Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study)

Rothwell, P M; Coull, A J; Silver, L E; Fairhead, J F; Giles, M.F.; Lovelock, CE; Redgrave, Jne; Bull, Linda; Welch, Sarah; Cuthbertson, F C; Binney, Lucy E; Gutnikov, Sergei A.; Anslow, Philip; Banning, Adrian P.; Mant, David; Mehta, Ziyah

doi:10.1016/s0140-6736(05)67702-1

Cited by 826 publications

(362 citation statements)

References 32 publications

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“…Because TIA and stroke are associated with old age and generally occur in patients with other comorbidities, 10 such patients are likely to use substantial hospital resources even if they had not experienced a TIA or stroke, making the impact of disease on costs difficult to determine. Therefore, we also compared the costs for each of the 5 years after the index event with the costs incurred before the event by undertaking 2 analyses: (1) surviving cases, in which annual costs before and after the index event were compared only for patients who survived past 5 years; and (2) available cases, in which annual costs before and after the index event were compared by estimating the mean annual cost for patients, including patients who died, with complete data for that year.…”

Section: Discussionmentioning

confidence: 99%

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A Population-Based Study of Hospital Care Costs During 5 Years After Transient Ischemic Attack and Stroke

Luengo-Fernández

Gray

Rothwell

2012

Stroke

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Background and Purpose-Few studies have evaluated long-term costs after stroke onset, with almost no cost data for transient ischemic attack (TIA). We studied hospital costs during the 5 years after TIA or stroke in a population-based study. 595), with more than half of costs ($12 972) being incurred in the first year after the event. After index TIA, the mean censor-adjusted 5-year costs were $18 091 (95% confidence interval, 15 947-20 258). A multivariate analysis showed that event severity, recurrent stroke, and coronary events after the index event were independent predictors of 5-year costs. Differences by stroke subtype were mostly explained by stroke severity and subsequent events. Conclusions-Long-term hospital costs after TIA and stroke are considerable, but they are mainly incurred during the first year after the index event. Event severity and experiencing subsequent stroke and coronary events after the index event accounted for much of the increase in costs. Methods-Patients

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Section: Discussionmentioning

confidence: 99%

“…The study methods have been described elsewhere. 10 Briefly, patient registration began on April 2002, and it is ongoing. Only consenting patients recruited from April 1, 2002 to March 31, 2007, were included in this analysis.…”

Section: The Oxford Vascular Studymentioning

confidence: 99%

A Population-Based Study of Hospital Care Costs During 5 Years After Transient Ischemic Attack and Stroke

Luengo-Fernández

Gray

Rothwell

2012

Stroke

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“…Study methods have been described in detail elsewhere 19. Recruitment began in April 2002 and is ongoing.…”

Section: Methodsmentioning

confidence: 99%

Time Course of Evolution of Disability and Cause‐Specific Mortality After Ischemic Stroke: Implications for Trial Design

Ganesh

Luengo-Fernández

Wharton

et al. 2017

JAHA

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BackgroundOutcome in stroke trials is often based on a 3‐month modified Rankin scale (mRS). How 3‐month mRS relates to longer‐term outcomes will depend on late recovery, delayed stroke‐related deaths, recurrent strokes, and nonstroke deaths. We evaluated 3‐month mRS and death/disability at 1 and 5 years in a population‐based cohort study.Methods and ResultsIn 3‐month survivors of ischemic stroke (Oxford Vascular Study; 2002‐2014), we related 3‐month mRS to disability (defined as mRS >2) at 1 and 5 years and/or death rates (age/sex adjusted). Accrual of disability and index‐stroke‐related and nonstroke deaths in each poststroke year was categorized according to 3‐month mRS. Among 1606 patients with acute ischemic stroke, 181 died within 3 months, but 126 index‐stroke‐related deaths and 320 other deaths occurred during the subsequent 4866 patient‐years of follow‐up up to 5 years. Although 69/126 (54.8%) post‐3‐month index‐stroke‐related deaths occurred after 1 year, mRS>2 at 1 year strongly predicted these deaths (adjusted hazard ratio=21.94, 95%CI 7.88‐61.09, P<0.0001). Consequently, a 3‐month mRS >2 was a strong independent predictor of death at both 1 year (adjusted hazard ratio=6.67, 95%CI 4.16‐10.69, P<0.0001) and 5 years (adjusted hazard ratio=2.93, 95%CI 2.38‐3.60, P<0.0001). Although mRS improved by ≥1 point from 3 months to 1 year in 317/1266 (25.0%) patients with 3‐month mRS ≥1, improvement in mRS after 1 year was limited (improvement by ≥1 point: 91/858 [10.6%]; improvement to mRS ≤2: 13/353 [3.7%]).ConclusionsOur results reaffirm use of the 3‐month mRS outcome in stroke trials. Although later recovery does occur, extending follow‐up to 1 year would capture most long‐term stroke‐related disability. However, administrative mortality follow‐up beyond 1 year has the potential to demonstrate translation of early disability gains into additional reductions in long‐term mortality without much erosion by non‐stroke‐related deaths.

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“…Numerous studies have shown that men have higher stroke incidence than women in younger and middle‐age groups, but these differences narrow in older age groups and reverse in the elderly 11, 12, 13, 14, 15, 16. Recent studies have suggested declining stroke incidence in both men and women.…”

Section: Introductionmentioning

confidence: 99%

Trends in Acute Ischemic Stroke Hospitalizations in the United States

Ramírez

Kim-Tenser

Sanossian

et al. 2016

JAHA

140

125

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BackgroundPopulation‐based studies have revealed declining acute ischemic stroke (AIS) hospitalization rates in the United States, but no study has assessed recent temporal trends in race/ethnic‐, age‐, and sex‐specific AIS hospitalization rates.Methods and ResultsTemporal trends in hospitalization for AIS from 2000 to 2010 were assessed among adults ≥25 years using the Nationwide Inpatient Sample. Age‐, sex‐, and race/ethnic‐specific and age‐adjusted stroke hospitalization rates were calculated using the weighted number of hospitalizations and US census data. From 2000 to 2010, age‐adjusted stroke hospitalization rates decreased from 250 to 204 per 100 000 (overall rate reduction 18.4%). Age‐specific AIS hospitalization rates decreased for individuals aged 65 to 84 years (846 to 605 per 100 000) and ≥85 years (2077 to 1618 per 100 000), but increased for individuals aged 25 to 44 years (16 to 23 per 100 000) and 45 to 64 years (149 to 156 per 100 000). Blacks had the highest age‐adjusted yearly hospitalization rates, followed by Hispanics and whites (358, 170, and 155 per 100 000 in 2010). Age‐adjusted AIS hospitalization rates increased for blacks but decreased for Hispanics and whites. Age‐adjusted AIS hospitalization rates were lower in women and declined more steeply compared to men (272 to 212 per 100 000 in women versus 298 to 245 per 100 000 in men).ConclusionsAlthough overall stroke hospitalizations declined in the United States, the reduction was more pronounced among older individuals, women, Hispanics, and whites. Renewed efforts at targeting risk factor control among vulnerable individuals may be warranted.

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Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study)

Cited by 826 publications

References 32 publications

A Population-Based Study of Hospital Care Costs During 5 Years After Transient Ischemic Attack and Stroke

A Population-Based Study of Hospital Care Costs During 5 Years After Transient Ischemic Attack and Stroke

Time Course of Evolution of Disability and Cause‐Specific Mortality After Ischemic Stroke: Implications for Trial Design

Trends in Acute Ischemic Stroke Hospitalizations in the United States

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