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The incidence of all stroke and stroke subtype in the United Kingdom, 1985 to 2008: a systematic review.

Bhatnagar P, Scarborough P, Smeeton NC, Allender S - BMC Public Health (2010)

Bottom Line: MEDLINE and EMBASE were searched, reference lists inspected and authors of included papers were contacted.Only one paper, based in South London, had data on temporal trends.This could not be compared to any other locations in this review.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK. prachi.bhatnagar@dphpc.ox.ac.uk

ABSTRACT

Background: There is considerable geographic variation in stroke mortality around the United Kingdom (UK). Whether this is due to geographical differences in incidence or case-fatality is unclear. We conducted a systematic review of high-quality studies documenting the incidence of any stroke and stroke subtypes, between 1985 and 2008 in the UK. We aimed to study geographic and temporal trends in relation to equivalent mortality trends.

Methods: MEDLINE and EMBASE were searched, reference lists inspected and authors of included papers were contacted. All rates were standardised to the European Standard Population for those over 45, and between 45 and 74 years. Stroke mortality rates for the included areas were then calculated to produce rate ratios of stroke mortality to incidence for each location.

Results: Five papers were included in this review. Geographic variation was narrow but incidence appeared to largely mirror mortality rates for all stroke. For men over 45, incidence (and confidence intervals) per 100,000 ranged from 124 (109-141) in South London, to 185 (164-208) in Scotland. For men, premature (45-74 years) stroke incidence per 100,000 ranged from 79 (67-94) in the North West, to 112 (95-132) in Scotland. Stroke subtype data was more geographically restricted, but did suggest there is no sizeable variation in incidence by subtype around the country. Only one paper, based in South London, had data on temporal trends. This showed that there has been a decline in stroke incidence since the mid 1990 s. This could not be compared to any other locations in this review.

Conclusions: Geographic variations in stroke incidence appear to mirror variations in mortality rates. This suggests policies to reduce inequalities in stroke mortality should be directed at risk factor profiles rather than treatment after a first incident event. More high quality stroke incidence data from around the UK are needed before this can be confirmed.

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Related in: MedlinePlus

Flow chart of the reviewing process.
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Figure 1: Flow chart of the reviewing process.

Mentions: From the 502 papers identified in the initial search, five [6,11-14] were retained as meeting all of the inclusion criteria (figure 1). After examination of titles and abstracts, the most common reason for exclusion was incomplete ascertainment methods (eight studies excluded for this reason). Other common reasons for exclusion included not having a study population representative of the area, no definition of stroke reported and not reporting whether recurrent stroke was included. Nine papers were excluded having failed one of the inclusion criteria, while eighteen were excluded for multiple reasons.


The incidence of all stroke and stroke subtype in the United Kingdom, 1985 to 2008: a systematic review.

Bhatnagar P, Scarborough P, Smeeton NC, Allender S - BMC Public Health (2010)

Flow chart of the reviewing process.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2944372&req=5

Figure 1: Flow chart of the reviewing process.
Mentions: From the 502 papers identified in the initial search, five [6,11-14] were retained as meeting all of the inclusion criteria (figure 1). After examination of titles and abstracts, the most common reason for exclusion was incomplete ascertainment methods (eight studies excluded for this reason). Other common reasons for exclusion included not having a study population representative of the area, no definition of stroke reported and not reporting whether recurrent stroke was included. Nine papers were excluded having failed one of the inclusion criteria, while eighteen were excluded for multiple reasons.

Bottom Line: MEDLINE and EMBASE were searched, reference lists inspected and authors of included papers were contacted.Only one paper, based in South London, had data on temporal trends.This could not be compared to any other locations in this review.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK. prachi.bhatnagar@dphpc.ox.ac.uk

ABSTRACT

Background: There is considerable geographic variation in stroke mortality around the United Kingdom (UK). Whether this is due to geographical differences in incidence or case-fatality is unclear. We conducted a systematic review of high-quality studies documenting the incidence of any stroke and stroke subtypes, between 1985 and 2008 in the UK. We aimed to study geographic and temporal trends in relation to equivalent mortality trends.

Methods: MEDLINE and EMBASE were searched, reference lists inspected and authors of included papers were contacted. All rates were standardised to the European Standard Population for those over 45, and between 45 and 74 years. Stroke mortality rates for the included areas were then calculated to produce rate ratios of stroke mortality to incidence for each location.

Results: Five papers were included in this review. Geographic variation was narrow but incidence appeared to largely mirror mortality rates for all stroke. For men over 45, incidence (and confidence intervals) per 100,000 ranged from 124 (109-141) in South London, to 185 (164-208) in Scotland. For men, premature (45-74 years) stroke incidence per 100,000 ranged from 79 (67-94) in the North West, to 112 (95-132) in Scotland. Stroke subtype data was more geographically restricted, but did suggest there is no sizeable variation in incidence by subtype around the country. Only one paper, based in South London, had data on temporal trends. This showed that there has been a decline in stroke incidence since the mid 1990 s. This could not be compared to any other locations in this review.

Conclusions: Geographic variations in stroke incidence appear to mirror variations in mortality rates. This suggests policies to reduce inequalities in stroke mortality should be directed at risk factor profiles rather than treatment after a first incident event. More high quality stroke incidence data from around the UK are needed before this can be confirmed.

Show MeSH
Related in: MedlinePlus