RESUMEN
BACKGROUND: Glasgow's low life expectancy and high levels of deprivation are well documented. Studies comparing Glasgow to similarly deprived cities in England suggest an excess of deaths in Glasgow that cannot be accounted for by deprivation. Within Scotland comparisons are more equivocal suggesting deprivation could explain Glasgow's excess mortality. Few studies have used life expectancy, an intuitive measure that quantifies the between-city difference in years. This study aimed to use the most up-to-date data to compare Glasgow to other Scottish cities and to (i) evaluate whether deprivation could account for lower life expectancy in Glasgow and (ii) explore whether the age distribution of mortality in Glasgow could explain its lower life expectancy. METHODS: Sex specific life expectancy was calculated for 2007-2011 for the population in Glasgow and the combined population of Aberdeen, Dundee and Edinburgh. Life expectancy was calculated for deciles of income deprivation, based on the national ranking of datazones, using the Scottish Index of Multiple Deprivation. Life expectancy in Glasgow overall, and by deprivation decile, was compared to that in Aberdeen, Dundee and Edinburgh combined, and the life expectancy difference decomposed by age using Arriaga's discrete method. RESULTS: Life expectancy for the whole Glasgow population was lower than the population of Aberdeen, Dundee and Edinburgh combined. When life expectancy was compared by national income deprivation decile, Glasgow's life expectancy was not systematically lower, and deprivation accounted for over 90 % of the difference. This was reduced to 70 % of the difference when carrying out sensitivity analysis using city-specific income deprivation deciles. In both analyses life expectancy was not systematically lower in Glasgow when stratified by deprivation. Decomposing the differences in life expectancy also showed that the age distribution of mortality was not systematically different in Glasgow after accounting for deprivation. CONCLUSIONS: Life expectancy is not systematically lower across the Glasgow population compared to Aberdeen, Dundee and Edinburgh combined, once deprivation is accounted for. This provides further evidence that tackling deprivation in Glasgow would probably reduce the health inequalities that exist between Scottish cities. The change in the amount of unexplained difference when carrying out sensitivity analysis demonstrates the difficulties in comparing socioeconomic deprivation between populations, even within the same country and when applying an established ecological measure. Although the majority of health inequality between Glasgow and other Scottish cities is explained by deprivation, the difference in the amount of unexplained inequality depending on the relative context of deprivation used demonstrates the challenges associated with attributing mortality inequalities to an independent 'place effect'.
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Ciudades , Disparidades en el Estado de Salud , Renta , Esperanza de Vida , Pobreza , Población Urbana , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Muerte , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Escocia/epidemiología , Adulto JovenRESUMEN
BACKGROUND: This study examined urban-rural and socioeconomic differences in adolescent toothbrushing. METHODS: The data were modelled using logistic multilevel modelling and the Markov Chain Monte Carlo method of estimation. Twice-a-day toothbrushing was regressed upon age, family affluence, family structure, school type, area-level deprivation and rurality, for boys and girls separately. RESULTS: Boys' toothbrushing was associated with area-level deprivation but not rurality. Variance at the school level remained significant in the final model for boys' toothbrushing. The association between toothbrushing and area-level deprivation was particularly strong for girls, after adjustment for individuals' family affluence and type of school attended. Rurality too was independently significant with lower odds of brushing teeth in accessible rural areas. CONCLUSION: The findings are at odds with the results of a previous study which showed lower caries prevalence among children living in rural Scotland. A further study concluded that adolescents have a better diet in rural Scotland. In total, these studies highlight the need for an examination into the relative importance of diet and oral health on caries, as increases are observed in population obesity and consumption of sugars.
