(Stroke. 1997;28:2180-2184.)
© 1997 American Heart Association, Inc.
Articles |
Epidemiology of Stroke in Innherred, Norway, 1994 to 1996
Incidence and 30-Day Case-Fatality Rate
From Innherred Hospital, Levanger, and National Institute of Public Health, Community Medicine Research Unit, Verdal, Norway (H.E.); National Institute of Public Health, Community Medicine Research Unit, Verdal, Norway (J.H.); Department of Medicine, University of Trondheim (Norway) (B.I.); and Department of Medicine, University of Uppsala (Sweden) (A.T.).
Correspondence to Hanne Ellekjær, National Institute of Public Health, Community Medicine Research Unit, N-7650 Verdal, Norway. E-mail verdalfh{at}due.unit.no
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Abstract |
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 Top Abstract IntroductionSubjects and MethodsResultsDiscussionReferences |
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Background and Purpose In Norway, as well as other industrialized countries, mortality from stroke has declined over the past decades. Data on stroke morbidity are lacking. This study was conducted to determine the incidence, case fatality, and risk factors of stroke in a defined Norwegian population.
Methods During the period 1994 to 1996, a population-based
stroke registry collected uniform information about all cases of
first-ever and recurrent stroke occurring in people aged 
15 years in
the region of Innherred in the central part of Norway (target
population 70 000), where the prevalence of
cardiovascular risk factors was screened in 1984 to
1986 and 1995 to 1997.
Results During the 2 years of registration (September 1, 1994, to August 31, 1996), 432 first-ever (72.8%) and 161 recurrent (27.2%) strokes were registered. The crude annual incidence rate was 3.12/1000 (2.85/1000 for males and 3.38/1000 for females). Adjusted to the European population, the annual incidence rate of first-ever stroke was 2.21/1000. The annual incidence rate of cerebral infarction was 2.32/1000, intracerebral hemorrhage 0.32/1000, subarachnoid hemorrhage 0.19/1000, and unspecified stroke 0.38/1000. The 30-day case-fatality rate was 10.9% for cerebral infarction, 37.8% for intracerebral hemorrhage, and 50.0% for unspecified stroke. Fourteen percent of the patients were found outside the hospital, and only 50% of the suspected stroke cases in the hospital (at admission or reviewed discharge diagnosis of ICD-9 codes 430 to 438) fitted the final inclusion criteria.
Conclusions This first population-based stroke register in Norway revealed incidence rates of stroke similar to other Scandinavian countries, and comparison between other European countries did not indicate regional variations within Western Europe.
Key Words: epidemiology • incidence • Norway • prognosis
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Introduction |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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Mortality from stroke has been declining in most industrialized countries.1 The reason for the decrease has not been fully explained; possible causes include decreased incidence, decline in case fatality because of better treatment, or a shift toward milder strokes. Changes in risk factors over time may explain the fall in mortality.2 There are many population-based stroke registers around the world, but few studies are well designed.3 Time trend studies from population-based stroke registers in Scandinavia have provided conflicting results. Some studies suggest an increasing incidence of stroke, while others report a decrease or no change of incidence.4 5 6 Little is known about incidence and time trend in Norway. Therefore, a community-based stroke register was established in Innherred, Norway, on September 1, 1994, to determine incidence, risk factors, and prognosis of stroke; factors of importance for primary prevention of stroke (eg, treatment of hypertension); and treatment and rehabilitation of the stroke patient (regional health service planning). This article presents incidence and case-fatality data for stroke from a population-based stroke registry for 1994 to 1996.
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Subjects and Methods |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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Study Population
Innherred is a rural area located in the Nord-Trøndelag county in the central part of Norway with a population of 69 295 inhabitants (January 1, 1995) in 10 municipalities aged
15 years
(Figure
). The population of Innherred is
stable and has a sex and age distribution similar to Norway as a whole;
the proportion of the population aged 65 years was 20.3% and 19.8%,
respectively (January 1, 1995). During 1984 to 1986 the first
Nord-Trøndelag Health Survey, a risk factor screening, took
place.7 Eighty-eight percent of the residents aged 20
years participated. This survey contributes to baseline data for
further studies on the impact of different risk factors on stroke.
