Twenty-Year Trends in Long-Term Mortality Risk in 17 149 Survivors of Ischemic Stroke Less Than 55 Years of Age

Giang, Kok Wai; Björck, Lena; Nielsen, Susanne; Novak, Masuma; Sandström, Tatiana Zverkova; Jern, Christina; Rosengren, Annika

doi:10.1161/strokeaha.113.002936

Cited by 24 publications

(28 citation statements)

References 41 publications

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“…In another recent registry-based study from Sweden, the SMR for all patients with ischemic stroke aged 18 to 54 years was 8.15, which is in line with our figures considering the different age cuf off. 7 The average annual mortality rate in our study (1.6%) was in accordance with previous studies (1.4%-1.6%). 4,28 In our study, factors associated with mortality during the follow-up are similar to previous ones because our analysis showed that increasing age, active malignancy, type 1 diabetes mellitus, heart failure, heavy drinking, stroke in multiple territories, and increasing NIHSS score are associated with long-term mortality at young age.…”

Section: Discussionsupporting

confidence: 93%

“…If no visible ischemic lesion was present but symptoms lasted for 24 hours, lesion size was considered small. 18 Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) both as a total score at admission and as divided into mild (0-6), moderate (7)(8)(9)(10)(11)(12)(13)(14), and severe (≥15). 19 The classification of stroke pathogenesis was done independently by pairs of investigators, reaching consensus when necessary.…”

Section: Baseline Datamentioning

confidence: 99%

“…Recent studies have revealed that mortality among young patients with stroke is lower than in the elderly but significantly higher than in the age-adjusted general population. [4][5][6][7][8] Previous studies show that the cumulative mortality among young and middle-aged ischemic patients with stroke is 10.7% at 5 years, and this figure rises ≤27% after a mean follow-up of 18.3 years. 9,10 When transient ischemic attack and hemorrhagic stroke are added, the cumulative mortality after mean 11.1 year follow-up was 20%.…”

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confidence: 99%

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Long-Term Mortality After First-Ever and Recurrent Stroke in Young Adults

Aarnio

Haapaniemi

Melkas

et al. 2014

Stroke

116

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Background and Purpose-Mortality after first-ever stroke, and particularly after recurrent stroke, and predictors of longterm mortality among young and middle-aged stroke patients are not well-known. We assessed 17-year risk of mortality with focus on the effect of recurrence on the risk of death of young and middle-aged patients with stroke. Methods-Mortality and recurrent stroke rate of 970 consecutive 30-day survivors of first-ever ischemic stroke aged 15 to 49 years (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) were studied. Prospective follow-up data came from the Finnish Care Register for Health Care and Statistics Finland. Mean follow-up was 10.2±4.3 years. We compared survival between clinical subgroups and identified factors associated with mortality. Standardized mortality ratio was calculated for demographic and pathogenetic subgroups using mortality data of the general population matched with age, sex, calendar year, and geographical area. Results-At the end of follow-up, 152 (15.7%) patients had died (cumulative risk, 23.0%; 95% confidence interval, 19.1%-26.9%) and 132 (13.6%) had experienced a recurrent stroke. After adjusting for baseline characteristics, recurrent stroke was statistically the most important risk factor for mortality after first-ever ischemic stroke (hazard ratio, 16.68; 95% confidence interval, 2.33-119.56; P=0.005). Observed mortality was 7-fold higher than the expected mortality (standardized mortality ratio, 6.94; 95% confidence interval, 5.84-8.04) and particularly high among patients who experienced a recurrent stroke (standardized mortality ratio, 14.43; 95% confidence interval, 10.11-18.74). Conclusions-The high mortality rates and the striking impact of recurrent stroke on the risk of death should lead to development of more robust primary and secondary prevention strategies for young patients with stroke. (Stroke. 2014;45:2670-2676.)

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Section: Discussionsupporting

confidence: 93%

Section: Baseline Datamentioning

confidence: 99%

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confidence: 99%

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Long-Term Mortality After First-Ever and Recurrent Stroke in Young Adults

Aarnio

Haapaniemi

Melkas

et al. 2014

Stroke

116

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“…Furthermore, cardiovascular diseases were shown to be most common causes of death among younger ischemic stroke survivors (Giang et al. 2013). During the first decade of our investigation (1983–2003), a statistically valid decrease in body mass index in Lithuanian men was observed (Nichols et al.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors propose a hypothesis that the progressive male hormones (testosterone) deficiency is a major cause of difference in survival between the sexes in patients with stroke (Giang et al. 2013). Moreover, our study found that male standardized mortality rate during the study period decreased by 35% and that of females by 63%.…”