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Conducta del Adolescente/psicología , Conductas Relacionadas con la Salud , Población Rural/estadística & datos numéricos , Cepillado Dental/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adolescente , Factores de Edad , Estudios Transversales , Femenino , Humanos , Masculino , Escocia , Factores Sexuales , Factores SocioeconómicosRESUMEN
The objective of the study was to present socioeconomic and geographic inequalities in adolescent smoking in Scotland. The international literature suggests there is no obvious pattern in the geography of adolescent smoking, with rural areas having a higher prevalence than urban areas in some countries, and a lower prevalence in others. These differences are most likely due to substantive differences in rurality between countries in terms of their social, built and cultural geography. Previous studies in the UK have shown an association between lower socioeconomic status and smoking. The Scottish Health Behaviour in School-aged Children study surveyed 15 year olds in schools across Scotland between March and June of 2010. We ran multilevel logistic regressions using Markov chain Monte Carlo method and adjusting for age, school type, family affluence, area level deprivation and rurality. We imputed missing rurality and deprivation data using multivariate imputation by chained equations, and re-analysed the data (N = 3577), comparing findings. Among boys, smoking was associated only with area-level deprivation. This relationship appeared to have a quadratic S-shape, with those living in the second most deprived quintile having highest odds of smoking. Among girls, however, odds of smoking increased with deprivation at individual and area-level, with an approximate dose-response relationship for both. Odds of smoking were higher for girls living in remote and rural parts of Scotland than for those living in urban areas. Schools in rural areas were no more or less homogenous than schools in urban areas in terms of smoking prevalence. We discuss possible social and cultural explanations for the high prevalence of boys' and girls' smoking in low SES neighbourhoods and of girls' smoking in rural areas. We consider possible differences in the impact of recent tobacco policy changes, primary socialization, access and availability, retail outlet density and the home environment.
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Conducta del Adolescente/psicología , Disparidades en el Estado de Salud , Áreas de Pobreza , Características de la Residencia/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Fumar/epidemiología , Población Urbana/estadística & datos numéricos , Adolescente , Estudios Transversales , Femenino , Humanos , Masculino , Análisis Multinivel , Factores de Riesgo , Escocia/epidemiología , Factores SocioeconómicosRESUMEN
OBJECTIVES: The objectives of this study were to explore the extent of the social gradient for deaths due to assault and its impact on overall inequalities in mortality and to investigate the contribution to assault mortality of knives and other sharp weapons. DESIGN: An analysis of death records and contemporaneous population estimates was conducted. SETTING: The authors investigated the social patterning of homicide in Scotland. PARTICIPANTS: This study included deaths between 1980 and 2005 due to assault. MAIN MEASUREMENTS: Death rates were standardised to the European standard population. Time trends were analysed and inequalities were assessed, using rate ratios and the slope index of inequality, along axes defined by individual occupational socioeconomic status and area deprivation. RESULTS: An increase in mortality due to assault was most pronounced at ages 15-44 and was steeper among assaults involving knives. The death rate among men in routine occupations aged 20-59 was nearly 12 times that of those in higher managerial and professional occupations. Men under 65 living in the most deprived quintile of areas had a death rate due to assault 31.9 times (95% CI 13.1 to 77.9) that of those living in the least deprived quintile; for women, this ratio was 35.0 (4.8 to 256.2). Despite comprising just 3.2% of all male deaths between 15 and 44 years, assault accounted for 6.4% of the inequalities in mortality. CONCLUSIONS: Inequalities in mortality due to assault in Scotland exceed those in other countries and are greater than for other causes of death in Scotland. Reducing mortality and inequalities depends on addressing the problems of deprivation as well as targeting known contributors, such as alcohol use, the carrying of knives and gang culture.
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Homicidio/tendencias , Violencia/tendencias , Adolescente , Adulto , Distribución por Edad , Intervalos de Confianza , Empleo , Femenino , Vivienda , Humanos , Masculino , Vigilancia de la Población , Escocia/epidemiología , Factores Socioeconómicos , Heridas Punzantes/mortalidad , Adulto JovenRESUMEN
OBJECTIVES: Ethnic minority groups are at a higher risk of stroke and heart disease. However, designing effective prevention strategies requires responding to the needs of different ethnic groups. The aims of this study were to estimate the prevalence of four behavioural risk factors (smoking, drinking, exercise and weight) for stroke among Black Caribbeans, Black Africans and Whites, and also to examined reported willingness to change these behaviours. DESIGN: A random sample of 311 Black Caribbean, 300 White, and 105 Black Africans aged 45-74 registered with 16 practices in south London were surveyed in 1995. Information was obtained on smoking, drinking and exercise patterns, body mass index and perceptions of being at risk of stroke, and willingness to change risk behaviour. RESULTS: White respondents (31% age and sex standardised prevalence) were more likely to smoke than Black Caribbeans (23%) and Black Africans (10%) (p < 0.001). Self reported rates of drinking were higher than the government's 'sensible drinking levels' for 19% of Whites, 11% of Black Caribbeans and 4% Black Africans (p < 0.001). In contrast, fewer Whites (51%) were overweight (BMI > 27) than Black Caribbeans (60%) and Black Africans (68%) (p = 0.001). A high proportion of smokers wished to give up (89% Black African; 83% Black Caribbean; 74% White). A higher proportion of Black Caribbeans (35%) reported a willingness to reduce their alcohol intake compared to only 15% of Whites (p = 0.040). There was a difference between groups in attitudes to weight reduction with 69% Black Caribbean women expressing a desire to be thinner compared to 86% Whites and 82% Black Africans (p = 0.051). CONCLUSION: Strategies to reduce behavioural risk factors for heart attack and stroke need to emphasise different risk foctors among ethnic groups, especially in relation to alcohol use in the White population and weight in the Black Caribbean population. Influencing the change of these behaviours requires working in partnership with local community' groups.