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Case Ascertainment
All incident cases of stroke (first-ever and recurrent),
occurring from September 1, 1994, through August 31, 1996, were
registered in permanent residents aged 15 years (target population
69 295, January 1, 1995). We identified hospitalized stroke patients
by checking admission lists daily, and a specially trained coworker
traced the different wards in the hospital twice a week. Discharge
records from the hospital (ICD-9 codes 430 to 438) (outpatient
clinics included) and death certificates on patients with a stroke
noted as either the underlying or a contributary cause of death were
reviewed regularly. Discharge records from the two neighboring
hospitals outside the study area were also reviewed. The GPs in the
area were asked to report nonhospitalized cases. Information about the
study was provided by meetings, a special booklet, and a newsletter
that was sent to the participating doctors in the hospital, GPs, and
collaborators in the district nursing services regularly during the
study period. To evaluate the case-finding procedures, an intensified
search for nonhospitalized cases was performed in four municipalities
selected at random (n=31 853) in a 4-month period. Every week, nursing
homes and district nursing services were contacted and asked for new
suspected stroke cases. In addition, intensified screening of discharge
records of cases with nonstroke diagnoses from the local hospital
was performed in the same period.
Patient Assessment
The patients were examined by the consulting physician (GP or
the physician on call at the hospital) within 48 hours after the event.
In addition to a standard neurological examination, an estimate of
disability before the stroke and 5 to 9 days after onset was
made.8 Both GPs and physicians on call in the hospital
were asked to refer clinical data on suspected strokes cases by
completing a special form including symptoms and signs, duration,
earlier cerebrovascular events, and time of onset. The form was given
to the physician on call when suspected stroke cases were expected
(referral diagnoses of vertigo, disturbances in consciousness,
and syncope were included). Before the study started, a booklet that
included part of the study protocol was distributed to the
participating physicians, and meetings were arranged to explain the
procedures of registration of clinical data. The GPs and hospital
medical records were reviewed to obtain more information about each
case and previous illnesses. Information about fatal strokes occurring
outside the hospital was obtained from copies of death certificates,
and clinical data were obtained from the certifying physician and
nursing home records. Both first-ever stroke (first in a lifetime)
and recurrent stroke (>21 days since last event) were recorded.
The final diagnosis was made with the use of the World Health
Organization criteria, ie, "rapidly developing clinical signs of
focal (or global) disturbance of cerebral function, lasting
more than 24 hours or leading to death, with no apparent cause other
than that of vascular origin."9 Classification into
subgroups (cerebral infarction, intracerebral
hemorrhage, and subarachnoid hemorrhage; ICD-9
codes 434, 431, and 430) was based on the result of CT or necropsy.
Cerebral infarction was diagnosed if CT within 3 weeks or necropsy
showed no signs of intracerebral hemorrhage.
Cerebral hemorrhage was diagnosed if CT scan or necropsy showed
intracerebral hemorrhage. Acute headache,
meningism, and coma were classified as subarachnoid
hemorrhage if supported by diagnostic CT, MRI, or
necropsy. A diagnosis of unspecified stroke was given to patients who
underwent only clinical examination. Excluded cases were categorized as
TIA, probable stroke, or other diagnosis.
We examined whether misclassification was a problem in this study by measuring the interobserver agreement between the research registrar, a neurologist, and a specialist in internal and physical medicine. A total of 34 suspected strokes were classified into five categories: first-ever stroke, recurrent stroke, probable stroke, TIA, and "other."
Ethics
Before they were recorded, surviving patients received an
information letter and provided written consent to personal
recording. Consent by next of kin was obtained from patients
who were severely ill or unconscious. The Ministry of Health and Social
Affairs accepted reports on fatal stroke from the local mortality
statistics without having consent by next of kin. The patients who
refused to participate were recorded without personal
identification. The Stroke in Nord-Trøndelag Study has been approved
by the Ethics Committee of health region IV and the National Computer
Data Inspection Board.
