This Article Full Text Full Text (PDF) All Versions of this Article: 40/3/873    most recent STROKEAHA.108.529479v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Glymour, M. M. Articles by Avendano, M. Search for Related Content PubMed PubMed Citation Articles by Glymour, M. M. Articles by Avendano, M. Related Collections Health policy and outcome research Behavioral/psychosocial - stroke Behavioral Changes and Stroke Epidemiology

(Stroke. 2009;40:873.)
© 2009 American Heart Association, Inc.

Original Contributions

Can Self-Reported Strokes Be Used to Study Stroke Incidence and Risk Factors?

Evidence From the Health and Retirement Study

From the Department of Epidemiology (M.M.G.), Mailman School of Public Health, New York, NY; the Department of Society, Human Development, and Health (M.M.G.), Harvard School of Public Health, Boston, Mass; the Department of Public Health (M.A.), Erasmus Medical Center, Rotterdam, The Netherlands; and the Center for Population and Development Studies (M.A.), Harvard School of Public Health, Boston, Mass.

Correspondence to M. Maria Glymour, ScD, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115. E-mail mglymour{at}hsph.harvard.edu

Background and Purpose— Most stroke incidence studies use geographically localized (community) samples with few national data sources available. Such samples preclude research on contextual risk factors, but national samples frequently collect only self-reported stroke. We examine whether incidence estimates from clinically verified studies are consistent with estimates from a nationally representative US sample assessing self-reported stroke.

Methods— Health and Retirement Study (HRS) participants (n=17 056) age 50+ years were followed for self- or proxy-reported first stroke (1293 events) from 1998 to 2006 (average, 6.8 years). We compared incidence rates by race, sex, and age strata with those previously documented in leading geographically localized studies with medically verified stroke. We also examined whether cardiovascular risk factor effect estimates in HRS are comparable to those reported in studies with clinically verified strokes.

Results— The weighted first-stroke incidence rate was 10.0 events/1000 person-years. Total age-stratified incidence rates in whites were mostly comparable with those reported elsewhere and were not systematically higher or lower. However, among blacks in HRS, incidence rates generally appeared higher than those previously reported. HRS estimates were most comparable with those reported in the Cardiovascular Health Study. Incidence rates approximately doubled per decade of age and were higher in men and blacks. After demographic adjustment, all risk factors predicted stroke incidence in whites. Smoking, hypertension, diabetes, and heart disease predicted incident stroke in blacks.

Conclusions— Associations between known risk factors and stroke incidence were verified in HRS, suggesting that misreporting is nonsystematic. HRS may provide valuable data for stroke surveillance and examination of classical and contextual risk factors.

Key Words: epidemiology • incidence • prevention • public health • risk factors • stroke

This article has been cited by other articles:

				A. A. Divani, G. Vazquez, A. M. Barrett, M. Asadollahi, and A. R. Luft Risk Factors Associated With Injury Attributable to Falling Among Elderly Population With History of Stroke Stroke, October 1, 2009; 40(10): 3286 - 3292. [Abstract] [Full Text] [PDF]