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Differing Definitions of First-Ever Stroke Influence Incidence Estimates More than Trends: A Study Using Linked
David Youens1,2, Judith Katzenellenbogen1, Rathina Srinivasa Ragavan3
1Cardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Crawley, Washington, Australia.
Neuroepidemiology
|September 26, 2023
Summary
Stroke incidence in Western Australia has declined. However, how stroke is defined significantly impacts incidence estimates, more so than trend estimates.
Area of Science:
- Epidemiology
- Public Health
- Neurology
Background:
- Administrative data definitions for stroke incidence vary among researchers.
- Accurate stroke incidence measurement is crucial for public health planning.
Purpose of the Study:
- To investigate how different stroke definitions and lookback periods affect incidence estimates.
- To provide updated stroke incidence rates and trends for Western Australia (WA).
Main Methods:
- Utilized linked state-wide hospital and death records from 1985-2017.
- Applied a standard definition for incident strokes (2005-2017) with a 10-year lookback period.
- Compared alternative definitions and lookback periods against the standard, calculating age-standardised incidence rates and trends.
Main Results:
- The standard definition identified 31,274 incident strokes.
- Varying definitions altered case numbers significantly (e.g., +19.3% for secondary diagnoses, -11.1% for excluding death records).
- Stroke incidence declined by 0.6% annually, with trends largely consistent across definitions, except when excluding death records.
Conclusions:
- Stroke incidence has decreased in Western Australia.
- Methodological choices in identifying stroke cases have a substantial impact on incidence estimates.
- Declines in stroke incidence are predominantly due to fewer fatal strokes.
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