Statistical Methods
Sex- and age-specific incidence rates were adjusted to the
Norwegian population in 1993 by the direct method, and the comparison
between different studies was performed by direct adjustment to the
European population.10 The CIs of age-specific rates were
calculated according to Schoenberg,11 and CIs of
age-adjusted rates were estimated by the method of
Armitage.12
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Results |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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A total of 1169 cases of suspected stroke were reported to the stroke register from September 1, 1994, through August 31, 1996, in the study population. According to the standardized criteria, 593 cases (50.7%) were included: 432 first-ever strokes (72.8%) and 161 recurrent strokes (27.2%). CT scan was performed in 87.5% (n=378) of the first-ever strokes, with a mean of 2.4 days from onset of the stroke. The first-ever strokes occurred in 235 women (mean age, 77.7 years [SD, 10.7]) and in 197 men (mean age, 75.3 years [SD, 11.7]). Ninety-one women suffered a recurrent stroke (mean age, 80.9 years [SD, 7.6]) and 70 men (mean age, 76.0 years [SD, 10.9]. A total of 88.7% (n=383) of the first-ever stroke cases occurred in patients aged
65 years.
A total of 576 referrals were excluded for various reasons, the most
noteworthy being possible stroke (n=56), TIA (n=168), other stroke
diagnosis (ICD-9 code 432, subdural hematoma [n=7]; ICD-9 code 433,
stenosis of precerebral arteries [n=8]; ICD-9 code 437,
cerebral arteriosclerosis [n=5]; and ICD-9 code
438, stroke sequelae [n=126]), vertigo/syncope (n=48),
coronary heart disease (n=10), tumor cerebri (n=14), mors
subita (n=11), infections (n=9), epilepsy (n=9), intoxication (n=9),
and migraine (n=6). The source of referral is presented in
Table 1. Out-of-hospital cases (fatal and
notfatal) were 13.3% (n=79) of the total number of strokes
included.
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In the period of intensified case finding, a total of four first-ever
stroke cases were found, which gave an estimated number of 28 cases in
the target population per year, in addition to those cases found by the
standard case-finding procedures. The mean age of these cases was 82.8
years (SD, 3.3; range, 79 to 86 years). Thus, the completeness of the
case-finding of first-ever stroke in the target population was 100% in
the group aged 15 to 74 years, 87% in the group aged 75 to 84 years,
and 76% in the group aged 85 years.
The validation of the classification obtained by measurement of
interobserver agreement resulted in a 
index of 0.68 between
research registrar and neurologist, 0.61 between research registrar and
specialist in internal medicine, and 0.65 between neurologist and
specialist in internal medicine.
Table 2 shows annual age- and
sex-specific incidence rates, which increased by each decade. The
increase by age was statistically significant between groups aged 55
years in women and between groups aged 45 years, except the two
oldest groups, in men. The incidence of stroke was higher in males than
in females in all age groups, and the relative difference between the
sexes increased with each age group, but this was not statistically
significant. The incidence rates (male and female), including
intensified case finding, were 20.94/1000 (95% CI, 18.18 to 24.10) in
the group aged 75 to 84 years and 39.75/1000 (95% CI, 33.03 to 54.39)
in the group aged 85 years. These rates did not differ significantly
from incidence rates based on standard case-finding routines but
indicated an underestimation in the oldest groups.
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The crude annual incidence rate of first-ever stroke in the population
aged 15 years in 1994 through 1996 was 3.12/1000 (2.85/1000 in males
and 3.38/1000 in females). When age- and sex-adjusted by the direct
method to the 1993 Norwegian population, the annual incidence rate was
3.01/1000. By direct adjustment to the European
population,10 the annual incidence rate was 2.21/1000.
The different subtypes of first-ever stroke were as follows: 322
(74.5%) suffered a cerebral infarction, 45 (10.5%) had
intracerebral hemorrhage, and 13 (3.0%) had
subarachnoid hemorrhage. In 52 cases (12.0%),
classification into subtypes was impossible because neither CT scan nor
necropsy was done. The total annual incidence rates per 1000 of
different types of stroke were as follows: cerebral infarction, 2.32;
intracerebral hemorrhage, 0.32;
subarachnoid hemorrhage, 0.19; and unspecified, 0.38
(Table 3).