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Negro o Afroamericano/psicología , Conductas Relacionadas con la Salud/etnología , Promoción de la Salud/organización & administración , Asunción de Riesgos , Accidente Cerebrovascular/etnología , África/etnología , Anciano , Consumo de Bebidas Alcohólicas/etnología , Población Negra , Índice de Masa Corporal , Ejercicio Físico , Femenino , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Fumar/etnología , Clase Social , Accidente Cerebrovascular/prevención & control , Encuestas y Cuestionarios , Indias Occidentales/etnología , Población Blanca/psicologíaRESUMEN
OBJECTIVES: People of African Caribbean descent have higher mortality rates from stroke than other ethnic groups. However, little is known about the prevalence of stroke risk factors in UK ethnic minority groups. We investigated the prevalence of these risk factors amongst African Caribbeans, black Africans and whites. DESIGN: A random sample of patients aged 45-74 registered with 16 general practices in south London was surveyed in 1995. Main outcome measures were: prevalence of hypertension, mean serum cholesterol, serum fibrinogen and glycosylated haemoglobin AIC. Logistic and linear regressions were used to determine ethnic differences in these measures. RESULTS: Hypertension was more prevalent in black Caribbeans (79.4%) and black Africans (71.6%) than in whites (54.3%) (p < 0.0001). There were ethnic group differences in mean random total cholesterol (p < 0.0001), triglycerides (p < 0.0001), fibrinogen (p = 0.03), HDL (p = 0.02) and HbAIC (p < 0.0001). Whites had higher mean random total cholesterol, triglycerides and fibrinogen than black Caribbeans but lower HDL and HbA1C. Black Africans had similar rates to black Caribbeans for these risk factors apart from lower triglvceride levels. CONCLUSION: These differences in risk factors may partially explain the high stroke mortality rates in black Caribbeans and black Africans compared to whites. There was little difference in prevalence of these risk factors between black Caribbean and black African groups. Specific strategies targeted to each ethnic group need to be developed to reduce risk factors.
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Enfermedad Coronaria/etnología , Accidente Cerebrovascular/etnología , África/etnología , Anciano , Población Negra , Colesterol/sangre , Enfermedad Coronaria/sangre , Enfermedad Coronaria/prevención & control , Femenino , Hemoglobina Glucada/análisis , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Prevalencia , Factores de Riesgo , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/prevención & control , Encuestas y Cuestionarios , Triglicéridos/sangre , Indias Occidentales/etnología , Población BlancaRESUMEN
BACKGROUND AND PURPOSE: Policy makers require evidence on the costs and outcomes of different ways of organizing stroke care. This study compared the costs and survival of different ways of providing stroke care. METHODS: Hospitalized stroke patients from 13 European centers were included, with demographic, case-mix, and resource use variables measured for each patient. Unit costs were collected and converted into US dollars using the purchasing power parity (PPP) index. Cox and linear regression analyses were used to compare survival and costs between the centers adjusting for case mix. RESULTS: A total of 1847 patients were included in the study. After case-mix adjustment, the mean predicted costs ranged from $466 [95% CI 181 to 751] in Riga (Latvia) to $8512 [7696 to 9328] in Copenhagen (Denmark), which reflected differences in unit costs, and resource use. The mean length of hospitalization ranged from 8.3 days in Menorca (Spain) to 36.8 days in Turku B (Finland). In the 3 Finnish centers at least 80% of patients were admitted to wards providing organized stroke care, which was not provided at the centers in Almada (Portugal), Menorca, or Riga. Patients in Turku A and Turku B were less likely to die than those in Riga, Warsaw (Poland), or Menorca. The adjusted hazard ratios were 0.18 [0.10 to 0.32] for Turku A, 0.18 [0.10 to 0.32] for Turku B, 0.68 [0.48 to 0.96] for Warsaw, and 0.56 [0.33 to 0.96] for Menorca, all compared with Riga. CONCLUSIONS: The cost of stroke care varies across Europe because of differences in unit costs, and resource use. Further research is needed to assess which ways of organizing stroke care are the most cost-effective.
