(Stroke. 1999;30:736-743.)
© 1999 American Heart Association, Inc.
Original Contributions |
Stroke Incidence and Survival Among Middle-Aged Adults
9-Year Follow-Up of the Atherosclerosis Risk in Communities (ARIC) Cohort
From the Department of Epidemiology (W.D.R.) and Collaborative Studies Coordinating Center, Department of Biostatistics (L.E.C., C.H.W.), University of North Carolina, Chapel Hill, NC; Division of Epidemiology, University of Minnesota, Minneapolis, MN (A.R.F., P.G.M., E.S.); Department of Public Health Science, Wake Forest University School of Medicine, Winston-Salem, NC (G.H.); and the National Heart, Lung, and Blood Institute, Bethesda, Md (L.S.C.).
Correspondence to Wayne D. Rosamond, PhD, Department of Epidemiology, University of North Carolina, 137 East Franklin St, Suite 306, Chapel Hill, NC 27514. E-mail wayne_rosamond{at}unc.edu
Background and Purpose—Although stroke mortality rates in the United States are well documented, assessment of incidence rates and case fatality are less well studied.
Methods—A cohort of 15 792 men and women aged 45 to 64 years from a population sample of households in 4 US communities was followed from 1987 to 1995, an average of 7.2 years. Incident strokes were identified through annual phone contacts and hospital record searching and were then validated.
Results—Of the 267 incident definite or probable strokes, 83% (n=221) were categorized as ischemic strokes, 10% (n=27) were intracerebral hemorrhages, and 7% (n=19) were subarachnoid hemorrhages. The age-adjusted incidence rate (per 1000 person-years) of total strokes was highest among black men (4.44), followed by black women (3.10), white men (1.78), and white women (1.24). The black versus white age-adjusted rate ratio (RR) for ischemic stroke was 2.41 (95% CI, 1.85 to 3.15), which was attenuated to 1.38 (95% CI, 1.01 to 1.89) after adjustment for baseline hypertension, diabetes, education level, smoking status, and prevalent coronary heart disease. There was a tendency for the adjusted case fatality rates to be higher among blacks and men, although none of the case fatality comparisons across sex or race was statistically significant.
Conclusions—After accounting for established baseline risk factors, blacks still had a 38% greater risk of incident ischemic stroke compared with whites. Identification of new individual and community-level risk factors accounting for the elevated incidence of stroke requires further investigation and incorporation into intervention planning.
Key Words: cerebral infarction • epidemiology • intracerebral hemorrhage • racial differences
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I. M. van der Meer, A. Iglesias del Sol, A. E. Hak, M. L. Bots, A. Hofman, and J. C.M. Witteman Risk Factors for Progression of Atherosclerosis Measured at Multiple Sites in the Arterial Tree: The Rotterdam Study Stroke, October 1, 2003; 34(10): 2374 - 2379. [Abstract] [Full Text] [PDF]
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 L. M Steffen, D. R Jacobs Jr, J. Stevens, E. Shahar, T. Carithers, and A. R Folsom Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study Am. J. Clinical Nutrition, September 1, 2003; 78(3): 383 - 390. [Abstract] [Full Text] [PDF]
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 J. E. Stahl, K. L. Furie, S. Gleason, and G. S. Gazelle Stroke: Effect of Implementing an Evaluation and Treatment Protocol Compliant with NINDS Recommendations Radiology, September 1, 2003; 228(3): 659 - 668. [Abstract] [Full Text] [PDF]
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 J. L Ruhland and P. L. van Kan Medial Pontine Hemorrhagic Stroke Physical Therapy, June 1, 2003; 83(6): 552 - 566. [Abstract] [Full Text] [PDF]
