, however, decreased significantly over time. Stroke with severe neurological deficit decreased in later decades, with a fall in rates of severe stroke cases in which patients were unconscious on admission to the hospital. There was no substantial change in the case mix of infarcts and hemorrhages and no decline in hemorrhage to account for the decline in severity. The proportion of isolated transient ischemic attacks increased significantly over the 30 years studied, yielding an apparent and significant decline in case-fatality rates in men only.Conclusions: Secular trends in stroke incidence and fatality did not follow a clear or definite pattern of decline. While a significant decline in stroke severity occurred over three decades, incidence of infarction fell only in women. The decline in total case fatality rates occurred only in men and resulted largely from an increased incidence of isolated transient ischemic attacks. The severity of completed stroke was significantly lower in the later decades under study. (Stroke 1992;23:1551-1555)

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Section: Discussionmentioning

confidence: 99%

Secular trends in stroke incidence and mortality. The Framingham Study.

Wolf

D’Agostino

O’Neal

et al. 1992

Stroke

294

162

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“…Their findings are thus supportive of our nationwide analysis, despite the fact that we were hampered by the lack of true incidence data. Kuller,33 who reviewed the Rochester data, considered several factors that could be operative in producing the stabilization, other than a change in diagnosis or better case ascertainment. These included an increased prevalence of hypertension, a less effective treatment regimen, decline in ischemic heart disease mortality, and increased complications of cardiovascular surgery.…”

Section: Discussionmentioning

confidence: 99%

Some epidemiological aspects of stroke: mortality/morbidity trends, age, sex, race, socioeconomic status.

Modan

Wagener

1992

Stroke

108

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Background and Purpose:The reasons for decreasing stroke mortality could be related to either decreasing incidence and/or improved prognosis. Thus far, secular trends of stroke have been analyzed either through mortality or morbidity data. This report examines both aspects simultaneously, on a nationwide basis, for the period 1968-1988.Methods: Mortality statistics were based on the Compressed Mortality File. Estimates of morbidity were based on the National Hospital Discharge Survey. The Area Resource File was used to obtain county-specific socioeconomic statistics.Results: The decline in stroke mortality continued through the 1970s and 1980s, whereas morbidity remained constant and possibly even increased. Mortality and morbidity rates were similar in both sexes, higher in blacks, and lower in other (primarily Asian) Americans. There was an inverse correlation between death rates and socioeconomic status, which was particularly marked in blacks. Temporal decline occurred in all strata.Conclusions: The observed decrease in stroke mortality rates results most probably from an improved survival rather than from a decline in incidence. The abundance of new drugs and screening programs may not have affected the overall morbidity of stroke, possibly because of inefficient treatment regimens.

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“…This lack of information hampers rational decisions about determining ways in which the trend might be maintained or even accel erated. Monitoring incidence and case fatality in large, well-defined populations is essential for determining time trends and geographical variations [49]. An attempt is being made in the stroke component of multinational WHO MONICA project to monitor the trends in stroke mortality and morbidity and to assess the extent to which they are related to changes in known risk factors measured at the same time in 19 defined communities [50], Improved quality of routinely available data, in partic ular the accuracy of death certificate information, is essential.…”

Section: Unresolved Issues and Future Directionsmentioning

confidence: 99%

Epidemiological Studies and the Prevention of Stroke

Bonita¹

1994

Cerebrovasc Dis

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The contribution of epidemiological studies of stroke has been fundamental to understanding the occurrence, natural history and the potential for both primary and secondary prevention. Descriptive studies of routinely available data such as death statistics provide some idea of the magnitude of the problem, differences between and within countries, and trends over time. Measuring the incidence of stroke, however, requires special population-based studies which are, unfortunately, expensive and difficult to accomplish and, until recently, provide limited information on the frequency, etiology and natural history of pathologically distinct types of stroke. Analytical studies, in particular the long-established cohort studies, have contributed to an understanding of the risk factors for stroke. Randomized controlled trials on the treatment of raised blood pressure confirmed findings from the observational studies that reducing blood pressure also reduced the relative risk of stroke. Increasing knowledge about stroke subtypes, which may behave in different ways in terms of prognosis and response to therapy, has resulted in further clinical trials tailoring potential therapies according to the precise categorization of subtypes. Few epidemiological studies have been established which can shed light on the reasons for the substantial decline in stroke mortality in recent decades. The available evidence suggests that an improvement in case fatality is the most likely explanation, rather than improvements in incidence. In turn, improvements in case fatality may reflect better management in the acute phase or changes in the natural history of the disease. Epidemiological studies of stroke can contribute to developing more cost-effective strategies for the prevention and control of cerebrovascular disease.

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Incidence rates of stroke in the eighties: the end of the decline in stroke?

Cited by 15 publications

References 8 publications

Secular trends in stroke incidence and mortality. The Framingham Study.

Secular trends in stroke incidence and mortality. The Framingham Study.

Some epidemiological aspects of stroke: mortality/morbidity trends, age, sex, race, socioeconomic status.

Epidemiological Studies and the Prevention of Stroke

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