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Costos de Hospital/estadística & datos numéricos , Mortalidad Hospitalaria , Unidades Hospitalarias/organización & administración , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/mortalidad , Anciano , Europa (Continente)/epidemiología , Femenino , Unidades Hospitalarias/economía , Unidades Hospitalarias/estadística & datos numéricos , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Modelos Lineales , Masculino , Evaluación de Resultado en la Atención de Salud/economía , Formulación de Políticas , Análisis de SupervivenciaRESUMEN
OBJECTIVES: to identify the factors associated with hospital admission and the differences in management and outcome of stroke patients between hospital and home. DESIGN: a prospective community stroke register (1995-8) with multiple notification sources. SETTING: an inner city multi-ethnic population of 234 533 in South London, UK. PARTICIPANTS: 975 subjects with first in a lifetime strokes, whether or not they were admitted to hospital. Patients dying suddenly and those already hospitalized at the time of stroke were excluded. MAIN OUTCOME MEASURES: factors associated with hospital admission; differences in management in the acute phase of stroke; mortality and dependency assessed by the Barthel index 3 months post-stroke. RESULTS: 812 patients were admitted to hospital for stroke; 163 were managed in the community. Factors independently associated with hospital admission included stroke severity, pre-stroke independence, atrial fibrillation, having an intracranial haemorrhage and having a non-lacunar infarction. Computed tomography scan rates were higher in admitted (78%) than non-admitted patients (63%; P=0.001). By 3 months, 285 (35%) of the admitted patients had died compared with 13 (8%) of non-admitted patients (P<0.001). Of the admitted patients, 241 (47%) had a Barthel index > or =18 compared with 106 (72%) of those who were not admitted (P<0.001). After adjusting for case-mix variables, the odds ratios for death and dependency (Barthel index<18) in admitted and non-admitted patients were 2.21 (0.96-5.12) and 2.39 (1.35-4.22) respectively. CONCLUSION: patients with clinical indicators for a more severe stroke were more likely to be admitted to hospital. Hospitalized stroke patients may have poorer survival and disability rates than those who remain at home, even after adjustment for case mix. There may be some aspects of acute hospital care that may be detrimental to outcome in certain groups of stroke patients. This requires further investigation.
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Servicios de Atención a Domicilio Provisto por Hospital/tendencias , Hospitales Comunitarios/tendencias , Accidente Cerebrovascular/mortalidad , Anciano , Servicios de Salud Comunitaria , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente , Estudios Prospectivos , Accidente Cerebrovascular/terapia , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: The goals of the present study were to estimate the prevalence of acute impairments and disability in a multiethnic population of first-ever stroke and to identify differences in impairment and early disability between pathological and Bamford subtypes. Associations between impairments and death and disability at 3 months were identified. METHODS: Impairments that occur at the time of maximum neurological deficit were recorded, and disability according to the Barthel Index (BI) was assessed 1 week and 3 months after stroke in patients in the South London Stroke Register: RESULTS: Of 1259 registered patients, 6% had 1 or 2, 31.1% had 3 to 5, 50.6% had 6 to 10, and 10.6% had >10 impairments. Common impairments were weakness (upper limb, 77.4%), urinary incontinence (48.2%), impaired consciousness (44.7%), dysphagia (44.7%), and impaired cognition (43.9%). Patients with total anterior circulation infarcts had the highest age-adjusted prevalence of weakness, dysphagia, urinary incontinence, cognitive impairment, and disability. Patients with subarachnoid hemorrhage had the highest rates of coma. Patients with lacunar stroke had the high prevalence of weakness but were least affected by disability, incontinence, and cognitive dysfunction. Blacks had higher age- and sex-adjusted rates of disability in ischemic stroke (BI <20, odds ratio 2.76, 95% CI 1.47 to 5.21, P=0.002; BI <15, odds ratio 1.8, 95% CI 1.45 to 2.81, P=0.01) but impairment rates similar to those of whites. On multivariable analysis, incontinence, coma, dysphagia, cognitive impairment, and gaze paresis were independently associated with severe disability (BI <10) and death at 3 months. CONCLUSIONS: The extent of these findings indicates that an acute assessment of impairments and disability is necessary to determine the appropriate nursing and rehabilitation needs of patients with stroke.