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The overall 30-day case-fatality rates were 19.2% (83/432) for patients with first-ever stroke and 37.9% (61/161) for patients with recurrent stroke. The 30-day case-fatality rates for the different subtypes of stroke were as follows: cerebral infarction, 10.9%; intracerebral hemorrhage, 37.8%; subarachnoid hemorrhage, 38.5%; and unspecified, 50.0%. The mean ages for the four subgroups, respectively, were 76.2 years (SD, 10.3; range, 22.3 to 98.1), 73.8 years (SD, 14.3; range, 20.3 to 92.8), 65.0 years (SD, 14.8; range, 32.3 to 89.1), and 84.5 years (SD, 7.8; range, 64.9 to 100.9).
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Discussion |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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This first stroke register in Norway was established in an area with geographic and demographic characteristics fairly representative of Norway as a whole. The population is stable, and there is a close relationship and cooperation between the hospital and GPs. The population is served by one acute hospital with an active stroke unit, which encourages admission of stroke patients. The proportion of all strokes not admitted to the hospital was 13.6%, which is lower than that reported from some studies5 13 14 and higher than that reported from others.4 15 16
Evaluation of the case-finding procedures indicated a complete
detection of first-ever stroke in the group aged 15 to 74 years; this
was somewhat lower in the oldest groups. Both diagnosis of stroke and
case finding are more complicated in the older patient because of
disability caused by other diseases (eg, dementia and osteoarthritis)
and a lower hospital admission rate for stroke. The variation in stroke
incidence for the most elderly among studies could be real because of
differences in the detection and management of risk factors such as
hypertension, or they could be artificial because of variation in case
ascertainment (Table 4). Randomized
trials have shown a primary preventive effect of blood
pressure–lowering therapy in elderly people,18 19 20 but the
impact on stroke incidence in the population is not known.
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Another issue of importance for measurement of stroke incidence in the population is the accuracy of the diagnosis. In this study all cases were examined by a standard neurological examination within 48 hours after stroke onset and classified according to the standardized criteria by one of the authors (H.E.). Considering the results of the interobserver agreement between the research registrar, neurologist, and a specialist in internal medicine, we do not see misclassification as a major problem in this study.
The fairly high age- and sex-specific stroke incidence rates we found
support results from other Scandinavian studies (Table 4
). All studies follow the same pattern
of increased incidence by age and a trend toward higher incidence in
men compared with women in all age groups, except the oldest. In the
group aged 85 years, three studies report a higher incidence in women
than in men.15 17 21
When age-specific rates from different studies were adjusted to the
European population, we found nearly the same incidence rate in five of
six studies in the group aged 55 to 84 years (Table 5), which does not
indicate regional variations in this age group within Western
Europe.
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The age-specific incidence of cerebral infarction and intracerebral hemorrhage supports studies from other countries6 16 22 and confirms the increasing incidence of cerebral infarction by age. In comparison to Sweden, the overall 30-day case-fatality rate of first-ever stroke is lower than that reported from Söderhamn21 and Enköping-Habo17 and higher than that reported from Malmö.15 The case-fatality rates of different subgroups show a better outcome for cerebral infarction than for intracerebral hemorrhage and unspecified stroke, supporting results from similar studies.15 16 22
The first population-based stroke register in Norway revealed incidence rates of stroke similar to those of other Scandinavian countries, and comparison between other European countries did not indicate regional variations within Western Europe. We believe that a population-based stroke register is the only way to get accurate measurement of incidence and case-fatality rates and further information on risk factors of stroke.
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Selected Abbreviations and Acronyms |
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Acknowledgments |
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This study was supported by the Norwegian Research Council and the County Council of Nord-Trøndelag. We wish to thank the GPs in the Innherred region for supporting the local data collection and coworker Marit Holthe for excellent and accurate registration.
Received April 17, 1997; revision received May 23, 1997; accepted July 2, 1997.
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References |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
|---|
1. Bonita R, Stewart A, Beaglehole R. International trends in stroke mortality: 1970-1985. Stroke. 1995;21:989-992.
2.
