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4. Stroke Epidemiology and Outcome in Southern Sweden

Author

Aked, Joseph

Subjects
Population-based cohort study, Neurology, Epidemiology, Stroke incidence, Stroke Outcome, intracerebral haemorrhage, cardiovascular diseases, Functional outcome, stroke, Ischemic Stroke
Abstract

Background: Stroke is a common cause of mortality and disability worldwide and continuously updated, thorough information of itsoccurrence and outcome is needed. In recent years, multiple advances have been made in stroke prevention and treatment that mayhave changed the epidemiology and outcome of stroke.Aims: To investigate updated population-based stroke epidemiology as well as long-term survival, recurrence and functional outcomein southern Sweden.Methods: Paper I: A population-based cohort of 413 consecutive patients with first-ever stroke in 2015-2016 was assembled usingthe prospective hospital-based stroke studies Lund Stroke Register (LSR) and Riksstroke, as well as retrospective searches ofprimary care, outpatient clinic and autopsy sources. Age- and sex-standardized incidence rates were calculated and compared with aprior study from the same study area in 2001-2002.Paper II: A subset of the population-based cohort of 400 patients (only ischemic stroke and intracerebral hemorrhage) was comparedwith LSR and Riksstroke regarding case ascertainment and which patients were not included in the hospital-based stroke studies.Paper III: The 400 individuals in the population-based cohort were followed up after 3 years regarding survival and causes of deathby using the Swedish Causes of Death Register, and stroke recurrence by using medical record review. Index and recurrent strokeswere classified by pathogenetic mechanism using the TOAST classification. Stroke survival at 3 years was compared with priorstudies in our area from 1983-1985, 1993-1995, and 2001-2002.Paper IV: The population-based cohort was followed-up in-person or via telephone at 3-4 years regarding functional outcome (mRS),dependency in activities of daily living (ADL), and health-related quality of life (HRQoL). Data were also collected on potentiallycorrelated health problems after stroke such as fatigue, cognitive impairment and depression.Results: Paper I: The total population-based age- and sex-standardized rate of stroke incidence was 165 per 100 000 person yearsin our study area, a 33% decrease compared with a population-based study in our area from 2001-2002. However, stroke incidencerates did not change for hemorrhagic stroke or among those

Published
2021

6. Completeness of case ascertainment in Swedish hospital‐based stroke registers.

Author

Aked, Joseph, Delavaran, Hossein, Norrving, Bo, and Lindgren, Arne

Subjects
*HEALTH facilities, *WATERSHEDS, *STROKE patients, *UNIVERSITY hospitals, *PRIMARY care
Abstract

Background: There is a worldwide development toward using data from hospital‐based stroke registers to estimate epidemiological trends. However, incomplete case ascertainment may cause selection bias. We examined the completeness of case ascertainment and selection bias in two hospital‐based Swedish stroke registers. Methods: First‐ever stroke cases between March 2015 and February 2016 in the catchment area of Skåne University Hospital, Lund, Sweden, were included from multiple overlapping sources: two hospital‐based stroke registers, Riksstroke‐Lund and Lund Stroke Register (LSR); local outpatient and inpatient registers; primary care registers; and autopsy registers. The resulting population‐based cohort was used as reference to assess completeness of case ascertainment and patient characteristics in Riksstroke‐Lund and LSR. Results: In total, 400 stroke patients were identified. Riksstroke‐Lund detected 328 (82%) patients, whereas LSR detected 363 (91%). Patients undetected by hospital‐based registers had higher 28‐day case fatality than those detected (44% vs 9%; P =.001). Patients only detected in primary care (n = 11) more often lived in healthcare facilities compared with those detected by hospital‐based registers (57% vs 7%; P =.001). Patients not detected by Riksstroke‐Lund, but detected by population‐based sources, had less severe strokes (median NIHSS 3 vs 5; P =.013). Conclusions: Some first‐ever stroke patients, such as those with high early case fatality and those with mild stroke, may go undetected with hospital‐based screening used in clinical stroke registers. This can result in selection bias due to not identifying specific groups of patients including some with high early case fatality and those living in healthcare facilities. [ABSTRACT FROM AUTHOR]

Published
2020
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