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C. A Carroll, M. M Coen, and R. W Piepho Economic Impact of Ramipril on Hospitalization of High-Risk Cardiovascular Patients Ann. Pharmacother., March 1, 2003; 37(3): 327 - 331. [Abstract] [Full Text] [PDF]
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E. Shahar, L. E. Chambless, W. D. Rosamond, L. L. Boland, C. M. Ballantyne, P. G. McGovern, and A. R. Sharrett Plasma Lipid Profile and Incident Ischemic Stroke: The Atherosclerosis Risk in Communities (ARIC) Study Stroke, March 1, 2003; 34(3): 623 - 631. [Abstract] [Full Text] [PDF]
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 A. T. Schneider, A. M. Pancioli, J. C. Khoury, E. Rademacher, A. Tuchfarber, R. Miller, D. Woo, B. Kissela, and J. P. Broderick Trends in Community Knowledge of the Warning Signs and Risk Factors for Stroke JAMA, January 15, 2003; 289(3): 343 - 346. [Abstract] [Full Text] [PDF]
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P. Piriyawat, M. Smajsova, M. A. Smith, S. Pallegar, A. Al-Wabil, N. M. Garcia, J. M. Risser, L. A. Moye, and L. B. Morgenstern Comparison of Active and Passive Surveillance for Cerebrovascular Disease: The Brain Attack Surveillance in Corpus Christi (BASIC) Project Am. J. Epidemiol., December 1, 2002; 156(11): 1062 - 1069. [Abstract] [Full Text] [PDF]
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S. S. Rathore, A. R. Hinn, L. S. Cooper, H. A. Tyroler, and W. D. Rosamond Characterization of Incident Stroke Signs and Symptoms: Findings From the Atherosclerosis Risk in Communities Study Stroke, November 1, 2002; 33(11): 2718 - 2721. [Abstract] [Full Text] [PDF]
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H.J. Fullerton, D.M. Chetkovich, Y.W. Wu, W.S. Smith, and S.C. Johnston Deaths from stroke in US children, 1979 to 1998 Neurology, July 9, 2002; 59(1): 34 - 39. [Abstract] [Full Text] [PDF]
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T. Y. Wong, R. Klein, A. R. Sharrett, D. J. Couper, B. E. K. Klein, D.-P. Liao, L. D. Hubbard, T. H. Mosley, and for the ARIC Investigators Cerebral White Matter Lesions, Retinopathy, and Incident Clinical Stroke JAMA, July 3, 2002; 288(1): 67 - 74. [Abstract] [Full Text] [PDF]
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L. S. Kinsinger, R. Harris, S. H. Woolf, H. C. Sox, and K. N. Lohr Chemoprevention of Breast Cancer: A Summary of the Evidence for the U.S. Preventive Services Task Force Ann Intern Med, July 2, 2002; 137(1): 59 - 69. [Abstract] [Full Text] [PDF]
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S. Fuchs, E. Stabile, T. D. Kinnaird, G. S. Mintz, L. Gruberg, D. A. Canos, E. E. Pinnow, R. Kornowski, W. O. Suddath, L. F. Satler, et al. Stroke Complicating Percutaneous Coronary Interventions: Incidence, Predictors, and Prognostic Implications Circulation, July 2, 2002; 106(1): 86 - 91. [Abstract] [Full Text] [PDF]
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B. G. Vickrey, T. S. Rector, S. L. Wickstrom, P. M. Guzy, E. M. Sloss, P. B. Gorelick, S. Garber, D. F. McCaffrey, M. D. Dake, and R. A. Levin Occurrence of Secondary Ischemic Events Among Persons With Atherosclerotic Vascular Disease Stroke, April 1, 2002; 33(4): 901 - 906. [Abstract] [Full Text] [PDF]
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 C D A Wolfe, A G Rudd, R Howard, C Coshall, J Stewart, E Lawrence, C Hajat, and T Hillen Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register J. Neurol. Neurosurg. Psychiatry, February 1, 2002; 72(2): 211 - 216. [Abstract] [Full Text] [PDF]
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J. E. Williams, F. J. Nieto, C. P. Sanford, D. J. Couper, H. A. Tyroler, and A. Algra The Association Between Trait Anger and Incident Stroke Risk: The Atherosclerosis Risk in Communities (ARIC) Study * Editorial Comment: The Atherosclerosis Risk in Communities (ARIC) Study Stroke, January 1, 2002; 33(1): 13 - 20. [Abstract] [Full Text] [PDF]
