Background
Methods
Search Strategy
Inclusion criteria
For studies of all stroke
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Stroke defined in the paper using either ICD-8 or ICD-9 430-438; ICD-10 I60-69 for cerebrovascular disease.
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Only studies of first cases of stroke included.
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Only prospective or retrospective study designs included.
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Study population and setting must be clearly defined, and within the United Kingdom.
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Study population must be the general population for the setting under study, rather than specific subset such as 'residential care patients'.
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Reasonable attempt must be made to identify all events in the study population (i.e. at least six monthly searching of databases of general practitioners in the study area for all patients coded with a cerebrovascular diagnosis.)
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Stroke events must be followed up for re-occurrence within individuals within the study period, using linked and overlapping data sources (e.g. GP and hospital records).
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Age and gender specific estimates must be recorded.
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Data collection period must cover at least one year.
Inclusion criteria for stroke subtypes
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Stroke subtypes defined by ICD codes, using the following definitions: Subarachnoid haemorrhage (ICD-8 or ICD-9 430; ICD-10 I60); Haemorrhagic stroke (ICD-8 431; ICD-9 431-432; ICD-10 I61-62); Ischaemic stroke (ICD-8 432-434; ICD-9 433-434; ICD-10 I63).
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At least 80% of events must have been categorised to stroke subtype by use of autopsy or brain scanning [5].
Analysis
Results
Setting | Population source | Study years | Number of strokes | Population | Study Design | ICD code | Reference |
---|---|---|---|---|---|---|---|
East Lancashire | 93 GP practices | 1994-1995 | 642 | 405,272 | Prospective; GP contacts, Hospital registers, death certificates, rehabilitation Services | ICD 9 430-438 | Du et al 1997 |
Oxfordshire | 63 Family Physician Registries | 2002-2005 | 439 | 91,106 | Prospective;, GP visits, monthly practice listings, monthly referral listings, death certificates; imaging or autopsy | ICD-10 I60-69 | Rothwell 2005 |
South London | Lewisham, Southwark & Lambeth | 1995-2004 | 2,874 | 271,817 | Prospective; multiple overlapping sources of information, death certificates; CT scan/MRI, necropsy, cerebrospinal fluid analysis | ICD-9 430-434 & 436 ICD-10 I60-69 | Heuschmann et al 2008 |
Scottish Borders Region | 39 GP practices | 1998-2000 | 596 | 106,352 | Prospective; Multiple notification sources - GPs, nursing staff, neurovascular clinic staff, neighbouring hospitals, social services, "Chest, Heart and Stroke, Scotland"; hot pursuit by research nurses; death certificates' CT scans | ICD 9 430-438 ICD 10 160-169 | Syme et al 2005 |