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Evaluación de la Discapacidad , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/epidemiología , Distribución por Edad , Anciano , Población Negra , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , Comorbilidad , Demografía , Femenino , Escala de Coma de Glasgow , Humanos , Incidencia , Modelos Logísticos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Vigilancia de la Población , Prevalencia , Sistema de Registros/estadística & datos numéricos , Distribución por Sexo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Tomografía Computarizada por Rayos X , Población Urbana , Población BlancaRESUMEN
BACKGROUND: there is a need for more information on the costs of different ways of managing stroke. Methods to compare the costs of stroke care in different countries have not been previously developed. OBJECTIVE: to develop and use a method to compare the costs of acute stroke care across Europe. SETTING: acute hospitals in 13 different European centres. SUBJECTS AND METHODS: we included in the study stroke patients hospitalized during 1996-7 at 13 centres across Europe (n=2072). We recorded the duration of acute hospital stay and use of investigations. Mean costs for each centre were predicted using linear regression analysis to adjust for case-mix differences. RESULTS: the average acute hospital stay ranged from 9 days (Spain) to 35 days (UK; P < 0.001). The predicted mean cost of treating conscious, continent men aged > 74 ranged from $220 (95% confidence interval 191-254) in Latvia to $5164 (4294-6191) in Austria. CONCLUSIONS: differences in the acute costs of stroke exist across Europe because of differences in clinical practice and unit costs. This methodology will be used to capture the costs incurred by a broad range of care providers. These estimates will then be suitable for using in cost-effectiveness analysis.
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Grupos Diagnósticos Relacionados/economía , Precios de Hospital/estadística & datos numéricos , Tiempo de Internación/economía , Accidente Cerebrovascular/economía , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Costos y Análisis de Costo , Europa (Continente) , Femenino , Humanos , Masculino , Rehabilitación de Accidente CerebrovascularRESUMEN
BACKGROUND AND PURPOSE: The "2 simple questions" were designed as an efficient way of measuring outcome after stroke. We assessed the sensitivity and specificity of this tool, adapted for use in 8 European centers, and used it to compare outcomes across centers. METHODS: Data were taken from the Biomed II prospective study of stroke care and outcomes. Three-month poststroke data from 8 European centers were analyzed. Sensitivity and specificity were assessed by comparing responses to the 2 simple questions with Barthel Index and modified Rankin scale scores. Adjusting for case mix, logistic regression was used to compare patients in each center with "good" outcome (not dependent and fully recovered) at 3 months. RESULTS: Data for 793 patients were analyzed. For the total sample, the dependency question had a sensitivity of 88% and a specificity of 77%; the recovery question had a sensitivity of 78% and a specificity of 90%. Dependency data from Riga had much lower sensitivity. There was variation in good outcome between centers (P:=0.0015). Compared with the reference center (Kaunas), patients in Dijon, Florence, and Menorca were more likely to have good outcome, after adjusting for case mix. CONCLUSIONS: Dependency and recovery questions showed generally high sensitivity and specificity. There were significant differences across centers in outcome, but reasons for these are unclear. Such differences raise particular questions about how patients interpreted and answered the simple questions and the extent to which expectations of recovery and perceived needs for assistance vary cross-culturally.
