TY - JOUR AU - Feigin V. AU - Theadom A. AU - Arroll B. AU - Jones A. AU - Bonita R. AU - Brown P. AU - Tobias M. AU - Anderson Craig AU - Parag V. AU - Bennett D. AU - Krishnamurthi R. AU - Barker-Collo S. AU - McPherson K. AU - Barber P. AU - Witt E. AU - Abbott M. AU - Bhattacharjee R. AU - Rush E. AU - Suh F. AU - Rathnasabapathy Y. AU - B. Ao Te AU - Parmar P. AB -

BACKGROUND: Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years. METHODS: Four stroke incidence population-based register studies were undertaken in adult residents (aged >/=15 years) of Auckland NZ in 1981-1982, 1991-1992, 2002-2003 and 2011-2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution. RESULTS: 5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Maori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Maori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in frequency of current smoking among stroke patients. CONCLUSIONS: In this unique temporal series of studies spanning 30 years, stroke incidence, early case-fatality and 1-year mortality have declined, but ethnic disparities in risk and outcome for stroke persisted suggesting that primary stroke prevention remains crucial to reducing the burden of this disease.

AD - Auckland University of Technology, Auckland, New Zealand.
The University of Auckland, Auckland, New Zealand.
Health Research Council of New Zealand, Auckland, New Zealand.
Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Public Health Intelligence, Ministry of Health, Wellington, New Zealand.
Auckland University of Technology, Auckland, New Zealand; University of California Merced, Merced, California, United States of America.
University of Queensland, Brisbane, Australia.
Waitemata District Health Board, North Shore Hospital, Auckland, New Zealand.
The University of Sydney, Camperdown, NSW, Australia. AN - 26291829 BT - PLoS One C2 - PMC4546383 DP - NLM ET - 2015/08/21 LA - eng LB - AUS
NMH
FY16 M1 - 8 N1 - Feigin, Valery L
Krishnamurthi, Rita V
Barker-Collo, Suzanne
McPherson, Kathryn M
Barber, P Alan
Parag, Varsha
Arroll, Bruce
Bennett, Derrick A
Tobias, Martin
Jones, Amy
Witt, Emma
Brown, Paul
Abbott, Max
Bhattacharjee, Rohit
Rush, Elaine
Suh, Flora Minsun
Theadom, Alice
Rathnasabapathy, Yogini
Te Ao, Braden
Parmar, Priya G
Anderson, Craig
Bonita, Ruth
ARCOS IV Group
Research Support, Non-U.S. Gov't
United States
PLoS One. 2015 Aug 20;10(8):e0134609. doi: 10.1371/journal.pone.0134609. eCollection 2015. N2 -

BACKGROUND: Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years. METHODS: Four stroke incidence population-based register studies were undertaken in adult residents (aged >/=15 years) of Auckland NZ in 1981-1982, 1991-1992, 2002-2003 and 2011-2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution. RESULTS: 5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Maori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Maori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in frequency of current smoking among stroke patients. CONCLUSIONS: In this unique temporal series of studies spanning 30 years, stroke incidence, early case-fatality and 1-year mortality have declined, but ethnic disparities in risk and outcome for stroke persisted suggesting that primary stroke prevention remains crucial to reducing the burden of this disease.

PY - 2015 SN - 1932-6203 (Electronic)
1932-6203 (Linking) EP - e0134609 T2 - PLoS One TI - 30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies VL - 10 Y2 - FY16 ER -