Devon & Cornwall | Referrals to Neurosurgery department | 1992-1996 | 800 | 1,504,847 | Retrospective; Hospital records, death statistics, cerebral angiography database, surgery database, GP records; CT scans, necropsy | ICD-10 I60, I61.5, I61.9, I62, I62.1, I62.9, I67.1, I69-I69.2, I72.0, I72.9 and corresponding ICD-9 codes before 1994. | Pobereskin 2001 |
Geographical Trends in Stroke Incidence
All Strokes
Incidence/100,000 population (95% Confidence Interval) | ||||||
---|---|---|---|---|---|---|
All stroke | Setting | Years | Males | Females | ||
Du et al 1997 | East Lancashire | 1994-1995 | 152.06 | (134.43 - 172.00) | 118.99 | (107.36 - 131.88) |
Syme et al 2005 | Scottish Borders Region | 1998-2000 | 184.78 | (163.78 - 208.47) | 145.76 | (130.57 - 162.72) |
Rothwell et al 2005 | Oxfordshire | 2002-2005 | 134.89 | (117.63 - 154.67) | 108.05 | (94.65 - 123.36) |
Heuschmann et al 2008 | South London | 1995-1996 | 150.20 | (133.76 - 168.65) | 115.20 | (103.34 - 128.44) |
1997-1998 | 163.96 | (146.71 - 183.23) | 112.64 | (96.56 - 120.42) | ||
1999-2000 | 134.94 | (119.09 - 152.90) | 93.93 | (82.72 - 106.65) | ||
2001-2002 | 144.86 | (128.28 - 163.59) | 107.83 | (99.84 - 127.08) | ||
2003-2004 | 124.16 | (109.23 - 141.13) | 87.52 | (82.92 - 160.06) | ||
Ischaemic stroke
| ||||||
Rothwell et al 2005 | Oxfordshire | 2002-2005 | 120.93 | (104.62-139.78) | 91.63 | (79.48 -105.63) |
Heuschmann et al 2008 | South London | 1995-1996 | 111.58 | (97.50 - 127.70) | 79.93 | (70.14 - 91.08) |
1997-1998 | 117.60 | (103.20 - 134.02) | 82.12 | (72.12 - 93.50) | ||
1999-2000 | 99.24 | (85.82 - 114.75) | 73.44 | (63.73 - 84.63) | ||
2001-2002 | 102.30 | (88.50 - 118.25) | 80.06 | (69.79 - 91.83) | ||
2003-2004 | 99.24 | (86.02 - 114.49) | 70.27 | (60.84 - 81.17) | ||
Intracerebral haemorrhage
| ||||||
Rothwell et al 2005 | Oxfordshire | 2002-2005 | 10.88 | (6.85 - 17.27) | 7.61 | (4.66 - 12.42) |
Heuschmann et al 2008 | South London | 1995-1996 | 19.20 | (13.91 - 26.50) | 15.01 | (11.01 -20.47) |
1997-1998 | 28.67 | (21.85 - 37.63) | 12.49 | (8.93 - 17.49) | ||
1999-2000 | 25.53 | (17.45 - 31.73) | 10.17 | (6.87 - 15.05) | ||
2001-2002 | 24.37 | (18.20 - 32.64) | 13.70 | (9.58 - 19.60) | ||
2003-2004 | 14.21 | (9.75 - 20.73) | 8.64 | (5.69 - 13.13) | ||
Subarachnoid haemorrhage
| ||||||
Pobereskin et al 2001 | Devon and Cornwall | 1992-1996 | 5.76 | (4.19 - 7.93) | 8.85 | (8.08 - 9.70) |
Rothwell et al 2005 | Oxfordshire | 2002-2005 | 3.01 | (1.13 - 8.02) | 8.94 | (5.19 - 15.40) |
Heuschmann et al 2008 | South London | 1995-1996 | 5.39 | (2.90 - 10.02) | 7.62 | (4.80 - 12.09) |
1997-1998 | 5.69 | (3.06 - 10.57) | 3.41 | (1.62 - 7.15) | ||
1999-2000 | 5.71 | (3.07 - 10.61) | 5.83 | (3.23 - 10.52) | ||
2001-2002 | 9.84 | (6.12 - 15.82) | 6.83 | (3.88 - 12.03) | ||
2003-2004 | 3.94 | (1.88 - 8.27) | 5.62 | (3.19 - 9.90) |
Stroke subtypes
Incidence/100,000 population (95% Confidence Interval) | ||||||
---|---|---|---|---|---|---|
All stroke | Setting | Years | Males | Females | ||
Du et al 1997 | East Lancashire | 1994-1995 | 79.19 | (66.98 - 93.63) | 46.25 | (38.30 - 55.85) |
