Variations in stroke mortality could be explained by changes in factors that act around the time of death (period effect) and by risk factors that are present in early life (cohort effect). The aim of this study was to analyze mortality rates for stroke in Sweden during the period 1969 through 1993 and to predict mortality trends until the year 2003, taking into account age, cohort, and period effects.
Age-period-cohort models were used to analyze stroke mortality in Sweden between 1969 and 1993 and to predict age-specific death rates and total number of deaths for the periods 1994 through 1998 and 1999 through 2003.
Mortality rates in the age group 25 to 89 years decreased from 203 to 143 per 100,000 for men and from 185 to 113 per 100,000 for women over the study period (average annual decrease of 1.3% for men and 1.9% for women). The decline was present in all age groups. The full age-period-cohort model provided an acceptable fit in both sexes. Predictions based on these models gave a mortality rate of 122 and 92 per 100,000 for the period 1999-2003 in men and women, respectively. Despite an aging and increasing population, the total number of stroke deaths in Sweden is predicted to decline by approximately 10% in both men and women from 1989-1993 to 1999-2003.
Both factors, cohort and calendar period, contain relevant information to explain the decline in stroke mortality trends in Sweden. Predictions indicate that the decline of both age-specific and total mortality will continue.
The do-not-resuscitate (DNR) order is a mechanism of withholding cardiopulmonary resuscitation (CPR). The lack of DNR guidelines specific for acute stroke may result in many stroke patients receiving unnecessary and futile resuscitation and ventilator-assisted breathing.
A prospective multicenter evaluation of disease-specific criteria for DNR orders in acute stroke was initiated using a modified Delphi process. The participants were the Canadian and Western New York Stroke Consortium members who are closely involved in caring for acute stroke patients and conducting clinical trials at the academic centers. Previously published provisional criteria were reviewed by the participants. Modifications were made to the criteria until statistically significant agreement (P
BACKGROUND AND PURPOSE: Since stroke is a principal cause of death in elderly people, we analyzed the association between alcohol and stroke mortality in a cohort of 15,077 middle-aged and older men and women. METHODS: Data on alcohol habits were obtained from a questionnaire in 1967. The subsequent 20 years yielded 769 deaths from stroke, of which 574 were ischemic. Relative mortality risks (RR) were estimated from logistic regression analyses with lifelong alcohol abstainers as a reference group. Adjustments were made for age and smoking. RESULTS: No association was found between alcohol intake and hemorrhagic stroke. An elevated risk of ischemic stroke was found for men who drank infrequently, that is, a few times a year or less often (RR, 2.0; 95% confidence interval [CI], 1.3 to 3.2), for those who were intoxicated now and then (RR, 1.8; 95% CI, 1.1 to 2.8), and for those who reported "binge" drinking a few times in the year or less often (RR, 1.6; 95% CI, 1.1 to 2.5). Among women only ex-drinkers had an elevated risk of dying of ischemic stroke (RR, 3.3; 95% CI, 1.5 to 7.2). The risk was reduced for women who had an estimated average consumption of 0 to 5 g pure alcohol per day (RR, 0.6; 95% CI, 0.5 to 0.8); for those who did not drink every day (RR, 0.7; 95% CI, 0.5 to 0.9); and for those who never "went on a binge" (RR, 0.6; 95% CI, 0.5 to 0.8) or became intoxicated (RR, 0.7; 95% CI, 0.5 to 0.9). CONCLUSIONS: Drinking habits were associated only with deaths from ischemic stroke, and the risk patterns were different for men and women. In analyses, ex-drinkers should not be included with lifelong abstainers, since the former tend to run high health risk.
Over a period both a monetary and physical measure of antihypertensive drug consumption has increased in Denmark, but the consumption has varied considerably between counties in any given year. Concurrently, SMR for myocardial infarctions and cerebrovascular diseases due to hypertension has declined. The relation between intensity of treatment and outcome in terms of reduced loss of life time or healthy time is analyzed at an aggregate level within a health economic framework. The relation is analyzed by using a pooled time series cross section regression analysis. Two models, a covariance and an error component model are used. Within the range of observed drug consumption, loss of life years and loss of good health show a tendency towards negative regression on consumption of drugs when controlled for relevant variables such as occupational structure, degree of urbanization, and hardness of the drinking water.
Treatment of stroke patients on specialised stroke units has become more frequent, yet the effect of this treatment has not been determined. In this prospective, community-based study of 1241 unselected acute stroke patients we compared outcome between patients geographically randomised to treatment on a stroke unit or a general neurological/medical ward, from the time of acute admission to the end of rehabilitation. Baseline characteristics were comparable between the two treatment groups regarding age, sex, marital status, prestroke residence, and stroke severity. The patients treated on the stroke unit had higher comorbidity with regard to hypertension and diabetes. Multivariate linear and logistic regression analyses were applied to estimate the independent influence of stroke unit treatment on outcome. Stroke unit treatment significantly reduced in-hospital mortality (OR 0.50), case-fatality rate (OR 0.45), 6-month mortality (OR 0.57), 1-year mortality (0.59, and discharge rate to a nursing home (OR 0.61). The relative chance of being discharged to own home was almost doubled (OR 1.9), and the length of hospital stay reduced by 30% in patients treated on the stroke unit, P
Are geographical differences in cardiovascular mortality due to morbidity differences or to methodological differences? The project "myocardial infarction in Mid-Sweden".
Geographical variations in cardiovascular mortality have been reported from Mid-Sweden. IHD mortality for men aged 45-64 was 60% higher in the western part than in the east. Mortality from stroke for men aged 45-74 was 73% higher on the west. Similar differences were found for women. One possible explanation could be that there are no incidence differences but that the mortality differences are due to different survival rates or to differences certifying the cause of death. These two possible explanations were tested in this study. Data for all patients hospitalised during the 10-year period 1972-1981 for myocardial infarction or stroke in a high mortality area, the County of Värmland in the west, and a low mortality area, the County of Uppsala in the east, were collected. In addition, a substudy was performed where the basis for the death certificate diagnosis was studied. The western area generally had a higher case fatality rate than the eastern. However, a larger proportion of the deaths the eastern area, occurred outside hospital, so that the net effect would be that the differences found were not large enough to explain the mortality differences. The autopsy rate in the western part was lower than in the east but since a larger proportion of the deaths occurred in hospital the rank order for IHD and stroke mortality between east and west was the same whether all IHD or stroke deaths were counted or only those considered the most well documented.
An increased mortality from lung cancer, cardiovascular disease, haematolymphatic malignancy and cirrhosis of the liver has been reported among smelter workers and others exposed to arsenic. This study uses the case-referent (case-control) technique and is concerned with workers in a copper smelter in a complex work environment, characterised by the presence of trivalent arsenic in combination with sulphur dioxide and copper, and also with other agents. Lung cancer mortality was found to be increased about five-fold and cardiovascular disease about two-fold, showing a dose-response relationship to arsenic exposure. Mortality from malignant blood disease (leukaemia and myeloma) and cirrhosis of the liver was also slightly increased. This mortality pattern among the smelter workers is consistent with earlier reports. An increased mortality from cardiovascular disease in this type of industry is of particular interest as it has been reported only once before.
