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High stroke incidence in the prospective community-based L'Aquila registry (1994-1998). First year's results
A Carolei1, C Marini, M Di Napoli
1Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila-Collemaggio, Italy.
Insights
Stroke incidence remains high, particularly in older adults, indicating that strokes may be delayed rather than prevented by population aging. This study highlights the ongoing burden of stroke in aging populations.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Population aging is hypothesized to alter stroke incidence, but empirical evidence is limited.
- Understanding stroke trends is crucial for public health planning and resource allocation.
Purpose of the Study:
- To investigate the incidence and outcomes of first-ever strokes in a defined Italian population.
- To examine the relationship between stroke incidence and an aging population.
Main Methods:
- A prospective, community-based stroke registry was established in the L'Aquila district, Italy (1994-1998).
- First-ever strokes were identified through active monitoring and classified using the International Classification of Diseases (ICD-9 and ICD-10 NA).
- Data included patient demographics, neuroimaging, stroke type, incidence rates, and 30-day and 1-year case-fatality.
Main Results:
- The crude annual incidence of first-ever stroke was 2.75/1000, significantly increasing to 24.23/1000 in individuals over 80 years.
- Cerebral infarction was the most common stroke type (80.2%).
- The 30-day case-fatality rate was 25.6%, with 36.9% mortality and 38.9% disability at 1 year.
Conclusions:
- Stroke incidence is notably high in older age groups, suggesting postponement rather than reduction.
- The findings underscore the significant public health challenge posed by stroke in aging societies.
- Stroke incidence and outcomes did not vary by socioeconomic status or residence type.
Background And Purpose:
Changes in stroke incidence are likely to occur as a consequence of aging of the population, but evidence for this hypothesis is lacking.
Methods:
A prospective community-based registry of first-ever strokes (1994 to 1998) classified according to the International Classification of Diseases, 9th Revision (ICD-9) was established in the L'Aquila district, central Italy, with a total population of 297,838 (1991 census). Patients were identified by active monitoring of multiple sources, including general practitioners.
Results:
In 1994, 819 patients (398 men and 421 women; mean +/- SD age, 74.8 +/- 11.3 years) suffered from a first-ever stroke. Eighty-nine percent of the patients had neuroimaging studies of the brain and were reclassified with the recent Application of the International Classification of Diseases to Neurology (ICD-10 NA). The occurrence of subarachnoid hemorrhage, intracerebral hemorrhage, cerebral infarction, and ill-defined events was 2.9%, 14.9%, 80.2%, and 2.0%, respectively. Crude annual incidence of first-ever stroke was 2.75/1000 (95% confidence interval [CI], 2.57 to 2.94) and 24.23/1000 (95% CI, 21.65 to 27.10) in patients older than 80 years. Incidence rates were higher in men and steeply increased with age. The standardized rate was 2.37/1000 for the Italian and 2.28/1000 for the European population. The 30-day case-fatality rate was 25.6% (95% CI, 22.8% to 28.7%). The occurrence of death, disability, and full recovery at 1 year was 36.9%, 38.9%, and 24.2%, respectively. No differences were found in stroke incidence and case-fatality according to income and urban or rural residences.
Conclusions:
In our population-based study, we found a high stroke incidence notably in the older age subgroups, suggesting that rather than declining, stroke is only being postponed until later in life.