Syme et al 2005 | Scottish Borders Region | 1998-2000 | 111.94 | (94.96 - 131.95) | 74.65 | (61.48 - 90.64) |
Rothwell et al 2005 | Oxfordshire | 2002-2005 | 81.71 | (68.12 - 98.02) | 56.15 | (45.04 - 70.00) |
Heuschmann et al 2008 | South London | 1995-1996 | 102.76 | (89.17 - 118.42) | 64.87 | (54.80 - 76.79) |
1997-1998 | 108.31 | (94.13 - 124.64) | 58.70 | (56.10 - 80.60) | ||
1999-2000 | 97.31 | (83.65 - 113.19) | 57.67 | (47.75 - 69.64) | ||
2001-2002 | 104.51 | (90.16 - 121.15) | 67.24 | (49.15 - 70.09) | ||
2003-2004 | 87.38 | (74.54 - 102.44) | 50.88 | (53.06 - 79.32) | ||
Ischaemic stroke
| ||||||
Rothwell et al 2005 | Oxfordshire | 2002-2005 | 73.70 | (60.87- 89.24) | 44.94 | (38.56 - 52.37) |
Heuschmann et al 2008 | South London | 1995-1996 | 76.06 | (64.49 - 89.71) | 45.99 | (37.69 - 56.12) |
1997-1998 | 78.80 | (66.88 - 92.83) | 43.91 | (35.63 - 54.11) | ||
1999-2000 | 71.21 | (59.68 - 84.98) | 42.46 | (34.11 - 52.87) | ||
2001-2002 | 71.86 | (60.09 - 85.94) | 45.56 | (36.74 - 56.49) | ||
2003-2004 | 67.86 | (56.66 - 81.28) | 39.21 | (31.17 - 49.32) | ||
Intracerebral haemorrhage
| ||||||
Rothwell et al 2005 | Oxfordshire | 2002-2005 | 4.93 | (2.35 -10.34) | 3.50 | (1.46 - 8.41) |
Heuschmann et al 2008 | South London | 1995-1996 | 13.63 | (9.21 - 20.17) | 9.44 | (6.02 - 14.80) |
1997-1998 | 20.51 | (14.79 - 28.43) | 7.01 | (4.15 - 11.84) | ||
1999-2000 | 18.37 | (12.99 - 25.98) | 6.55 | (3.72 - 11.53) | ||
2001-2002 | 18.35 | (12.97 - 25.94) | 10.49 | (6.69 - 16.45) | ||
2003-2004 | 11.20 | (7.22 - 17.35) | 5.61 | (3.10 - 10.12) | ||
Subarachnoid haemorrhage
| ||||||
Pobereskin et al 2001 | Devon and Cornwall | 1992-1996 | 5.16 | (4.48 - 5.94) | 7.69 | (6.90 - 8.56) |
Rothwell et al 2005 | Oxfordshire | 2002-2005 | 3.01 | (1.13 - 8.02) | 7.84 | (4.22 - 14.57) |
Heuschmann et al 2008 | South London | 1995-1996 | 5.39 | (2.90 -10.02) | 6.03 | (3.43 -10.62) |
1997-1998 | 5.28 | (2.75 - 10.14) | 3.14 | (1.41 - 7.00) | ||
1999-2000 | 4.87 | (2.43 - 9.73) | 5.56 | (2.99 - 10.33) | ||
2001-2002 | 8.98 | (5.42 - 14.90) | 6.83 | (3.88 - 12.03) | ||
2003-2004 | 3.53 | (1.59 - 7.87) | 4.46 | (2.23 - 8.92) |
Comparison with mortality rates
Mortality rate | Incidence rate | Rate ratio of mortality to incidence | |||||||
---|---|---|---|---|---|---|---|---|---|
Region | Year | Male | Female | Male | Female | Male | 95% CI | Female | 95% CI |
Ages 45 and over
| |||||||||
Oxfordshire | 2002-2005 | 45 | 47 | 135 | 108 | 0.33 | (0.28 - 0.39) | 0.44 | (0.38 - 0.50) |
South London | 1995-2004 | 35 | 30 | 143 | 104 | 0.24 | (0.23 - 0.27) | 0.29 | (0.27 - 0.31) |
East Lancashire | 1994-1995 | 52 | 47 | 152 | 119 | 0.34 | (0.29 - 0.41) | 0.39 | (0.35 - 0.45) |
Scottish Borders | 1998-2000 | 62 | 71 | 185 | 146 | 0.34 | (0.27 - 0.41) | 0.49 | (0.41 - 0.57) |
Ages 45 to 74
| |||||||||
Oxfordshire | 2002-2005 | 6 | 4 | 82 | 56 | 0.07 | (0.05 - 0.10) | 0.07 | (0.05 - 0.10) |
South London | 1995-2004 | 12 | 7 | 100 | 60 | 0.12 | (0.10 - 0.14) | 0.12 | (0.10 - 0.14) |
East Lancashire | 1994-1995 | 16 | 12 | 79 | 46 | 0.20 | (0.16 - 0.26) | 0.26 | (0.20 - 0.34) |
Scottish Borders | 1998-2000 | 12 | 19 | 112 | 75 | 0.11 | (0.08 - 0.15) | 0.25 | (0.18 - 0.36) |