Long-term trends in death and dependence after ischaemic strokes: A retrospective cohort study using the South London Stroke Register (SLSR)


Autoři: Hatem A. Wafa aff001;  Charles D. A. Wolfe aff001;  Ajay Bhalla aff001;  Yanzhong Wang aff001
Působiště autorů: School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom aff001;  National Institute for Health Research (NIHR) Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, United Kingdom aff002;  National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, London, United Kingdom aff003;  Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom aff004
Vyšlo v časopise: Long-term trends in death and dependence after ischaemic strokes: A retrospective cohort study using the South London Stroke Register (SLSR). PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003048
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003048

Souhrn

Background

There have been reductions in stroke mortality over recent decades, but estimates by aetiological subtypes are limited. This study estimates time trends in mortality and functional dependence by ischaemic stroke (IS) aetiological subtype over a 16-year period.

Methods and findings

The study population was 357,308 in 2011; 50.4% were males, 56% were white, and 25% were of black ethnic backgrounds. Population-based case ascertainment of stroke was conducted, and all participants who had their first-ever IS between 2000 and 2015 were identified. Further classification was concluded according to the underlying mechanism into large-artery atherosclerosis (LAA), cardio-embolism (CE), small-vessel occlusion (SVO), other determined aetiologies (OTH), and undetermined aetiologies (UND). Temporal trends in survival rates were examined using proportional-hazards survival modelling, adjusted for demography, prestroke risk factors, case mix variables, and processes of care. We carried out additional regression analyses to explore patterns in case-fatality rates (CFRs) at 30 days and 1 year and to explore whether these trends occurred at the expense of greater functional dependence (Barthel Index [BI] < 15) among survivors. A total of 3,128 patients with first-ever ISs were registered. The median age was 70.7 years; 50.9% were males; and 66.2% were white, 25.5% were black, and 8.3% were of other ethnic groups. Between 2000–2003 and 2012–2015, the adjusted overall mortality decreased by 24% (hazard ratio [HR] per year 0.976; 95% confidence interval [CI] 0.959–0.993). Mortality reductions were equally noted in both sexes and in the white and black populations but were only significant in CE strokes (HR per year 0.972; 95% CI 0.945‒0.998) and in patients aged ≥55 years (HR per year 0.975; 95% CI 0.959‒0.992). CFRs within 30 days and 1 year after an IS declined by 38% (rate ratio [RR] per year 0.962; 95% CI 0.941‒0.984) and 37% (RR per year 0.963; 95% CI 0.949‒0.976), respectively. Recent IS was independently associated with a 23% reduced risk of functional dependence at 3 months after onset (RR per year 0.983; 95% CI 0.968–0.998; p = 0.002 for trend). The study is limited by small number of events in certain subgroups (e.g., LAA), which could have led to insufficient power to detect significant trends.

Conclusions

Both mortality and 3-month functional dependence after IS decreased by an annual average of around 2.4% and 1.7%, respectively, during 2000‒2015. Such reductions were particularly evident in strokes of CE origins and in those aged ≥55 years.

Klíčová slova:

Computed axial tomography – Death rates – Ethnic epidemiology – Etiology – Ischemic stroke – Magnetic resonance imaging – Medical risk factors – Stroke


Zdroje

1. Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA, et al. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990–2013: The GBD 2013 Study. Neuroepidemiology. 2015;45(3):161–76. doi: 10.1159/000441085 26505981

2. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197–223. doi: 10.1016/S0140-6736(12)61689-4 23245608

3. Wang YZ, Rudd AG, Wolfe CDA. Trends and Survival Between Ethnic Groups After Stroke The South London Stroke Register. Stroke. 2013;44(2):380–+. doi: 10.1161/STROKEAHA.112.680843 23321449

4. Bray BD, Paley L, Hoffman A, James M, Gompertz P, Wolfe CDA, et al. Socioeconomic disparities in first stroke incidence, quality of care, and survival: a nationwide registry-based cohort study of 44 million adults in England. Lancet Public Health. 2018;3(4):e185–e93. doi: 10.1016/S2468-2667(18)30030-6 29550372

5. Rothwell PM, Coull AJ, Giles MF, Howard SC, Silver LE, Bull LM, et al. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet. 2004;363(9425):1925–33. doi: 10.1016/S0140-6736(04)16405-2 15194251

6. Bhalla A, Wang Y, Rudd A, Wolfe CD. Differences in outcome and predictors between ischemic and intracerebral hemorrhage: the South London Stroke Register. Stroke. 2013;44(8):2174–81. doi: 10.1161/STROKEAHA.113.001263 23813988

7. Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2(1):43–53. doi: 10.1016/s1474-4422(03)00266-7 12849300

8. Cadilhac DA, Kim J, Lannin NA, Kapral MK, Schwamm LH, Dennis MS, et al. National stroke registries for monitoring and improving the quality of hospital care: A systematic review. Int J Stroke. 2016;11(1):28–40. doi: 10.1177/1747493015607523 26763018

9. Gropen TI, Gagliano PJ, Blake CA, Sacco RL, Kwiatkowski T, Richmond NJ, et al. Quality improvement in acute stroke: the New York State Stroke Center Designation Project. Neurology. 2006;67(1):88–93. doi: 10.1212/01.wnl.0000223622.13641.6d 16832083

10. McGrath K, Cunningham N, Moloney E, O'Connor M, McManus J, Peters C, et al. Enhancing acute stroke services: a quality improvement project. BMJ Open Qual. 2018;7(3):e000258. doi: 10.1136/bmjoq-2017-000258 30019014

11. Asplund K, Hulter Asberg K, Norrving B, Stegmayr B, Terent A, Wester PO, et al. Riks-stroke—a Swedish national quality register for stroke care. Cerebrovasc Dis. 2003;15 Suppl 1(Suppl. 1):5–7.

