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Background: Stroke is the second leading cause of death in Korea but long-term survival of Korean stroke patients has not been studied. Thus, we examined 6-year survival and causes of death in a nationally representative inpatient sample. Methods: Between January 2000 and March 2000 in 152 sample hospitals, 4,299 first-ever stroke patients were identified and followed-up for vital status until December 2005. Mortality and mortality-related factors were evaluated by the Kaplan-Meier method and Cox proportional hazard regression analysis. Results: Ischemic stroke was the most common subtype (62.9%), followed by intracerebral hemorrhage (ICH, 21.2%), and subarachnoid hemorrhage (SAH, 6.4%). Six-year mortality was estimated at 37.1% for all strokes, 37.2% for ischemic, 41.0% for ICH, and 29.2% for SAH. Common causes of death were stroke (58.2%), malignancies (10.3%), other cardiovascular diseases (7.7%), and diabetes (6.8%). Six-year mortality was associated with old age (hazard ratio 1.70 per 10 years, 95% CI 1.62–1.78), male sex (1.29, 1.16–1.43), subtypes of ICH (1.30, 1.15–1.48) and SAH (1.43, 1.14–1.80), longer hospital admission (1.01 per 10 days, 1.00–1.03), and loss of consciousness (1.32, 1.13–1.55). Conclusions: More than 60% of Korean patients with first-ever stroke survived to 6 years. Major causes of death were stroke, cancer, cardiovascular diseases, and diabetes. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Prospective stroke registries allow analyzing important aspects of the natural history of acute cerebrovascular events. Using the Sagrat Cor Hospital of Barcelona Stroke Registry, we aimed to determine trends in risk factors, stroke subtypes, prognosis and in-hospital mortality over 19 years in hospitalized stroke patients. Methods: The study population consisted of 2,416 first-ever stroke patients (ischemic stroke, n = 2,028; intracerebral hemorrhage, n = 334) included in the stroke registry up to December 31, 2004. Temporal trends in stroke patient characteristics for the periods 1986–1992, 1993–1998 and 1999–2004 were assessed. Results: Age was significantly different among the analyzed periods (p < 0.001), showing an increment in older patients throughout time. Hypertension (p = 0.001), diabetes (p = 0.004), ischemic heart disease (p = 0.002) and atrial fibrillation increased (p = 0.000) as opposed to heavy smoking (p = 0.000) and history of TIA (p = 0.025). The mortality rate and the length of hospital stay decreased (p = 0.001), whereas transfer to convalescent/rehabilitation units increased (p = 0.001). Conclusions: An improvement in acute-stroke management and possibly evolution of cerebrovascular risk factors is reflected by changes in the risk factors and outcome of first-ever stroke patients admitted to a stroke unit over a 19-year time span. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having ‘first-ever stroke’ (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006. Background: An estimated 5.8 million people died from stroke (cerebrovascular disease) in 2005, two thirds of them were from low-/middle-income countries but reliable population-based studies are scarce. Methods: The manual on WHO STEPwise approach to stroke surveillance (STEPS Stroke; http://www.who.int/chp/steps/Manual pdf) was the operational protocol. We selected a well-defined community (H-district) having verifiable census data and being representative of the population structure of Mumbai (Bombay). Of 337,391 permanent residents, 156,861 persons between the age of 25 and 94+ years who were eligible for survey were screened. The responses to a predefined questionnaire (version 2.0) were entered in coded data sheets for analysis. Results: During the 2-year study period (January 2005 to December 2006), 456 (238 males and 218 females) had FES, indicating an annual incidence in subjects of 25 years and above of 145/100,000 persons (CI 95%: 120–170); for males it is 149/100,000 persons (CI 95%: 120–170) and for females it is 141/100,000 persons (CI 95%: 120–160). The age-standardized rate for study population (both sexes) by the direct method using Segi’s 1996 world population is 152/100,000/year (CI 95%: 132–172). Stroke diagnosis was supported by computed tomography in 407 (89.2%) of 456 FES cases: 366 (80.2%) had ischemic stroke, 81 (17.7%) had hemorrhagic stroke and 9 (1.9%) were in the unspecified category. The mean age was 66 ± (SD) 13.60 years, women were older as compared to men (mean age 68.9 ± 13.12 years vs. 63.4 ± 13.53 years). Case fatality: at 28 days, 320 (70%) of 456 FES cases were still alive and 136 (29.8%) had died. Of the 320 surviving patients 38.5% had moderate to severe disability by the modified Rankin scale. Conclusions: The results of Mumbai stroke study, using uniform definitions and methodologies, show that the annual standardized incidence rates, stroke subtypes and case fatality rate are very similar to those reported from developed nations. To plan effective intervention and prevention strategies, standardized data in representative samples of regional populations are urgently needed. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: Our aim was to assess prevalence rates of cerebrovascular disease (CVD; stroke and transient ischemic attacks) according to age and gender in three populations in central Spain using data from the Neurological Disorders in Central Spain (NEDICES) study, a population-based survey of elderly participants. Methods: Individuals from one suburban municipality of Greater Madrid (Las Margaritas neighborhood, Getafe), one urban district of Madrid (Lista) and one rural site (Arévalo county, Avila) were evaluated at baseline (n = 5,278). The evaluation included a screening questionnaire and a neurological assessment when possible. We used point prevalence with a reference date of May 1, 1994. Results: Of the 5,278 subjects, there were 186 prevalent stroke cases and 71 cases of transient ischemic attacks. Prevalence rates, adjusted to the standard European populations, were 4.9% for CVD (95% confidence interval [CI] = 4.3–5.4), 3.4% for stroke (95% CI = 2.9–3.9) and 1.3% for transient ischemic attacks (95% CI = 1.0–1.6) in the total population. Age-specific prevalence rates of CVD, stroke and transient ischemic attacks increased exponentially with advancing age. The prevalence rates of CVD, stroke and transient ischemic attacks were higher for men than for women. Prevalence figures were higher in the suburban area of Margaritas compared to the rural region. Conclusions: In this study, the prevalence of stroke and transient ischemic attacks were higher in men and in urban areas. Central Spain would be a medium stroke prevalence zone. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Several studies have shown a relationship between low socioeconomic status, age and stroke mortality. However, there is lack of similar studies in relation to stroke incidence. All cases of first-ever stroke occurring in a population aged 35–85 years from the city of Umeå were collected from hospital-based registers during a 2-year study period (2000–2002), from death certificates and also from nursing homes during a 6-month period. The WHO definition of stroke was used. Register data served to analyze educational level. A total of 457 first-ever strokes (244 women and 213 men) were registered, corresponding to an overall annual incidence rate of first-ever stroke of 413.4 per 100,000. The incidence of first-ever stroke was significantly higher among low-educated compared to high-educated men and women. The highest stroke incidence was found among low-educated women aged 75–85 years. The educational-related differences in stroke incidence persisted in the oldest age group (75–85 years), also after controlling for sex and age. This is one of the first studies that analyzes first-ever stroke incidence also among elderly men and women (75–85 years) in relation to socioeconomic status. More community-based studies are needed in order to confirm the results. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: There is uncertainty regarding the impact of changes in stroke care and natural history of stroke in the community. We examined factors responsible for trends in survival after stroke in a series of population-based studies. Methods: We used statistical models to assess temporal trends in 28-day and 1-year case fatality after first-ever stroke cases registered in 3 stroke incidence studies undertaken in Auckland, New Zealand, over uniform 12-month calendar periods in 1981–1982 (n = 1,030), 1991–1992 (1,305) and 2001–2002 (1,423). Cox proportional hazards regression was used to evaluate the significance of pre-defined ‘patient’, ‘disease’ and ‘service/care’ factors on these trends. Results: Overall, there was a 40% decline in 28-day case fatality after stroke over the study periods, from 32% (95% confidence interval, 29–35%) in 1981–1982 to 23% (21–25%) in 1991–1992 and then 19% (17–21%) in 2002–2003. Similar relative declines were seen in 1-year case fatality. In regression models, the trends were still significant after adjusting for patient and disease factors. However, further adjustment for care factors (higher hospital admission and neuroimaging) explained most of the improvement in survival. Conclusions: These data show significant downwards trends in case fatality after stroke in Auckland over 20 years, which can largely be attributed to improved stroke care associated with increases in hospital admission and brain imaging during the acute phase of the illness. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]