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Declining stroke rates in Californian children with sickle cell disease
Heather J Fullerton1, Robert J Adams, Shoujun Zhao
1University of California, San Francisco, Department of Neurology, 505 Parnassus Ave, Box 0114, San Francisco, CA 94143, USA. hjfc@itsa.ucsf.edu
Insights
The Stroke Prevention Trial in Sickle Cell Anemia (STOP) showed transfusions prevent strokes in children with sickle cell disease (SCD). Since 1998, California has seen a significant decline in stroke rates among these children.
Area of Science:
- Pediatric Neurology
- Hematology
- Public Health
Background:
- The Stroke Prevention Trial in Sickle Cell Anemia (STOP) established blood transfusions as effective for primary stroke prevention in high-risk children with sickle cell disease (SCD).
- The public health impact and real-world effectiveness of the STOP trial findings on stroke rates in children with SCD have not been previously assessed.
- Monitoring stroke incidence in pediatric SCD populations is crucial for evaluating preventative strategies.
Purpose of the Study:
- To determine if stroke rates in Californian children diagnosed with sickle cell disease (SCD) have decreased following the 1998 publication of the STOP trial.
- To analyze trends in first-time stroke admissions among children with SCD in California from 1991 to 2000.
- To assess the public health impact of the STOP trial on stroke prevention in pediatric SCD.
Main Methods:
- Utilized a California-wide hospital discharge database to identify all first admissions for stroke in children with SCD between 1991 and 2000.
- Calculated annual stroke incidence rates by dividing the number of first stroke admissions by the estimated population of Californian children with SCD for each year.
- Analyzed trends in stroke incidence over the study period, comparing rates before and after the 1998 STOP trial publication.
Main Results:
- A total of 93 first-time strokes were recorded in 92.5% ischemic and 7.5% hemorrhagic cases among children with SCD during 12,030 person-years of follow-up (1991-2000).
- The overall first stroke rate was 0.77 per 100 person-years.
- A statistically significant decline in annual stroke incidence was observed post-1998, with rates dropping from 0.88/100 person-years (1991-1998) to 0.50 in 1999 and 0.17 in 2000 (P <.005 for trend).
Conclusions:
- The publication of the STOP trial in 1998 appears to correlate with a significant reduction in first-time stroke admissions among children with sickle cell disease in California.
- These findings suggest that the implementation of evidence-based stroke prevention strategies, such as those recommended by the STOP trial, can have a positive public health impact.
- Continued surveillance and adherence to preventative measures are essential for reducing stroke burden in pediatric SCD populations.
Abstract:
Although the Stroke Prevention Trial in Sickle Cell Anemia (STOP) demonstrated the efficacy of blood transfusions for primary stroke prevention in high-risk children with sickle cell disease (SCD) in 1998, the impact of this trial on public health has not been studied. Our objective was to determine whether stroke rates in Californian children with SCD have declined since 1998. Using a California-wide hospital discharge database, we identified all first admissions for stroke in children with SCD from 1991 through 2000. Annual stroke incidence rates were calculated as the number of admissions divided by the estimated population of Californian children with SCD in that year. For 1991-2000, 93 children with SCD were admitted to Californian hospitals with a first stroke during 12 030 person-years of follow-up; 92.5% were ischemic and 7.5% hemorrhagic. Overall, the rate of first stroke was 0.77/100 person-years. For the study years 1991-1998, the rate for first stroke was 0.88/100 person-years compared to 0.50 in 1999 and 0.17 in 2000 (P <.005 for trend). Since the publication of the STOP study in 1998, annual rates of admissions for first stroke for Californian children with SCD have declined.