12. Wolfe CD, Smeeton NC, Coshall C, Tilling K, Rudd AG. Survival differences after stroke in a multiethnic population: follow-up study with the South London stroke register. BMJ. 2005;331(7514):431. doi: 10.1136/bmj.38510.458218.8F 16055452

13. Xian Y, Holloway RG, Noyes K, Shah MN, Friedman B. Racial Differences in Mortality Among Patients With Acute Ischemic Stroke An Observational Study. Annals of Internal Medicine. 2011;154(3):152–+. doi: 10.7326/0003-4819-154-3-201102010-00004 21282694

14. Gushulak B. Healthier on arrival? Further insight into the "healthy immigrant effect". CMAJ. 2007;176(10):1439–40. doi: 10.1503/cmaj.070395 17485696

15. Seminog OO, Scarborough P, Wright FL, Rayner M, Goldacre MJ. Determinants of the decline in mortality from acute stroke in England: linked national database study of 795 869 adults. BMJ. 2019;365:l1778. doi: 10.1136/bmj.l1778 31122927

16. Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP). Rising to the Challenge, The Fourth SSNAP Annual Report. Available from: https://www.strokeaudit.org/Documents/AnnualReport/2016-17-SSNAP-Annual-Report.aspx. [cited 2019 July 11].

17. Aked J, Delavaran H, Norrving B, Lindgren A. Temporal Trends of Stroke Epidemiology in Southern Sweden: A Population-Based Study on Stroke Incidence and Early Case-Fatality. Neuroepidemiology. 2018;50(3–4):174–82. doi: 10.1159/000487948 29621789

18. Carandang R, Seshadri S, Beiser A, Kelly-Hayes M, Kase CS, Kannel WB, et al. Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA. 2006;296(24):2939–46. doi: 10.1001/jama.296.24.2939 17190894

19. Carter KN, Anderson CS, Hackett ML, Barber PA, Bonita R. Improved survival after stroke: is admission to hospital the major explanation? Trend analyses of the Auckland Regional Community Stroke Studies. Cerebrovascular Diseases. 2007;23(2–3):162–8. doi: 10.1159/000097054 17124398

20. Lakshminarayan K, Berger AK, Fuller CC, Jacobs DR, Anderson DC, Steffen LM, et al. Trends in 10-Year Survival of Patients With Stroke Hospitalized Between 1980 and 2000 The Minnesota Stroke Survey. Stroke. 2014;45(9):2575–+. doi: 10.1161/STROKEAHA.114.005512 25028450

21. Lawlor DA, Smith GD, Leon DA, Sterne JA, Ebrahim S. Secular trends in mortality by stroke subtype in the 20th century: a retrospective analysis. Lancet. 2002;360(9348):1818–23. doi: 10.1016/S0140-6736(02)11769-7 12480358

22. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8(4):355–69. doi: 10.1016/S1474-4422(09)70025-0 19233729

23. Thorvaldsen P, Kuulasmaa K, Rajakangas AM, Rastenyte D, Sarti C, Wilhelmsen L. Stroke trends in the WHO MONICA project. Stroke. 1997;28(3):500–6. doi: 10.1161/01.str.28.3.500 9056602

24. Addo J, Bhalla A, Crichton S, Rudd AG, McKevitt C, Wolfe CD. Provision of acute stroke care and associated factors in a multiethnic population: prospective study with the South London Stroke Register. BMJ. 2011;342:d744. doi: 10.1136/bmj.d744 21349892

25. Stewart JA, Dundas R, Howard RS, Rudd AG, Wolfe CD. Ethnic differences in incidence of stroke: prospective study with stroke register. BMJ. 1999;318(7189):967–71. doi: 10.1136/bmj.318.7189.967 10195965

26. Wolfe CD, Crichton SL, Heuschmann PU, McKevitt CJ, Toschke AM, Grieve AP, et al. Estimates of outcomes up to ten years after stroke: analysis from the prospective South London Stroke Register. PLoS Med. 2011;8(5):e1001033. doi: 10.1371/journal.pmed.1001033 21610863

27. ONS. Census 2011: Population and Household Estimates for the United Kingdom: Office for National Statistics; 2011. Available from: https://www.nomisweb.co.uk/census/2011/dc2101ew. [cited 10 Jan 2017].