Section: Discussionmentioning

confidence: 99%

Twenty years trends in mortality rates from stroke in Klaipeda

et al. 2016

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BackgroundDuring the past decades, mortality from stroke decreased in many western European countries; however, changes concerning long‐term stroke mortality in eastern European countries are less evident.ObjectiveTo assess age‐ and gender‐specific trends in stroke mortality in Klaipeda (Lithuania) from 1994 to 2013.DesignDescriptive epidemiological study.Setting/subjectsPermanent population of Klaipeda.MethodsData on 2509 permanent residents of Klaipeda aged 35–79 years who died from stroke between 1994 and 2013 were gathered. Directly, age‐standardized (European population) stroke mortality rates were analyzed using joinpoint regression separately for specific age groups (35–64, 65–79, and 35–79 years) and by gender. Annual percentage change (APC) and 95% CIs were presented.ResultsStroke mortality in the 35‐ to 79‐year‐old age group peaked in 1994–1997, it then decreased by −9.9% (95% CI: −18.7, −0.2) yearly up until 2001 and leveled off by −0.2% (−5.1, 4.9) between 2001 and 2013. Among men aged 35–64 years, mortality decreased substantially by 12.8% (−21.5, −3.3) per year from 1994 to 2001 and turned positive by 6.3% (0.8, 12.1) between 2000 and 2013. Among women aged 35–64 years, mortality decreased significantly by 15.5% (−28.1, −0.7) from 1994 to 2000. There was evidence of recent plateauing of trends for 35‐ to 64‐year‐old women between 2000 and 2013. In the 65‐ to 79‐year‐old age group, mortality decreased from 1994 onward yearly by −5.5% (−7.9, −3.0) in women and by −3.3% (−5.6, −0.9) in men.ConclusionsJoinpoint regression revealed steadily decreasing trend in stroke mortality between 1994 and 2001. The decline in death rates flattened out in the recent decade. Mortality rates varied among age groups and were more pronounced in adults aged 35–64 years. It is essential to monitor and manage stroke risk factors, especially among middle‐aged population.

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Association of Stroke Among Adults Aged 18 to 49 Years With Long-term Mortality

Ekker¹,

Verhoeven²,

Vaartjes

et al. 2019

JAMA

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IMPORTANCE Stroke remains the second leading cause of death worldwide. Approximately 10% to 15% of all strokes occur in young adults. Information on prognosis and mortality specifically in young adults is limited. OBJECTIVE To determine short-and long-term mortality risk after stroke in young adults, according to age, sex, and stroke subtype; time trends in mortality; and causes of death. DESIGN, SETTING, AND PARTICIPANTS Registry-and population-based study in the Netherlands of 15 527 patients aged 18 to 49 years with first stroke between 1998 and 2010, and follow-up until January 1, 2017. Patients and outcomes were identified through linkage of the national Hospital Discharge Registry, national Cause of Death Registry, and the Dutch Population Register. EXPOSURES First stroke occurring at age 18 to 49 years, documented using International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes for ischemic stroke, intracerebral hemorrhage, and stroke not otherwise specified. MAIN OUTCOMES AND MEASURES Primary outcome was all-cause cumulative mortality in 30-day survivors at end of follow-up, stratified by age, sex, and stroke subtype, and compared with all-cause cumulative mortality in the general population. RESULTS The study population included 15 527 patients with stroke (median age, 44 years [interquartile range, 38-47 years]; 53.3% women). At end of follow-up, a total of 3540 cumulative deaths had occurred, including 1776 deaths within 30 days after stroke and 1764 deaths (23.2%) during a median duration of follow-up of 9.3 years (interquartile range, 5.9-13.1 years). The 15-year mortality in 30-day survivors was 17.0% (95% CI, 16.2%-17.9%). The standardized mortality rate compared with the general population was 5.1 (95% CI, 4.7-5.4) for ischemic stroke (observed mortality rate 12.0/1000 person-years [95% CI, 11.2-12.9/1000 person-years]; expected rate, 2.4/1000 person-years; excess rate, 9.6/1000 person-years) and the standardized mortality rate for intracerebral hemorrhage was 8.4 (95% CI, 7.4-9.3; observed rate, 18.7/1000 person-years [95% CI, 16.7-21.0/1000 person-years]; expected rate, 2.2/1000 person-years; excess rate, 16.4/1000 person-years). CONCLUSIONS AND RELEVANCE Among young adults aged 18 to 49 years in the Netherlands who were 30-day survivors of first stroke, mortality risk compared with the general population remained elevated up to 15 years later.

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Twenty-Year Trends in Long-Term Mortality Risk in 17 149 Survivors of Ischemic Stroke Less Than 55 Years of Age

Cited by 24 publications

References 41 publications

Long-Term Mortality After First-Ever and Recurrent Stroke in Young Adults

Long-Term Mortality After First-Ever and Recurrent Stroke in Young Adults

Twenty years trends in mortality rates from stroke in Klaipeda

Association of Stroke Among Adults Aged 18 to 49 Years With Long-term Mortality

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