Incidence Trends of Ischemic Stroke and Transient Ischemic Attacks in a Well-Defined French Population From 1985 Through 1994

Abstract

Background and Purpose-The changing incidence of ischemic stroke is of major concern in view of its public health impact, to define the population concerned, to identify risk factors, and to set up health-care systems. The aim of this study was to evaluate the time trends associated with the incidence of all the subtypes of ischemic stroke and transient ischemic attacks in a well-defined population for 10 years. Methods-Since 1985, a population registry has recorded each patient living in Dijon (France) who suffered from a cerebrovascular disease (CVD) regardless of the type of management. This study involved all patients suffering from their first ischemic stroke and their first transient ischemic attacks (TIAs) during 1 calendar year between January 1, 1985 and December 31, 1994. The incidence changes according to age, sex, and type of cerebral ischemic event (cortico-subcortical infarct, lacunar infarct, and TIA) were studied on the basis of their annual variations. Results-During the 10-year study period, 834 cortico-subcortical infarcts (52.1%), 296 lacunar infarcts (18.5%), 369 TIAs (23.1%), and 101 undetermined ischemic strokes (6.3%) were collected. The incidence of all ischemic events was relatively stable in both sexes over the 10-year period. However, the incidence rates differed according to age and type of ischemia. An increased incidence of cerebral cortico-subcortical infarct was observed in patients older than 75 years of age (ϩ5.45% annual change [AC] in men, PϽ0.05; ϩ5.09% AC in women, NS). In parallel, a higher proportion of emboligenic cardiac arrhythmias was observed in these patients (PϽ0.001). The incidence of lacunar infarcts tended to decrease, regardless of age but mainly in men under younger than 75 years of age (Ϫ12.74% AC in men, NS; ϩ0.31% AC in women, NS). The incidence of TIAs was relatively stable in both sexes. Because our population consisted of a large number of elderly subjects, the increase in cardioembolic causes could partially explain the increased incidence of cerebral cortico-subcortical infarcts in patients older than 75 years of age. Conclusions-These preliminary data emphasize the importance of stroke surveillance in considering the variations of the different mechanisms of ischemic cerebrovascular disease. Although the incidence of TIA is stable and the incidence of lacunes tends to decrease in men, mainly before 75 years of age, we emphasize the rise of the crude incidence of cortico-subcortical infarcts in men older than 75 years of age, induced by an increase in cardioembolic causes. (Stroke. 1999;30:371-377.)

A Population-Based Study of Transient Ischemic Attack Incidence in Novosibirsk, Russia, 1987–1988 and 1996–1997

“…4,20 The overall TIA incidence rate in Novosibirsk adjusted to the European population (27/100 000; 95% CI, 9 to 79) is similar to that reported in a population-based study in Spain (21/100 000; 95% CI, 12 to 30) 7 and Italy (42/100 000; 95% CI, 33 to 54). 5 In Dijon, France, the world-standardized incidence of TIA over the 10-year period (1985-1994) 2 varied from 8.4 to 29.2 cases per 100 000 residents per year in men and from 3.9 to 18.8 cases per 100 000 residents per year in women, but these changes were not statistically significant. However, the mean age of TIA patients in Novosibirsk (62 years in men and 66 years in women) appears to be lower than that in some European countries.…”

“…Although incidence of TIA has been reported for numerous sites worldwide, only few incident population-based studies on TIA in all age groups of the population have been reported thus far. [1][2][3][4][5][6][7][8][9][10][11] No such data in Russia have ever been published in the international literature. However, data on TIA incidence trends are important in determining mechanisms and factors responsible for the occurrence of this disorder.…”

“…However, data on TIA incidence trends are important in determining mechanisms and factors responsible for the occurrence of this disorder. Thus far only 2 truly populationbased studies 2,4 have addressed a relationship between TIA and stroke incidence rates over a period of 1 or a few decades. Herein we summarize the TIA incidence rates in Novosibirsk, Russia, for the last 10 years, from 1987-1988 to 1996 -1997, and we compare the incidence of first TIA with that of first stroke obtained in the same study population and during the same study periods.…”

Mortality Rates for Stroke in England From 1979 to 2004

“…[3][4][5] Stroke incidence also appeared to decline in the 1960s and 1970s in the United States, 6,7 Asia, 8 and Europe, 9 -11 but this latter decline has also leveled off, and most studies during the 1980s and 1990s have shown either no change [12][13][14][15][16] or more commonly an increase in age-and sex-adjusted incidence. [17][18][19][20][21][22][23][24][25][26] In contrast, UK stroke mortality rates based on death certification have declined steeply in recent decades. 2,27 The decline in the UK appears to be consistent with a 40% decline in population-based stroke incidence and mortality in Oxfordshire, UK, between 1981 to 2004 and 2002 to 2004, 28 but national mortality data could have overestimated the time trends in the UK as a whole because of changes in the practice of death certification.…”

Independent Prognostic Factor

“…Although all patterns were largely due to the older age of our population, other reasons should be considered: diligent case ascertainment, complete screening procedures, and extensive use of cardiovascular examination, together with the progressive increase of cardioembolic stroke incidence in the general population, registered in the last decade, could explain the clinical characteristics of our stroke population. 26,27 From this standpoint, the possible presence of a selection bias is less plausible. We have prospectively validated our findings in another sample of stroke patients to be confident that our findings could be generalized beyond the group that we studied.…”