ABSTRACT
Background Information about long-term outcomes after stroke in developing countries provided by population-based methodologies is scarce. Aim This study aimed to know outcomes five years after a first-ever stroke in Joinville, Brazil. Methods Data were extracted from the Joinville Stroke Registry about all patients who had strokes in Joinville in 2010 and were followed up to 2015. Stroke recurrence, Kaplan-Meier survival probabilities, functional outcomes, and causes of death were ascertained at 30 days, six months, one and five years. Results A total of 399 strokes were studied. The mean age was 64 (standard deviation 16) years. After five years, 52% (95% confidence interval: 47-57%) survived and 20% (95% confidence interval: 15-26%) of the survivors had modified Rankin scale scores >2. More than half of these patients were institutionalized in nursing or home care settings. The average risk of death per year was ≈7%. Survival rates were significantly lower for subarachnoid hemorrhage and primary intracerebral hemorrhage than for ischemic stroke. The five-year recurrence rate was 12% (95% confidence interval: 9-15%). The index stroke was the cause of death in three quarters of the patients. Conclusions The results showed that 68% of the patients with stroke were either dead or disabled five years after first-ever stroke. This percentage is similar to proportions of other recent cohorts from developed countries, despite the lower age of the patients in this study.
Subject(s)
Stroke/epidemiology , Aged , Brazil/epidemiology , Cause of Death , Disability Evaluation , Female , Humans , Incidence , Kaplan-Meier Estimate , Male , Middle Aged , Prospective Studies , Recurrence , Registries , Stroke/classification , Stroke/diagnosis , Stroke/therapy , Treatment OutcomeABSTRACT
BACKGROUND: Temporal trends on the incidence of stroke and its subtypes could help assess on-going public health policies and point to further targets for action among middle- and low-income countries, where the stroke burden is very high. This study aimed at evaluating longitudinal trends of stroke incidence in Joinville, Brazil. METHODS: We ascertained the incidence of all first-ever strokes occurred in 1995, 2005-2006 and 2012-2013, which were extracted from Joinville Stroke Registry, a prospective epidemiological data bank, launched in 1995. RESULTS: From 1995 to 2013, the age-adjusted incidence of all strokes decreased 37% (95% CI 32-42). From 2005 to 2013, the haemorrhagic stroke (HS) incidence decreased 60% (95% CI 13-86), ischemic stroke (IS) incidence decreased 15% (95% CI 1-28), and subarachnoid haemorrhage incidence remained stable. The proportion of IS and HS patients with regularly treated hypertension increased by 60% (p = 0.01) and 33% (p = 0.01), respectively. The proportion of IS and HS patients that quit smoking increased 8% (p = 0.03) and 17% (p = 0.03), respectively. CONCLUSIONS: Stroke incidence has been decreasing in Joinville over the last 18 years, more so for HS than IS. Better control of hypertension and tobacco use might explain these findings.
Subject(s)
Stroke/epidemiology , Adult , Aged , Aged, 80 and over , Brazil , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , Registries , Risk Factors , Young AdultABSTRACT
A carência de dados epidemiológicos e a impressäo prévia de elevada incidência de acidente vascular cerebral (AVC) no Brasil criou o estímulo para estudo institucional prospectivo em Joinville. No período de 1-março-1995 a 1-março-1996, avaliamos o primeiro episódio e episódios recorrentes em AVC, incidência, mortalidade, taxa de fatalidade-caso em 30 dias (letalidade), frequência de fatores de risco, tempo para admissäo hospitalar e distribuiçäo dos infartos cerebrais por subtipos patológicos. Registramos 429 pacientes no período, 320 destes com primeiro episódio. Tomografia de crânio foi realizada em 98 por cento dos casos. A taxa de incidência anual ajustada por idade em primeiro episódio de AVC foi de 156/100000. A distribuiçäo por diagnóstico foi: 73,4 por cento para infarto cerebral, 18,4 por cento para hemorragia cerebral e 7,5 por cento para hemorragia subaracnóide. A taxa de mortalidade anual padronizada foi 25/100000. A letalidade foi 26 por cento. Hipertensäo, AVC prévio e diabetes foram os fatores de risco mais frequentes. Somente 25 por cento dos pacientes chegaram ao hospital nas primeira três horas iniciais. Concluimos que a taxa de incidência em primeiro episódio de AVC em pacientes institucionalizados em Joinville, Brasil, é elevada. A taxa de mortalidade e letalidade säo similares às de outras populaçoes.
Subject(s)
Middle Aged , Female , Humans , Cerebrovascular Disorders , Brazil , Cerebrovascular Disorders/etiology , Prospective StudiesABSTRACT
De julho a janeiro de 1989, foram avaliados, prospectivamente, 1.177 exames endoscopicos, realizados em pacientes residentes em Joinville (Santa Catarina) e, na sua maioria, operarios das industrias locais. Os autores deste estudo observaram uma alta incidencia de lesoes agudas da mucosa gastroduodenal, nitidamente relacionada com a atividade dos individuos na industria pesada (fundicao, produtos quimicos, eletrodomesticos) predominante naquela regiao. Trabalhando frequentemente em contato com vapores toxicos, metais pesados, excesso de ruido, alteracao de turno de trabalho e horario irregular de alimentacao, os individuos modificam seus habitos de vida e desenvolvem "stress", associado a fatores de agressao ja conhecidos como alcool, fumo e drogas.