28. Wolfe CD, Rudd AG, Howard R, Coshall C, Stewart J, Lawrence E, et al. Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register. J Neurol Neurosurg Psychiatry. 2002;72(2):211–6. doi: 10.1136/jnnp.72.2.211 11796771

29. Heuschmann PU, Grieve AP, Toschke AM, Rudd AG, Wolfe CD. Ethnic group disparities in 10-year trends in stroke incidence and vascular risk factors: the South London Stroke Register (SLSR). Stroke. 2008;39(8):2204–10. doi: 10.1161/STROKEAHA.107.507285 18535279

30. Tilling K, Sterne JAC, Wolfe CDA. Estimation of the incidence of stroke using a capture-recapture model including covariates. International Journal of Epidemiology. 2001;30(6):1351–9. doi: 10.1093/ije/30.6.1351 11821345

31. Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ. 1976;54(5):541–53. 1088404

32. Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35–41. doi: 10.1161/01.str.24.1.35 7678184

33. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6. doi: 10.1093/aje/kwh090 15033648

34. Wolfe CD, Taub NA, Woodrow EJ, Burney PG. Assessment of scales of disability and handicap for stroke patients. Stroke. 1991;22(10):1242–4. doi: 10.1161/01.str.22.10.1242 1833860

35. Rubin DB. Multiple imputation for nonresponse in surveys: John Wiley & Sons; 2004.

36. Wafa HA, Wolfe CDA, Rudd A, Wang Y. Long-term trends in incidence and risk factors for ischaemic stroke subtypes: Prospective population study of the South London Stroke Register. PLoS Med. 2018;15(10):e1002669. doi: 10.1371/journal.pmed.1002669 30289919

37. Koton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, Gottesman RF, et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014;312(3):259–68. doi: 10.1001/jama.2014.7692 25027141

38. Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP). National Clinical audit August-November 2016 Public Report. Available from: https://www.strokeaudit.org/Documents/National/Clinical/AugNov2016/AugNov2016-PublicReport.aspx. [cited 2019 June 11].

39. Rudd AG, Hoffman A, Grant R, Campbell JT, Lowe D, Intercollegiate Working Party for S. Stroke thrombolysis in England, Wales and Northern Ireland: how much do we do and how much do we need? J Neurol Neurosurg Psychiatry. 2011;82(1):14–9. doi: 10.1136/jnnp.2009.203174 20581132

40. Wardlaw JM, Murray V, Berge E, del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database of Systematic Reviews. 2014(7).

41. Flynn D, Ford GA, Rodgers H, Price C, Steen N, Thomson RG. A time series evaluation of the FAST National Stroke Awareness Campaign in England. PLoS ONE. 2014;9(8):e104289. doi: 10.1371/journal.pone.0104289 25119714

42. Friebel R, Hauck K, Aylin P. Centralisation of acute stroke services in London: Impact evaluation using two treatment groups. Health Econ. 2018;27(4):722–32. doi: 10.1002/hec.3630 29282793

43. Hunter RM, Davie C, Rudd A, Thompson A, Walker H, Thomson N, et al. Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: a comparative effectiveness before and after model. PLoS ONE. 2013;8(8):e70420. doi: 10.1371/journal.pone.0070420 23936427

44. Morris S, Ramsay AIG, Boaden RJ, Hunter RM, McKevitt C, Paley L, et al. Impact and sustainability of centralising acute stroke services in English metropolitan areas: retrospective analysis of hospital episode statistics and stroke national audit data. BMJ. 2019;364:l1. doi: 10.1136/bmj.l1 30674465

45. Vangen-Lonne AM, Wilsgaard T, Johnsen SH, Carlsson M, Mathiesen EB. Time trends in incidence and case fatality of ischemic stroke: the tromso study 1977–2010. Stroke. 2015;46(5):1173–9. doi: 10.1161/STROKEAHA.114.008387 25851772

46. HSE 2016. England’s changing health since the 1990s. Available from: http://healthsurvey.hscic.gov.uk/data-visualisation/data-visualisation/explore-the-trends.aspx. [cited 14 Feb 2018].

47. Ni Chroinin D, Asplund K, Asberg S, Callaly E, Cuadrado-Godia E, Diez-Tejedor E, et al. Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials. Stroke. 2013;44(2):448–56. doi: 10.1161/STROKEAHA.112.668277 23287777

48. Cocho D, Belvis R, Marti-Fabregas J, Bravo Y, Aleu A, Pagonabarraga J, et al. Does thrombolysis benefit patients with lacunar syndrome? Eur Neurol. 2006;55(2):70–3. doi: 10.1159/000091982 16534209

49. Quinn TJ, Langhorne P, Stott DJ. Barthel index for stroke trials: development, properties, and application. Stroke. 2011;42(4):1146–51. doi: 10.1161/STROKEAHA.110.598540 21372310

50. National Health Services (NHS). The NHS Long Term Plan, 2019. Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf. [cited 2019 Sep 19].

Štítky
Interní lékařství

Článek vyšel v časopise

PLOS Medicine


2020 Číslo 3

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

VIRTUÁLNÍ ČEKÁRNA ČR Jste praktický lékař nebo pediatr? Zapojte se! Jste praktik nebo pediatr? Zapojte se!

×