Vartiainen E, Sarti C, Tuomiletho J, Kuulassmaa
K. Do changes in cardiovascular risk factors
explain changes in mortality from stroke in Finland?
BMJ. 1995;310:901-904.
3. Malmgren R, Warlow C, Bamford J, Sandercock P. Geographical and secular trends in stroke incidence. Lancet. 1987;2:1196-1200.[Medline] [Order article via Infotrieve]
4.
Terent A. Increasing incidence among Swedish
women. Stroke. 1988;19:598-603.
5.
Lindenstrøm E, Boysen G, Nyboe J, Appleyard M.
Stroke incidence in Copenhagen 1976-88. Stroke. 1992;23:28-32.
6.
Jørgensen H, Plesner A, Hübbe P, Larsen
K. Marked increase of stroke incidence in men between 1972 and
1990 in Frederiksberg, Denmark. Stroke. 1992;23:1701-1704.
7. Holmen J, Midthjell K, Bjartveit K, Hjort PF, Lund-Larsen PG, Moum T, Næss S, Waaler HT. The Nord-Trøndelag Health Survey 1984-86: Purpose, Background and Methods: Participation, Non-participation and Frequency Distributions. Verdal, Norway: Statens Institutt for folkehelse. Senter for samfunnsmedisinsk forskning. Report No. 4/1990.
8. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Maryland State Med J. 1965;14:61-65.
9. Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ. 1976;54:541-53.[Medline] [Order article via Infotrieve]
10. Waterhouse J, Correa P, Muir C, Powell J, eds. Cancer Incidence in Five Continents. Lyon, France: IARC. 1976;3:456.
11. Schoenberg BS. Calculating confidence intervals for rates and ratios. Neuroepidemiology. 1983;2:257-265.
12. Armitage P, Berry G. Statistical Methods in Medical Research. Oxford, England: Blackwell Scientific Publications; 1987:400-403.
13.
Bamford J, Sandercock P, Dennis M, Warlow C, Jones L,
McPeherson K, Vessey M, Fowler G, Molyneux A, Hughes T, Burn J,
Wade D. A prospective study of acute cerebrovascular disease in
the community: the Oxfordshire Community Stroke Project 1981-86, I:
methodology, demography and incident cases of first ever
stroke. J Neurol Neurosurg Psychiatry. 1988;51:1373-1380.
14. Bonita R, Anderson CS, Broad JB, Jamrozik KD, Stewart-Wynne EG, Anderson NE. Stroke incidence and case fatality in Australasia: a comparison of the Auckland and Perth population-based stroke registers. Stroke. 1994;25:552-557.[Abstract]
15.
Jerntorp P, Berglund G. Stroke registry in
Malmö, Sweden. Stroke. 1992;23:357-361.
16.
Lauria G, Gentile M, Fassetta G, Casetta I, Agnoli F,
Andreotta G, Barp C, Caneve G, Cavallaro A, Cielo R, Mongillo D, Mosca
M, Olivieri P. Incidence and prognosis of stroke in the Belluno
province, Italy: first-year results of a community-based study.
Stroke. 1995;26:1787-1793.
17. Asberg K, Parow A. Event, incidence and fatality rates of cerebrovascular diseases in Enköping-Habo, 1986-88. Scand J Soc Med. 1991;19:134-139.[Medline] [Order article via Infotrieve]
18. Dahlöf B, Lindblom L, Hansson L, Sherstén B, Ekbom T, Wester P-O. Morbidity and mortality in the Swedish Trial in older patients (STOP-Hypertension). Lancet. 1991;338:1281-1285.[Medline] [Order article via Infotrieve]
19.
SHEP Cooperative Research Group: Prevention of stroke
by antihypertensive drug treatment in older persons with isolated
systolic hypertension: final results of the Systolic
Hypertension in the Elderly Program (SHEP). JAMA. 1991;265:3255-3264.
