One-Month to 10-Year Survival in the Copenhagen Stroke Study: Interactions Between Stroke Severity and Other Prognostic Indicators

Dalton

Steding-Jessen

et al. 2014

Self Cite

Background and Purpose-The risk for stroke is higher in low-income groups. It is not clear whether these groups also have a higher risk for death after a stroke. Methods-We studied survival in relation to income and level of education in all patients aged >40 years admitted to hospital for stroke in Denmark in 2003 to 2012. All Danish hospitals report data to the Danish Stroke Register for all patients admitted for acute stroke, including age, sex, stroke severity, subtype, and a cardiovascular risk profile. Information on income and education was obtained from Statistics Denmark; deaths from all causes from the Civil Registration Registry. Results-Information on education and disposable income was available for 56 581 Danes hospitalized for stroke during the 9.5-year study period. Median length of follow-up was 3.1 years. For the entire follow-up period, there was a significant, stepwise, independent relation between income and risk for death after stroke, which was 30% higher for the lowest than for the highest quintile income group (relative risk, 0.70, 95% confidence interval, 0.65-0.74). People aged <65 years with basic education had a slightly higher risk for death than those with the longest (relative risk, 1.15; 95% confidence interval, 1.02-1.30). Death within 1 month was not associated with income or education. Conclusions-The survival of patients with low income was reduced by 30% as compared with those with high income.Education had only a modest effect and only in patients aged <65 years.

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Socioeconomic Position and Survival After Stroke in Denmark 2003 to 2012

Dalton

Steding-Jessen

et al. 2014

Self Cite

“…Stronger effects of exposure to NO 2 in fatal ischemic may be explained by the fact that fatal strokes represent a subgroup of ischemic strokes that were more severe, and stroke severity is the single most important predictor of survival within the first poststroke month. 30 Another possible explanation is that fatal stroke triggered by air pollution has specific mechanisms leading to high severity such as vessel occlusion, arrhythmia, etc. We propose, therefore, that extended exposure to NO 2 leads to development of ischemic strokes and especially of severe ischemic strokes with a poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Stroke and Long-Term Exposure to Outdoor Air Pollution From Nitrogen Dioxide

Cederkvist

et al. 2012

112

Background and Purpose-Years of exposure to tobacco smoke substantially increase the risk for stroke. Whether long-term exposure to outdoor air pollution can lead to stroke is not yet established. We examined the association between long-term exposure to traffic-related air pollution and incident and fatal stroke in a prospective cohort study. Methods-We followed 57 053 participants of the Danish Diet, Cancer and Health cohort in the Hospital DischargeRegister for the first-ever hospital admission for stroke (incident stroke) between baseline (1993-1997) and 2006 and defined fatal strokes as death within 30 days of admission. We associated the estimated mean levels of nitrogen dioxide at residential addresses since 1971 to incident and fatal stroke by Cox regression analyses and examined the effects by stroke subtypes: ischemic, hemorrhagic, and nonspecified stroke. Results-Over a mean follow-up of 9.8 years of 52 215 eligible subjects, there were 1984 (3.8%) first-ever (incident) hospital admissions for stroke of whom 142 (7.2%) died within 30 days. We detected borderline significant associations between mean nitrogen dioxide levels at residence since 1971 and incident stroke (hazard ratio, 1.05; 95% CI, 0.99 -1.11, per interquartile range increase) and stroke hospitalization followed by death within 30 days (1.22; 1.00 -1.50). The associations were strongest for nonspecified and ischemic strokes, whereas no association was detected with hemorrhagic stroke. Conclusions-Long-term exposure to traffic-related air pollution may contribute to the development of ischemic but not hemorrhagic stroke, especially severe ischemic strokes leading to death within 30 days. (Stroke. 2012;43:320-325.)

“…Stroke status was based on the yes/no answers to the following questions: "Have you ever been told by a doctor that you have: Stroke" (Survey 1,1996); "In the last 3 years have you been told by a doctor that you have: Stroke" (Survey 2, 1999); "In the past 3 years, have you been diagnosed with or treated for: Stroke" (Survey [3][4][5][6][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011]. History of stroke was only classified as "yes" for participants who reported stroke at Survey 1 (baseline).…”

Section: Methodsmentioning

confidence: 99%

“…In Denmark, a 5-year study of people with first stroke found that 28% died within 28 days, 41% within 1 year, and 60% within 5 years 5 ; a 10-year study found a mortality rate of 81% and an association between stroke severity and survival. 6 In a 12-year study, Byles et al 7 found that two third of older Australian women with no previous history of stroke were still alive compared with only half with a history of stroke. A 21-year New Zealand study found that the mortality rate in those with stroke was double that of the general population.…”

mentioning

confidence: 99%

Stroke, Physical Function, and Death Over a 15-Year Period in Older Australian Women

Hubbard

Forder

et al. 2016

Data are from the 1921 to 1926 cohort of the Australian Longitudinal Study on Women's Health (ALSWH; http://www.alswh.org.au/). 8 Participants were randomly selected from the national health insurance database, with oversampling of women living in rural or remote areas. The study recruited and surveyed 12 432 women aged from 70 to 75 years in 1996 (born in 1921-1926). These women were followed up every 3 years between 1999 and 2011. Ethical approval was obtained from the Universities of Newcastle and Queensland.Background and Purpose-As populations age, an increasing number of older women are living with stroke. This study looks at long-term outcomes for women with stroke, comparing mortality rates for women with poor physical function (PF) and those with higher levels of function. The purpose is to understand not only how long women might live after a stroke, but also how long they live with physical disability. Methods-The study uses 15 years of data on women from the Australian Longitudinal Study on Women's Health 1921 to 1926 cohort. The risk of stroke and the risk of stroke and poor PF were estimated using Cox proportional hazard model. Among women who reported a stroke during the study period, mortality risk was compared according to their physical functioning level after that stroke. Results-Almost half of the women who had a stroke and poor PF survived past 10 years. The 10-year mortality rate was 37% for women with stroke and adequate PF and 51% for women with stroke and poor PF at the time of the stroke (hazard rate ratio, 1.52; 95% CI, 1.18-1.95; P=0.0015 adjusting for demographic and health covariates). Conclusions-This study provides evidence of the long-term outcomes of stroke among older women, with women living for many years with poor PF. This outcome has important implications for the women's quality of life during their later years and in understanding the burden of disability associated with stroke.