Stroke, Vol 23, 1551-1555, Copyright © 1992 by American Heart Association
PA Wolf, RB D'Agostino, MA O'Neal, P Sytkowski, CS Kase, AJ Belanger and WB Kannel
BACKGROUND: The reduction in US stroke mortality has been attributed to
declining stroke incidence. However, evidence is accumulating of a trend in
declining stroke severity. METHODS: We examined secular trends in stroke
incidence, prevalence, and fatality in Framingham Study subjects aged 55-64
years in three successive decades beginning in 1953, 1963, and 1973.
RESULTS: No significant decline in overall stroke and transient ischemic
attack incidence or prevalence occurred. In women, but not men, incidence
of completed ischemic stroke declined significantly. Stroke severity,
however, decreased significantly over time. Stroke with severe neurological
deficit decreased in later decades, with a fall in rates of severe stroke
cases in which patients were unconscious on admission to the hospital.
There was no substantial change in the case mix of infarcts and hemorrhages
and no decline in hemorrhage to account for the decline in severity. The
proportion of isolated transient ischemic attacks increased significantly
over the 30 years studied, yielding an apparent and significant decline in
case- fatality rates in men only. CONCLUSIONS: Secular trends in stroke
incidence and fatality did not follow a clear or definite pattern of
decline. While a significant decline in stroke severity occurred over three
decades, incidence of infarction fell only in women. The decline in total
case fatality rates occurred only in men and resulted largely from an
increased incidence of isolated transient ischemic attacks. The severity of
completed stroke was significantly lower in the later decades under study.
ARTICLES
Secular trends in stroke incidence and mortality. The Framingham Study
Department of Neurology, Boston University School of Medicine, MA.
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|
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|
R. L. Sacco, E. J. Benjamin, J. P. Broderick, M. Dyken, J. D. Easton, W. M. Feinberg, L. B. Goldstein, P. B. Gorelick, G. Howard, S. J. Kittner, et al. Risk Factors Stroke, July 1, 1997; 28(7): 1507 - 1517. [Full Text]
|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
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|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
W. H. Barker and J. P. Mullooly Stroke in a Defined Elderly Population, 1967-1985: A Less Lethal and Disabling But No Less Common Disease Stroke, February 1, 1997; 28(2): 284 - 290. [Abstract] [Full Text]
|
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M.J. Medrano, G. Lopez-Abente, M.J. Barrado, M. Pollan, and J. Almazan Effect of Age, Birth Cohort, and Period of Death on Cerebrovascular Mortality in Spain, 1952 Through 1991 Stroke, January 1, 1997; 28(1): 40 - 44. [Abstract] [Full Text]
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M. Peltonen and K. Asplund Age-Period-Cohort Effects on Stroke Mortality in Sweden 1969-1993 and Forecasts Up to the Year 2003 Stroke, November 1, 1996; 27(11): 1981 - 1985. [Abstract] [Full Text]
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C.L.M. Sudlow and C.P. Warlow Comparing Stroke Incidence Worldwide : What Makes Studies Comparable? Stroke, March 1, 1996; 27(3): 550 - 558. [Abstract] [Full Text]
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D. J. Lanska and P. M. Peterson Geographic Variation in the Decline of Stroke Mortality in the United States Stroke, July 1, 1995; 26(7): 1159 - 1165. [Abstract] [Full Text]
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D. Eisenblatter, L. Heinemann, and E. Claßen Community-Based Stroke Incidence Trends From the 1970s Through the 1980s in East Germany Stroke, June 1, 1995; 26(6): 919 - 923. [Abstract] [Full Text]
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P. Thorvaldsen, K. Asplund, K. Kuulasmaa, A.-M. Rajakangas, and M. Schroll Stroke Incidence, Case Fatality, and Mortality in the WHO MONICA Project Stroke, March 1, 1995; 26(3): 361 - 367. [Abstract] [Full Text]
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