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Evaluación de Resultado en la Atención de Salud/normas , Accidente Cerebrovascular/diagnóstico , Encuestas y Cuestionarios/normas , Actividades Cotidianas , Anciano , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Evaluación de Resultado en la Atención de Salud/métodos , Recuperación de la Función , Reproducibilidad de los Resultados , Autoevaluación (Psicología) , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/fisiopatologíaRESUMEN
BACKGROUND AND PURPOSE: The excess risk of stroke seen in the black population has not been explained by differences in age, sex, and social class, although differences in the frequency of cerebrovascular risk factors may be partly responsible. Data on risk factor profiles for the UK black stroke population are sparse. Previous studies have contrasted the association of cerebrovascular risk factors between hemorrhagic and ischemic stroke and between etiologic subtypes of infarct. The relationship of cerebrovascular risk factors to clinical classifications of stroke, however, has been little examined. The aim of this study was to establish the frequency of cerebrovascular risk factors in patients with first-ever strokes in the South London, UK, population and to examine the relationship of these risk factors to both ethnicity and Bamford stroke subtype. METHODS: The study included 1254 first-ever stroke patients registered in the South London Community Stroke Register between 1995 and 1998; 995 patients (79.3%) were white, 203 (16.2%) were black, 52 (4.1%) were of other ethnic origin, and 4 (0. 3%) were of unknown ethnic origin. RESULTS: In multivariate analysis, increasing age (P:<0.001) and previous cerebrovascular disease (P:=0.007) were independently associated with infarct rather than hemorrhage. Atrial fibrillation was associated with all nonlacunar (P:=0.02), total anterior circulation (P:=0.007), and partial anterior circulation infarcts (P:=0.02) compared with the lacunar group. All other risk factors were similar between infarct subtypes. Risk factors for hemorrhage subtypes were similar in multivariate analysis; increasing age was the only factor associated with primary intracerebral hemorrhage over subarachnoid hemorrhage (P:<0.001). The black stroke population suffered significantly less atrial fibrillation (P:=0.001) and engaged in less alcohol excess (P:<0. 001) and were less likely to have ever smoked (P:<0.001). Hypertension (P:<0.001) and diabetes mellitus (P:<0.001) were more prevalent in the black population. CONCLUSIONS: Physiological cerebrovascular risk factors for the UK black population are similar to those of the US black population, but behavioral risk factors differ. Risk factors differ between ethnic groups in the United Kingdom, and future measures for secondary prevention should take this into consideration. Bamford clinical subtypes bear little association with cerebrovascular risk factors. Other classification systems, such as those that classify stroke by etiology, may be more useful in explaining the excess risk of stroke and the scope for its prevention.
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Grupos Raciales/genética , Factores de Riesgo , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/genética , Distribución por Edad , Anciano , Fibrilación Atrial/epidemiología , Población Negra/genética , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Medición de Riesgo , Distribución por Sexo , Accidente Cerebrovascular/clasificación , Accidente Cerebrovascular/epidemiología , Reino Unido/epidemiología , Población Urbana , Población Blanca/genéticaRESUMEN
Although the prevalence of sleep-disordered breathing (SDB) in patients following stroke has been found to be high, there are few data about whether these changes persist in the months that follow stroke. The present study aims to confirm the prevalence of SDB following first ever stroke, to investigate an association between SDB and subtype of stroke and to determine the change in SDB three months following a first ever stroke.
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Síndromes de la Apnea del Sueño/etiología , Accidente Cerebrovascular/complicaciones , Anciano , Distribución de Chi-Cuadrado , Femenino , Estudios de Seguimiento , Humanos , Masculino , Oximetría , Polisomnografía , Prevalencia , Análisis de Regresión , Accidente Cerebrovascular/clasificaciónRESUMEN
BACKGROUND AND PURPOSE: Abnormal physiological parameters after acute stroke may induce early neurological deterioration. Studies of the effect of dehydration on stroke outcome are limited. We examined the association of raised plasma osmolality on stroke outcome at 3 months and the change of plasma osmolality with hydration during the first week after stroke. METHODS: Acute stroke patients had their plasma osmolality measured at admission and at days 1, 3, and 7. Maximum plasma osmolality and the area under curve (AUC) were also calculated during the first week. Patients were stratified according to how they were hydrated: orally, intravenously, or both. Outcome included survival at 3 months after stroke. Logistic regression was performed to examine the association between raised plasma osmolality (>296 mOsm/kg) and survival, adjusting for stroke severity. Linear regression was performed to examine the pattern of plasma osmolality across hydration groups. RESULTS: One hundred sixty-seven patients were included. Mean admission (300 mOsm/kg, SD 11.4), maximum (308.1 mOsm/kg, SD 17.1), and AUC (298.3 mOsm/kg, SD 11.7) plasma osmolality were significantly higher in those who died compared with survivors (293.1 mOsm/kg [SD 8.2], 297.7 mOsm/kg [SD 8. 7], and 291.7 mOsm/kg [SD 8.1], respectively; P:<0.0001). Admission plasma osmolality >296 mOsm/kg was significantly associated with mortality (OR 2.4, 95% CI 1.0 to 5.9). In patients hydrated intravenously, there was no significant fall in plasma osmolality compared with patients hydrated orally (P:=0.68). CONCLUSIONS: Raised plasma osmolality on admission is associated with stroke mortality, after correcting for case mix. Correction of dehydration after stroke requires a more systematic approach. Trials are required to determine whether correcting dehydration after stroke improves outcome.
