on January 31, 2008
Published online before print January 31, 2008, doi: 10.1161/STROKEAHA.107.493643
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Submitted on May 14, 2007
From the Neurological and Mental Health Division (M.S.I., C.S.A., K.C.), The George Institute for International Health, The Royal Prince Alfred Hospital and University of Sydney, NSW Australia; the Stroke Unit (G.J.H., K.H.), Department of Neurology, Royal Perth Hospital, WA, Australia; the Centre for Health Services Research (R.B.), School of Population Health, University of Western Australia; and the School of Population Health and Clinical Practice (K.J.), University of Adelaide, SA, Australia. * To whom correspondence should be addressed. E-mail: canderson{at}george.org.au.
Background and Purpose—We studied temporal trends in major stroke outcomes in Perth, Western Australia (WA), comparing 3 12-month periods, roughly 5 years apart, between 1989 and 2001. Methods—The Perth Community Stroke Study (PCSS) used uniform definitions and procedures in a representative segment (approximately 143 000 people in the year 2000) of Perth, WA. Crude and age-standardized incidence and 28-day case fatality for stroke in the different study periods were compared using Poisson regression. We also undertook temporal comparisons of severity, risk factors, and management of stroke to define the basis for any changes in rates. Data are reported with 95% confidence intervals (CI). Results—There were 251, 213, and 183 first-ever strokes identified in the first, second, and third study periods, respectively, reflecting significant declines in stroke rates overall, for major age groups, and for both ischemic stroke and intracerebral hemorrhage. The decline in rates was greater in men than women. Compared with the 1989 to 1990 period, sex- and age-adjusted rates declined by 25% (95% CI 10% to 37%) in 1995 to 1996, and by 43% (95% CI 31% to 53%) in 2000 to 2001, corresponding to a 5.5% average annual decrease overall. There were correspondingly significant reductions in the frequencies of key risk factors among cases. However, early case fatality remained stable, both overall and for major pathological subtypes of stroke. Conclusions—These data confirm significant declines in the incidence of stroke on the western side of Australia, coincident with some improvement in the vascular risk profile of cases in the population. Decreasing risk rather than improving survival appears to be the main driver of falling mortality from stroke in this population.
Revised on July 23, 2007
Accepted on July 25, 2007
Trends in Incidence and Outcome of Stroke in Perth, Western Australia During 1989 to 2001. The Perth Community Stroke Study
Md. Shaheenul Islam MBBS, MPH, MSc;
Key words: acute stroke • epidemiology • outcome • registry • risk factors • stroke management • case fatality