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C. D. Lee, A. R. Folsom, F. J. Nieto, L. E. Chambless, E. Shahar, and D. A. Wolfe White Blood Cell Count and Incidence of Coronary Heart Disease and Ischemic Stroke and Mortality from Cardiovascular Disease in African-American and White Men and Women: Atherosclerosis Risk in Communities Study Am. J. Epidemiol., October 15, 2001; 154(8): 758 - 764. [Abstract] [Full Text] [PDF]
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D. Mirchandani and F. Muggia Re: Prognosis and Treatment of Patients With Breast Tumors of One Centimeter or Less and Negative Axillary Lymph Nodes J Natl Cancer Inst, September 19, 2001; 93(18): 1420a - 1421a. [Full Text] [PDF]
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A. W. Tsai, A. R. Folsom, W. D. Rosamond, and D. W. Jones Ankle-Brachial Index and 7-Year Ischemic Stroke Incidence: The ARIC Study Stroke, August 1, 2001; 32(8): 1721 - 1724. [Abstract] [Full Text] [PDF]
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B. J. Quilliam, K. L. Lapane, and C. Leibson Clinical Correlates and Drug Treatment of Residents With Stroke in Long-Term Care Editorial Comment Stroke, June 1, 2001; 32(6): 1385 - 1393. [Abstract] [Full Text] [PDF]
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K. J. Hunt, G. W. Evans, A. R. Folsom, A. R. Sharrett, L. E. Chambless, C. H. Tegeler, and G. Heiss Acoustic Shadowing on B-Mode Ultrasound of the Carotid Artery Predicts Ischemic Stroke : The Atherosclerosis Risk in Communities (ARIC) Study Stroke, May 1, 2001; 32(5): 1120 - 1126. [Abstract] [Full Text] [PDF]
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A. C. Morrison, P. A. Doris, A. R. Folsom, F. J. Nieto, E. Boerwinkle, and R. A. Hegele G-Protein {beta}3 Subunit and {{alpha}}-Adducin Polymorphisms and Risk of Subclinical and Clinical Stroke Editorial Comment : Candidate Genes for Stroke: If Elected, Will They Serve? Stroke, April 1, 2001; 32(4): 822 - 829. [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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D. Knopman, L.L. Boland, T. Mosley, G. Howard, D. Liao, M. Szklo, P. McGovern, and A. R. Folsom Cardiovascular risk factors and cognitive decline in middle-aged adults Neurology, January 9, 2001; 56(1): 42 - 48. [Abstract] [Full Text] [PDF]
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L. B. Goldstein, R. Adams, K. Becker, C. D. Furberg, P. B. Gorelick, G. Hademenos, M. Hill, G. Howard, V. J. Howard, B. Jacobs, et al. Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association Circulation, January 2, 2001; 103(1): 163 - 182. [Full Text] [PDF]
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L. B. Goldstein, R. Adams, K. Becker, C. D. Furberg, P. B. Gorelick, G. Hademenos, M. Hill, G. Howard, V. J. Howard, B. Jacobs, et al. Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association Stroke, January 1, 2001; 32(1): 280 - 299. [Full Text] [PDF]
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M. L. Eigenbrodt, K. M. Rose, D. J. Couper, D. K. Arnett, R. Smith, and D. Jones Orthostatic Hypotension as a Risk Factor for Stroke : The Atherosclerosis Risk in Communities (ARIC) Study, 1987-1996 Stroke, October 1, 2000; 31(10): 2307 - 2313. [Abstract] [Full Text] [PDF]
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A. C. Morrison, M. Fornage, D. Liao, and E. Boerwinkle Parental History of Stroke Predicts Subclinical But Not Clinical Stroke : The Atherosclerosis Risk in Communities Study Stroke, September 1, 2000; 31(9): 2098 - 2102. [Abstract] [Full Text] [PDF]
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M. H. Gail, J. P. Costantino, J. Bryant, R. Croyle, L. Freedman, K. Helzlsouer, and V. Vogel Response J Natl Cancer Inst, April 5, 2000; 92(7): 574 - 574. [Full Text] [PDF]
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