Stroke hospitalization trends of the working-aged in Finland

Abstract

BackgroundThe age-standardized incidence of stroke has decreased globally but, for reasons unknown, conflicting results have been observed regarding trend in incidence of major stroke subtypes in young adults. We studied these trends among people of working age in a population-based setting in Finland, where cardiovascular risk factor profiles have developed favorably.MethodsAll hospitalizations for stroke in 2004–2005 and 2013–2014 for persons 18–64 years of age were identified from a national register. The search included all hospitals that provide acute stroke care on mainland Finland.ResultsHospitalizations for both intracerebral hemorrhage (ICH; -15.2%; p = 0.0008) and subarachnoid hemorrhage (SAH; -26.5%; p<0.0001) decreased overall and for both sexes separately. Concerning IS, hospitalizations decreased only for men (-6.3%; p = 0.0190) but not for women or overall. However, there was an increase in IS hospitalizations in men 35–44 years of age (+37.5%; p = 0.0019). The length of stay (LOS) of IS patients declined in nearly all subgroups (overall -20.8%, p<0.0001) whereas no change in LOS was observed for patients with ICH or SAH. In-hospital mortality decreased in patients with IS (-42.8%; p = 0.0092) but remained unchanged in patients with ICH or SAH.ConclusionsStroke hospitalizations of young people declined in Finland, except for men 35–44 years of age for whom IS hospitalizations increased. Declining LOS and in-hospital mortality of IS patients suggests admission of less severe cases, improved care or both.

Incidence of hospitalization and mortality due to stroke in young adults, residents of developed regions in Brazil, 2008-2018

“…Considering the physiopathology of the disease, it is an expected scenario since elder individuals are more exposed to risk factors, such as hypertension, dyslipidemia and diabetes [20]. Moreover, in line with this Dutch study and another marked out in Finland (2004-2014), we also found increase in stroke hospitalization incidence rates limited to IS [21]. In Brazil, it was already pointed by Cabral et al (2017), who observed a 66% increase in IS incidence rate ratios in adults aged < 55 (IRR = 1.66; CI: 95%, 1.09-2.54) [7].…”

“…These results are concerning since stroke in the young population can highly impact in their quality of life, as subsequently the economy, as the consequences can disable the youngers to work in their most productive years of life [4,14]. To mitigate these consequences, developed regions in Brazil had experienced an improving in health resources in the past decades, although the lack of evidence-based management guidelines is challenging for these unusual research-based etiologies that have been completed to date [21,38]. In addition to studies evaluating stroke occurrence in specific population subgroups, more studies are required to monitor trends in other risk factors, such as tobacco use, drug distribution, quality of health care and socioeconomic conditions.…”

Time Trends in Survival Following First Hemorrhagic or Ischemic Stroke Between 1991 and 2015 in the Rotterdam Study

“…12 In fact, the favorable trends observed after ischemic stroke will likely gradually translate to a greater accumulated burden of disability and stroke-related dependency. 3,[22][23][24] A majority of patients with stroke suffer from one or more disability after recovery including hemiparesis (≈50%), cognitive deficits (46%), aphasia (19%), depression (35%), and limitations with walking unassisted (30%). 25 Several reports showed an increase in long-term institutionalization, in-patient rehabilitation services, support services after discharge, and informal care giving among stroke survivors.…”

“…25 Several reports showed an increase in long-term institutionalization, in-patient rehabilitation services, support services after discharge, and informal care giving among stroke survivors. 3,[23][24][25] Stroke is ranked as one of the most expensive diseases in the Netherlands. 26 The burden of stroke-related disability and the associated costs are expected to continue to increase in aging populations.…”

Adult Migraine Hospital Admission Trends in Finland: A Nationwide Registry Study

“…Interestingly, there was no change in the annual stroke admission frequency of the working-aged in Finland in the same period [17], suggesting that an increasing number of patients were screened for no apparent benefit. At the same time, the number of hospital beds per 1000 population decreased from 7.1 to 4.5 [18], meaning that this increasingly scarce resource must be managed optimally.…”