Trends in Incidence, Lifetime Risk, Severity, and 30-Day Mortality of Stroke Over the Past 50 Years

Carandang, Raphael A.; Seshadri, Sudha; Beiser, Alexa; Kelly-Hayes, Margaret; Kase, Carlos S.; Kannel, William B.; Wolf, Philip A.

doi:10.1001/jama.296.24.2939

Cited by 443 publications

(336 citation statements)

References 61 publications

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“…Analyses from the Framingham Study revealed a decrease in stroke incidence for the past 50 years, although the lifetime risk of stroke did not decrease to the same degree [86]; this may reflect both an improvement in risk factor control, as well as an improvement in life expectancy. Population-based studies in Oxfordshire (United Kingdom) showed a major reduction in age-and genderspecific stroke incidence for the past 20 years [85].…”

Section: Trends In Strokementioning

confidence: 89%

“…In general, the trends in stroke incidence and mortality rates have decreased in the recent decades for high-income countries such as the U.S., the United Kingdom, and Canada [83][84][85][86]. Analyses from the Framingham Study revealed a decrease in stroke incidence for the past 50 years, although the lifetime risk of stroke did not decrease to the same degree [86]; this may reflect both an improvement in risk factor control, as well as an improvement in life expectancy.…”

Section: Trends In Strokementioning

confidence: 99%

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Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

2011

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Stroke is the fourth killer and number one cause of adult disability in the United States. The estimated direct and indirect costs of stroke care in this country are $68.9 billion for 2009. The prevalence of stroke and its cost will undoubtedly rise as the aging population increases. In addition, stroke incidence and mortality are increasing in less developed countries in which the lifestyles and population restructuring are rapidly changing. More population-based research to assess incidence, risk factors, and outcomes are needed in these countries. Epidemiologic studies can help identify groups of individuals or regions at higher risk for stroke. They can also help us better understand the natural history of certain conditions and therefore push the direction of therapeutic investigations. Furthermore, the study of trends across different time periods and different populations can help investigators evaluate the effects of stroke care programs and treatment options.

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Section: Trends In Strokementioning

confidence: 89%

Section: Trends In Strokementioning

confidence: 99%

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

2011

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“…[14][15][16] Stroke incidence was analyzed by 3 different periods to address potential diagnostic differences as well as potential cultural changes in lifestyle : 1950-1977 vs. 1978-1989 vs. 1990 or later. 17 Descriptive summary statistics and graphical analyses were used to assess each of the variables across all subjects as well as by gender. Differences in continuous variables between groups were assessed using two-sample t-test when assumptions did not hold and sufficient transformations were not possible.…”

Section: Discussionmentioning

confidence: 99%

Lifetime risk of stroke and impact of hypertension: estimates from the adult health study in Hiroshima and Nagasaki

et al. 2011

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Very few reports have been published on lifetime risk (LTR) of stroke by blood pressure (BP) group. This study included participants in the Radiation Effects Research Foundation Adult Health Study who have been followed up by biennial health examinations since 1958. We calculated the LTR of stroke for various BP-based groups among 7847 subjects who had not been diagnosed with stroke before the index age of 55 years using cumulative incidence analysis adjusting for competing risks. By 2003, 868 subjects had suffered stroke (512 (58.9%) were women and 542 (62.4%) experienced ischemic stroke). BP was a significant factor in determining risk of stroke for men and women, with distributions of cumulative risk for stroke significantly different across BP groups. The LTR of all-stroke for normotension (systolic BP/diastolic BP o120/80 mm Hg), prehypertension (120-139/80-89 mm Hg), stage1 hypertension (140-159/90-99 mm Hg) and stage 2 hypertension (4160/100 mm Hg) were 13.8-16.9-25.8-25.8% in men and 16.0-19.9-24.0-30.5% in women, respectively (Po0.001 among BP groups in both sexes). The estimates did not differ significantly (P¼0.16) between normotensive and prehypertensive subjects. One in five Japanese atomic bomb survivor subjects experienced stroke over their lifetime from the age of 55 years. Long-term stroke risks were elevated in those with hypertension (4140/90 mm Hg) at any of the index ages of 45, 55, 65 and 75 years.

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“…Epidemiologists have observed a decline in stroke incidence and case fatality in the United States attributable to improved risk factor control 1, 2. Obesity is an independent risk factor for stroke, and increased body mass index (BMI) has been associated with all‐cause mortality in the general population 3, 4.…”

Section: Introductionmentioning

confidence: 99%

Overweight, Obesity, and Survival After Stroke in the Framingham Heart Study

Aparicio

Himali

Beiser

et al. 2017

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BackgroundWe investigated how body weight affects survival after stroke, leveraging the availability of multiple prestroke body mass index (BMI) measurements and using a nested case‐control design in a community‐based sample.Methods and ResultsWe compared all‐cause mortality in participants stratified by prestroke weight. Separate analyses were performed for ischemic stroke and all stroke and for age‐, sex‐, and BMI category‐matched stroke‐free controls. Participants were grouped into BMI categories and followed for up to 10 years. Differences in survival were tested for interaction by case status. In sensitivity analysis, to exclude those with prestroke weight loss, we restricted the reference group to participants with 2 consistently normal BMI measurements within 10 years before stroke/matching. There were 782 stroke cases (age 71±9, 51% female participants, 87% ischemic stroke) and 2346 controls (age 72±9, 51% female participants). Overweight participants with ischemic stroke had a lower mortality compared with those with normal weight (hazard ratio [HR]=0.70, 95%CI 0.55‐0.90, P=0.005). The association of reduced mortality with BMI ≥25, compared with normal‐weight BMI 18.5 to <25, was pronounced among ischemic stroke cases but diminished with inclusion of hemorrhagic strokes (case‐control interaction P=0.051 and P=0.130, respectively). Compared with participants with stable normal weight, moderately increased weight was protective after ischemic stroke (overweight HR=0.72, 95%CI 0.53‐0.99, P=0.041).ConclusionsOverweight and mildly obese participants had better 10‐year survival after ischemic stroke compared with normal‐weight participants, even after excluding persons with recent prestroke weight loss. There may be unknown protective factors associated with a moderately increased body weight before stroke.

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Trends in Incidence, Lifetime Risk, Severity, and 30-Day Mortality of Stroke Over the Past 50 Years

Cited by 443 publications

References 61 publications

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

Lifetime risk of stroke and impact of hypertension: estimates from the adult health study in Hiroshima and Nagasaki

Overweight, Obesity, and Survival After Stroke in the Framingham Heart Study

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