(Stroke. 2004;35:2045.)
© 2004 American Heart Association, Inc.
Original Contributions |
Editorial Comment—Stroke Incidence Studies One Step Closer to the Elusive Gold Standard?
Clinical Trials Research Unit, Department of Medicine & School of Population Health, University of Auckland, New Zealand
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Stroke should be studied in a population-wide context because a large proportion of the burden of care for stroke is borne by health services outside the hospital sector and by families of affected patients.1,2 Assessing the need for stroke-related prevention strategies and health services, and geographical and secular trends in stroke burden, is best achieved with standardized population-based registers. Analyses limited to hospital cases, incomplete mortality data, or cases with varying criteria and definitions may distort results because of nonstandardized measures and nonrepresentative study populations. However, identifying all new stroke events in a population is particularly challenging, so that such epidemiological studies are relatively rare compared with studies using mortality data, hospital-based stroke registers, or incidence studies in younger age groups only.2,3 Moreover, even among published population-based stroke incidence studies, there are differences in the methodologies used to ensure completeness of case ascertainment.
Until recently, assessing completeness of case ascertainment in stroke incidence studies has been performed directly (eg, repeated cross-sectional surveys of the study population) and/or indirectly (eg, quality-control procedures, statistical modeling).3 Although repeated surveys are very expensive, other indirect methods may carry a considerable potential for error,3 and there is still no standard method of assessment of the completeness of stroke case ascertainment. Although capture–recapture method of case ascertainment is cost-efficient, there is much debate regarding its usefulness given the necessary assumptions that the population is closed; the sources of notification (or lists) are independent; the probability of being on a list should be the same. More extensive
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