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Comparison of worldwide First-ever-in-a-lifetime (FES) stroke incidence risk: implications for current and future stroke incidence Syme, P.D., Byrne, A., Chen, R., Finlayson, A. Aims To determine the contribution of stroke incidence risk to crude incidence Methods

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slide1

Comparison of worldwide First-ever-in-a-lifetime (FES) stroke incidence risk: implications for current and future stroke incidenceSyme, P.D., Byrne, A., Chen, R., Finlayson, A.

slide2
Aims

To determine the contribution of stroke incidence risk to crude incidence

Methods

18 worldwide incidence studies were compared with the Scottish Borders stroke study (SBSS)

Studies were selected if they fulfilled “ideal” incidence criteria and data was available on first-ever stroke (FES) numbers, the population denominator for each age group and the study duration

slide3
Methods cont.

Logistic regression was used along with age standardisation to estimate risk

An SBSS crude incidence prediction model was developed

The SBSS model was tested on the Scottish National dataset (110,000,000 person years of risk) for FES and admissions. The model was then tested on Australian National dataset for stroke admissions

comparison of age standardisation and odds ratio estimation of age adjusted risk
Comparison of age standardisation and odds ratio estimation of age-adjusted risk

Residuals (Age-adjusted incidence risk)

worldwide risk of stroke all ages
Worldwide risk of stroke (all ages)

SBSS

NW England

*

Dijon

London

* UK studies

*

ESPRO

All UK

Fredericksberg

Arcadia

Tees

*

Aukland

Study

SEPIVAC

NEMESIS

*

OCSP

Perth

Rochester

Belluno

Inherred

Valle D'Aosta

Soderhamn

Novosibirsk

.4

.6

.8

1.0

1.2

1.4

1.6

1.8

Age and sex-adjusted Odds Ratio (95% CI)

worldwide risk of stroke in 65 years old
Worldwide risk of stroke in < 65 years old

SBSS

Dijon

*

NWEngland

* UK studies

Inherred

All UK<65

ESPRO

Vallle D'Aosta

Arcadia

*

London

Aukland

Study

*

OCSP

Perth

Fredericksberg

Soderhamn

SEPIVAC

*

Tees

Belluno

NEMESIS

Rochester

Novosibirsk

0.0

.5

1.0

1.5

2.0

2.5

3.0

Age and sex-adjusted Odds Ratio (95% CI)

worldwide incidence risk
Worldwide incidence risk

crude incidence (n/10000)

F

Odds ratio (OR)

F

Odds ratio <65

% aged 65 years and over

60

F

2

1.8

50

1.6

F

1.4

40

F

F

1.2

F

(n/10000)

F

F

F

OR

F

30

1

F

F

F

F

F

F

F

F

F

F

F

F

F

F

F

F

F

F

F

F

0.8

F

F

F

F

F

F

20

0.6

F

F

F

0.4

10

0.2

0

0

Dijon

Tees

Perth

Novo

ESPro

SBSS

OCSP

d'Aosta

NWEng

Arcadia

London

Belluno

Auck 81

Fred 89-

Innherre

Roc 85-8

Sod 89-9

SEPIVAC

NEMESIS

World incidence studies

worldwide incidence risk8

60

1.6

F

1.4

F

50

F

F

1.2

F

F

F

40

F

F

F

F

1

F

F

F

F

F

F

F

F

F

F

F

(n/10000)

F

F

F

F

F

F

OR

F

F

F

30

0.8

F

F

F

F

F

F

0.6

20

0.4

F

10

0.2

0

0

Dijon

Tees

Novo

Perth

ESPro

SBSS

OCPS

d'Aosta

NWEng

Belluno

Arcadia

London

Auck 81

Fred 89-

Innherre

Roc 85-8

Sod 89-9

NEMESIS

SEPIVAC

World incidence studies

Worldwide incidence risk

crude incidence (n/10000)

F

Odds ratio (OR)

F

Odds ratio 65 years and over

% aged 65 years and over

slide10

Odds ratio estimation of age-adjusted risk

Residuals (Age-adjusted incidence risk)

Odds ratios

scottish first ever strokes smr1 from 1981 2000
Scottish First-ever strokes (SMR1) from 1981- 2000

Western Is

Scottish First-ever stroke 1981-2000

Tayside

3000

Lothian

Lanark

2000

Glas

Gramp

Scottish First-ever stroke (n)

Forth V

1000

Fife

D & G

0

Bord

A & A

-1000

A & C

8

10

12

14

16

18

percentage of the population >= 65 years old

sbss estimation of first ever stroke smr1 returns 1981 2000
SBSS estimation of first-ever stroke(SMR1 returns 1981-2000)

Western Is

Tayside

Lothian

Lanark

Glas

First-ever stroke numbers (n)

Gramp

Forth V

Fife

D & G

Bord

A & A

A & C

Rsq=0.97

scottish stroke admissions smr1 from 1981 2000
Scottish stroke admissions (SMR1) from 1981- 2000

Western Is

Scottish Stroke Admissions 1981-2000

Tayside

5000

Lothian

4000

Lanark

Glas

3000

Gramp

Scottish Stroke Admissions (n)

Forth V

2000

Fife

1000

D & G

Bord

0

A & A

-1000

A & C

8

10

12

14

16

18

percentage of the population >= 65 years old

sbss estimation of admissions smr1 returns 1981 2000
SBSS estimation of admissions(SMR1 returns 1981-2000)

Western Is

4000

Tayside

Lothian

Lanark

3000

Glas

Scottish Stroke Admissions (n)

Gramp

2000

Forth V

Fife

D & G

1000

Bord

A & A

A & C

0

0

1000

2000

3000

Rsq= 0.97

SBSS estimated First-ever stroke

sbss fes model tested on australian stroke admissions for 1999
SBSS FES model tested on Australian stroke admissions for 1999

Australian cerebrovascular admissions

14000

NT

12000

ACT

10000

Tas

SA

8000

Australian Stroke Admissions (n)

WA

6000

Qld

Vic

4000

NSW

2000

Total Population

0

Rsq = 0.9912

0

2000

4000

6000

8000

10000

12000

SBSS estimated First-ever stroke

conclusions
Conclusions
  • We have demonstrated significant differences in age-adjusted stroke incidence risk worldwide
  • Incidence risk has not declined over the last 20 years of incidence studies
  • For most populations, crude incidence can be accurately estimated by age-dependent incidence
  • We predict a massive increase in stroke incidence over the next 50 years due to population ageing