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Temporal and Age-Specific Trends in Acute Stroke Incidence: A 15-Year Population-Based Study of Administrative Data in Ontario, Canada

Published online by Cambridge University Press:  20 November 2020

Raed A. Joundi
Affiliation:
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ICES, Toronto, Canada
Eric E. Smith
Affiliation:
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ICES, Toronto, Canada
Amy Y.X. Yu
Affiliation:
ICES, Toronto, Canada Department of Medicine, Division of Neurology, University of Toronto, Toronto, Canada
Mohammed Rashid
Affiliation:
ICES, Toronto, Canada
Jiming Fang
Affiliation:
ICES, Toronto, Canada
Moira K. Kapral
Affiliation:
ICES, Toronto, Canada Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
Corresponding
E-mail address:

Abstract:

Background:

Contemporary data on temporal trends in acute stroke incidence, specific to stroke type and age, are lacking. We sought to evaluate temporal trends in incidence of ischemic stroke and intracerebral hemorrhage over 15 years in a large population.

Methods:

We used linked administrative data to identify all emergency department visits and hospital admissions for first-ever ischemic stroke or intracerebral hemorrhage in Ontario, Canada from 2003–2017. We evaluated annual age-/sex-standardized incidence per 100,000 person-years for ischemic stroke and intracerebral hemorrhage across the study period. We used negative binomial regression to determine incidence rate ratios for each year compared to 2003, with assessment of modification by age, sex, or stroke type.

Results:

Our cohort had 163,574 people with stroke (88% ischemic stroke). For ischemic stroke and intracerebral hemorrhage combined, age-/sex-standardized incidence decreased between 2003 and 2011 (standardized rate 109.4 to 85.8 per 100,000; 22%), then increased until 2017 (standardized rate 96.8 per 100,000; 13%). The pattern of change was similar for ischemic stroke and intracerebral hemorrhage, and for men and women, but was modified by age. For those aged 60 and above, adjusted incidence rate ratios decreased from 2003 to 2011 then subsequently increased, whereas for those aged <60 years incidence rate ratios increased throughout the entire study time period, particularly after 2011.

Conclusions:

Acute stroke incidence decreased from 2003 to 2011 but subsequently increased until 2017. Among those aged <60, incidence increased continuously from 2003 to 2017 but especially after 2011. The underlying reasons for these changes should be determined.

Résumé :

RÉSUMÉ :

Tendances relatives à l’âge et dans le temps en ce qui concerne l’incidence d’AVC aigus : une étude populationnelle de 15 ans reposant sur des données administratives ontariennes.

Contexte et objectif :

Il nous manque, à l’heure actuelle, des données portant sur l’incidence dans le temps des AVC aigus, notamment le type d’AVC qui surviennent ainsi que l’âge des personnes qui en sont victimes. Pour une période de 15 ans, nous avons donc cherché à évaluer les tendances portant sur l’incidence des accidents ischémiques et des hémorragies intracérébrales au sein d’une population importante.

Méthodes :

Pour ce faire, nous avons utilisé des données administratives interreliées afin de comptabiliser de 2003 à 2017 toutes les visites à un service des urgences et toutes les hospitalisations pour tout accident ischémique ou toute hémorragie cérébrale survenant une première fois en Ontario (Canada). Pour ces mêmes accidents ischémiques et hémorragies cérébrales, nous avons ensuite évalué tout au long de la période à l’étude l’incidence annuelle standardisée en fonction de l’âge et du sexe pour chaque tranche de 100 000 personnes. À cet égard, nous avons fait appel à un modèle de régression binomiale négative afin de déterminer, pour chaque année à l’étude, les ratios de taux d’incidence et de les comparer à 2003, l’année de référence. Nous avons ensuite été en mesure d’analyser l’évolution des tendances selon l’âge, le sexe ou le type d’AVC.

Résultats :

Notre cohorte rassemblait 163 574 personnes victimes d’un AVC. De ce nombre, 88 % d’entre elles avaient été victimes d’un accident ischémique. En tenant compte de tous les cas d’accident ischémique et d’hémorragie cérébrale combinés, l’incidence standardisée en fonction de l’âge et du sexe a diminué entre 2003 et 2011. En effet, le taux standardisé par 100 000 personnes est passé de 109,4 à 85,8, ce qui représente une diminution de 22 %. Ce taux a ensuite augmenté jusqu’en 2017 pour s’établir à 96,8 par 100 000 personnes, soit 13 % d’augmentation. Si le profil de changement s’est révélé semblable pour les accidents ischémiques et les hémorragies cérébrales ainsi que pour les hommes et les femmes, il a toutefois varié selon l’âge des personnes. Pour ceux et celles âgés de plus de 60 ans, les ratios de taux d’incidence ajustés ont diminué de 2003 à 2011 et ont ultérieurement augmenté tandis que ceux et celles âgés de moins de 60 ans ont au contraire vu leurs ratios de taux d’incidence augmenter tout au long de la période à l’étude, surtout après l’année 2011.

Conclusions :

Les taux d’incidence des accidents ischémiques ont certes diminué de 2003 à 2011 mais ont par la suite augmenté jusqu’en 2017. Parmi ceux et celles âgés de 60 ans et moins, ce taux a augmenté de façon continue entre 2003 et 2017, plus particulièrement après 2011. Les raisons sous-jacentes de cette évolution devraient être déterminées.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Canadian Journal of Neurological Sciences Inc.

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