Trends in Fatal and Nonfatal Strokes Among Persons Aged 35 to ≥85 Years During 1991–2002 in Finland

Background and Purpose-Stroke incidence rates were unchanged whereas fatality rates declined during the period 1971 to 1987 in Gothenburg (Göteborg), Sweden. For the period 1987 to 2006, we now report on trends in stroke incidence and mortality with concurrent risk factor trends in the same population. Since 1976 the incidence of myocardial infarction decreased by 50%. Methods-Through the National Hospital Discharge Register linked with the Cause of Death Register, 12 904 males and 15 250 females with first strokes were detected for the period 1987 to 2006. Cardiovascular risk factor data were available for random population samples of men and women aged 50 years from 1963 to 2003. Results-Incidence and mortality rates for all-stroke were unchanged. Rates for subarachnoid hemorrhage declined for the age group 45 to 54 in men, but not significantly in any other age group of men or women. Mortality rates of intracerebral hemorrhage declined for women aged 65 to 74, with no significant changes in any other age group. Ischemic stroke incidence did not change, but mortality increased for men and women aged 75 and older, whereas mortality declined for the age group 20 to 44 for men. In the general population there were significant reductions in smoking, total cholesterol, and blood pressure levels in both men and women, whereas diabetes prevalence, body weight, and BMI increased among both sexes, and triglycerides increased in men. Conclusion-Contrary

Section: Discussioncontrasting

confidence: 77%

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confidence: 99%

Stroke Incidence and Mortality Rates 1987 to 2006 Related to Secular Trends of Cardiovascular Risk Factors in Gothenburg, Sweden

Harmsen

Wilhelmsen

Jacobsson

2009

“…In Finland Ͼ97% of stroke diagnoses are verified by CT scan, MRI imaging, or necropsy. 16 We divided stroke into 3 categories, thrombotic, hemorrhagic, and other, based on groupings in the international classification of disease that have been used in previous analyses. [5][6][7] The number of cases in our study was insufficient for examination of smaller diagnostic groupings, such as subarachnoid hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Infant Growth and Stroke in Adult Life

Osmond

Kajantie

Forsén

et al. 2007

178

Background and Purpose-People who had low birth weight are at increased risk of stroke. Little is known about the effects of early postnatal growth on stroke risk. Methods-We followed-up 12 439 people born in Helsinki during 1934 to 1944. Their body size was measured at birth and, on average, 9 times between birth and age 2 years; 507 of them were hospitalized with stroke or died from the disease. Results-Hazard ratios for stroke declined progressively with increasing gain in weight between birth and age 2 years. The hazard ratio was 0.85 (95% CI, 0.78 to 0.93; Pϭ0.0004) per standard deviation increase in the difference between the weight attained at age 2 years and that predicted from birth weight. A 1-standard deviation increase in body mass index at 2 years of age was associated with a hazard ratio for stroke of 0.84 (95% CI, 0.77 to 0.92; Pϭ0.0002). This association was little changed by adjustment for measures of socio-economic status. Change in body size after the age of 2 years had little effect on the risk of later stroke. People whose mothers had a small external conjugate diameter of the pelvis had an increased risk of stroke. The hazard ratio associated with a diameter of Յ18 cm was 1.62 (95% CI, 1.30 to 2.02; PϽ0.0001). Conclusion-Thinness during infancy is associated with an increased risk of stroke in later life. This association may be the result of maternal influences which originated in the mother's infancy when her pelvic shape was established.

“…1,2 Although overall mortality from stroke is falling in western Europe and America, [3][4][5] trends in incidence are less clear and there are conflicting reports of stable, 6 increasing, 7,8 and decreasing rates. 5,9,10 Stroke is a disease of the elderly. As populations in developed countries age, stroke will become a major public health problem associated with significant use of healthcare resources.…”

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confidence: 99%

Sex Differences in Incidence, Mortality, and Survival in Individuals With Stroke in Scotland, 1986 to 2005

Lewsey

Gillies

Jhund

et al. 2009

Background and Purpose-The aim of this study was to examine the effect of sex across different age groups and over time for stroke incidence, 30-day case-fatality, and mortality. Methods-All first hospitalizations for stroke in Scotland (1986Scotland ( to 2005 were identified using linked morbidity and mortality data. Age-specific rate ratios (RRs) for comparing women with men for both incidence and mortality were modeled with adjustment for study year and socioeconomic deprivation. Logistic regression was used to model 30-day case-fatality. Results-Women had a lower incidence of first hospitalization than men and size of effect varied with age (55 to 64 years, RRϭ0.65, 95% CI 0.63 to 0.66; Ն85 years, RRϭ0.94, 95% CI 0.91 to 0.96). Women aged 55 to 84 years had lower mortality than men and again size of effect varied with age (65 to 74 years, RRϭ0.79, 95% CI 0.76 to 0.81); 75 to 84 years, RRϭ0.94, 95% CI 0.92 to 0.95). Conversely, women aged Ն85 years had 15% higher stroke mortality than men (RRϭ1.15, 95% CI 1.12 to 1.18). Adjusted risk of death within 30 days was significantly higher in women than men, and this difference increased over the 20-year period in all age groups (adjusted OR in 55 to 64 year olds 1.23, 95% CI 1.14 to 1.33 in 1986 and 1.51, 95% CI 1.39 to 1.63 in 2005). Conclusions-We observed lower rates of incidence and mortality in younger women than men. However, higher numbers of older women in the population mean that the absolute burden of stroke is greater in women. Short-term case-fatality is greater in women of all ages and, worryingly, these differences have increased from 1986 to 2005.