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Deshidratación/fisiopatología , Fluidoterapia , Accidente Cerebrovascular/fisiopatología , Enfermedad Aguda , Administración Oral , Factores de Edad , Anciano , Deshidratación/sangre , Deshidratación/terapia , Femenino , Hospitalización , Humanos , Infusiones Intravenosas , Modelos Logísticos , Masculino , Concentración Osmolar , Plasma/química , Estudios Prospectivos , Análisis de Regresión , Factores Sexuales , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Análisis de Supervivencia , Factores de TiempoRESUMEN
BACKGROUND AND PURPOSE: Comparison of incidence and case-fatality rates for stroke in different countries may increase our understanding of the etiology of the disease, its natural history, and management. Within the context of an aging population and the trend for governments to set targets to reduce stroke risk and death from stroke, prospective comparison of such data across countries may identify what drives the variation in risk and outcome. METHODS: Population-based stroke registers, using multiple sources of notification, ascertained cases of first in a lifetime stroke between 1995 and 1997 for all age groups. The study populations were in Erlangen, Germany; Dijon, France; and London, UK. Crude incidence rates were age-standardized to the European population for comparative purposes. Case-fatality rates up to 1 year after the stroke were obtained, and logistic regression adjusting for age group, sex, and pathological subtype of stroke was used to compare survival in the 3 communities. RESULTS: A total of 2074 strokes were registered over the 3 years. The age-standardized rate to the European population was 100.4 (95% CI 91.7 to 109.1) per 100 000 in Dijon, 123.9 (95% CI 115.6 to 132.2) in London, and 136.4 (95% CI 124.9 to 147.9) in Erlangen. Both crude and adjusted rates were lowest in Dijon, France. The incidence rate ratio, with Dijon as the baseline comparison (1), was 1.21 (95% CI 1.09 to 1.34) in London and 1.37 (95% CI 1.22 to 1.54) in Erlangen (P:<0.0001). There were significant differences in the proportion of the subtypes of stroke between populations, with London having lower rates of cerebral infarction and higher rates of subarachnoid hemorrhage and unclassified stroke (P:<0.001). Case-fatality rates varied significantly between centers at 1 year, after adjustment for age, sex, and subtype of stroke (35% overall, 34% Erlangen, 41% London, and 27% Dijon; P:<0.001). CONCLUSIONS: The impact of stroke is considerable, and the risk of stroke varies significantly between populations in Europe as does the risk of death. The striking differences in survival require clarification but lend weight to the evidence that stroke management may differ between northern and central Europe and influence outcome.