20. MRC Working Party: Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ. 1992;304:405-412.
21. Terent A. A prospective epidemiological survey of cerebrovascular disease in a Swedish community. Ups J Med Sci. 1979;84:235-246.[Medline] [Order article via Infotrieve]
22. Anderson CS, Jamrozik KD, Burvill PW, Chakera TMH, Johnson GA, Stewart-Wynne EG. Determining the incidence of different subtypes of stroke: results from the Perth Community Stroke Study, 1989-1990. Med J Aust. 1993;158:85-89.[Medline] [Order article via Infotrieve]
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H. Hannerz and M. L. Nielsen Life Expectancies Among Survivors of Acute Cerebrovascular Disease Stroke, August 1, 2001; 32(8): 1739 - 1744. [Abstract] [Full Text] [PDF]
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T. Inagawa Trends in Incidence and Case Fatality Rates of Aneurysmal Subarachnoid Hemorrhage in Izumo City, Japan, Between 1980-1989 and 1990-1998 Stroke, July 1, 2001; 32(7): 1499 - 1507. [Abstract] [Full Text] [PDF]
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R. G. J. Gibbs, R. Newson, R. Lawrenson, R. M. Greenhalgh, and A. H. Davies Diagnosis and Initial Management of Stroke and Transient Ischemic Attack Across UK Health Regions From 1992 to 1996 : Experience of a National Primary Care Database Stroke, May 1, 2001; 32(5): 1085 - 1090. [Abstract] [Full Text] [PDF]
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W.T. Longstreth Jr., C. Bernick, A. Fitzpatrick, M. Cushman, L. Knepper, J. Lima, and C.D. Furberg Frequency and predictors of stroke death in 5,888 participants in the Cardiovascular Health Study Neurology, February 13, 2001; 56(3): 368 - 375. [Abstract] [Full Text] [PDF]
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C. Marini, R. Totaro, F. De Santis, I. Ciancarelli, M. Baldassarre, and A. Carolei Stroke in Young Adults in the Community-Based L'Aquila Registry : Incidence and Prognosis Stroke, January 1, 2001; 32(1): 52 - 56. [Abstract] [Full Text] [PDF]
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 R. M Selmer, I. S. Kristiansen, A. Haglerød, S. Graff-Iversen, H. K Larsen, H. E Meyer, K. H Bønaa, and D. S Thelle Cost and health consequences of reducing the population intake of salt J Epidemiol Community Health, September 1, 2000; 54(9): 697 - 702. [Abstract] [Full Text]
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Y. Morikawa, H. Nakagawa, Y. Naruse, M. Nishijo, K. Miura, M. Tabata, W. Hirokawa, S. Kagamimori, M. Honda, K. Yoshita, et al. Trends in Stroke Incidence and Acute Case Fatality in a Japanese Rural Area : The Oyabe Study Stroke, July 1, 2000; 31(7): 1583 - 1587. [Abstract] [Full Text] [PDF]
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B. Johansson, B. Norrving, and A. Lindgren Increased Stroke Incidence in Lund-Orup, Sweden, Between 1983 to 1985 and 1993 to 1995 Stroke, February 1, 2000; 31(2): 481 - 486. [Abstract] [Full Text] [PDF]
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H. Ellekjær, J. Holmen, O. Kruger, and A. Terent Identification of Incident Stroke in Norway : Hospital Discharge Data Compared With a Population-Based Stroke Register Stroke, January 1, 1999; 30(1): 56 - 60. [Abstract] [Full Text] [PDF]
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P. L. Kolominsky-Rabas, C. Sarti, P. U. Heuschmann, C. Graf, S. Siemonsen, B. Neundoerfer, A. Katalinic, E. Lang, K.-G. Gassmann, and T. R. von Stockert A Prospective Community-Based Study of Stroke in Germany—The Erlangen Stroke Project (ESPro) : Incidence and Case Fatality at 1, 3, and 12 Months Stroke, December 1, 1998; 29(12): 2501 - 2506. [Abstract] [Full Text] [PDF]
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D. T. Lackland, D. L. Bachman, T. D. Carter, D. L. Barker, S. Timms, and H. Kohli The Geographic Variation in Stroke Incidence in Two Areas of the Southeastern Stroke Belt : The Anderson and Pee Dee Stroke Study Stroke, October 1, 1998; 29(10): 2061 - 2068. [Abstract] [Full Text] [PDF]
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