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Accidente Cerebrovascular/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Infarto Encefálico/epidemiología , Francia/epidemiología , Alemania/epidemiología , Humanos , Incidencia , Londres/epidemiología , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Factores Sexuales , Accidente Cerebrovascular/clasificación , Accidente Cerebrovascular/mortalidad , Hemorragia Subaracnoidea/epidemiología , Análisis de Supervivencia , Población UrbanaRESUMEN
BACKGROUND AND PURPOSE: Stroke patients have a 15-fold increased risk of recurrent stroke, and those with > or =1 risk factor have a further increased risk of recurrence. Previous work found management of physiological risk factors after stroke to be unsatisfactory, but there is little information on behavioral risks within the stroke population. This study estimates behavioral risk factor prevalence after stroke and explores lifestyle change. METHODS: The study used data from the population-based South London Stroke Register, collected prospectively between 1995 and 1998. Main measures included smoking status, alcohol use, and obesity. Logistic regression was used to determine sociodemographic differences in these measures. RESULTS: At 1 year after stroke, 22% of patients still smoked, 36% of patients were obese, and 4% drank excessively. Younger patients, whites, and men were more likely to smoke, and younger whites were more likely to drink excessively. Women and nonwhites were more likely to be obese. Those living in hospital, nursing home, or residential care and nonwhites were more likely to give up smoking, but there were no other associations between lifestyle change and the sociodemographic characteristics of patients. CONCLUSIONS: Different behavioral risk factors were associated with specific sociodemographic groups within the stroke population. After stroke, high-risk groups should continue to be targeted to prevent stroke recurrence. However, the relationship between sociodemographic characteristics and lifestyle change remains unclear; more research is needed into the process of change to find out how best to intervene to improve secondary prevention.
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Conducta , Estilo de Vida , Accidente Cerebrovascular/psicología , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Femenino , Humanos , Londres/epidemiología , Masculino , Obesidad/complicaciones , Obesidad/epidemiología , Obesidad/psicología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Prevención Secundaria , Factores Sexuales , Fumar/efectos adversos , Fumar/epidemiología , Fumar/psicología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Encuestas y CuestionariosRESUMEN
BACKGROUND AND PURPOSE: We sought to examine the frequency, predictors, and effects of nontreatment with antithrombotic and antihypertensive therapies 3 months after ischemic stroke. METHODS: The population-based South London Community Stroke Register prospectively collected data on first-in-a-lifetime strokes between 1995 and 1997. Among patients registered with ischemic stroke, treatment status with antithrombotic and antihypertensive therapies was examined 3 months after the event. RESULTS: In a cohort of 457 patients with ischemic stroke, 393 (86.0%) were considered appropriate for antiplatelet medication, 32 (7.0%) for anticoagulant medication, and 254 (55.9%) for antihypertensive medication. The rates of nontreatment observed 3 months after the event were 24.4% for antiplatelet, 59.4% for anticoagulant, and 29.5% for antihypertensive medication. Independent risk factors for nontreatment with antithrombotic therapies (antiplatelets and anticoagulants) were the subtype of stroke (nonlacunar infarct: OR=1. 60, 95% CI 1.07 to 2.54), stroke severity measured by the Glasgow Coma Scale (GCS) score (GCS
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Antihipertensivos/uso terapéutico , Fibrinolíticos/uso terapéutico , Accidente Cerebrovascular/prevención & control , Adulto , Anciano , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Humanos , Londres , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente Cerebrovascular , Resultado del Tratamiento , Población UrbanaRESUMEN
The authors estimated the prevalence of heart malformation during the first year of life, using five data sets with varying degrees of completeness from two English regional health authorities. These areas covered a total population of 6,872,000. Analysis was carried out using capture-recapture methods, including log-linear modeling, on data collected between June 1993 and August 1994. A large number of cases in the community were unrecorded by any of the current sources of information. In South East Thames, where an antenatal training screening program for detecting heart malformations had been implemented in the late 1980s, the estimated prevalence rate varied from 5.5 per 1,000 births (95% confidence interval (CI): 3.5, 10.8) to 9.0 per 1,000 births (95% CI: 6.4, 14.2), depending on the assumptions in the model and the number of sources used in the analysis. In the Wessex region, which did not have a formal training program, prevalence was lower and varied little, from 4.3 per 1,000 (95% CI: 3.4, 6.0) to 5.1 per 1,000 (95% CI: 4.0, 7.2), according to assumptions. These two estimates were reasonable rates in comparison with reports in the literature. This analysis was helpful in demonstrating that the training program designed to identify severe heart malformations during the antenatal period in one of these regions had no lasting impact on prevalence.
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Cardiopatías Congénitas/epidemiología , Modelos Estadísticos , Inglaterra/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , PrevalenciaRESUMEN
OBJECTIVE: To identify ethnic differences in the incidence of first ever stroke. DESIGN: A prospective community stroke register (1995-6) with multiple notification sources. Pathological classification of stroke in all cases was based on brain imaging or necropsy data. Rates were standardised to European and world populations and adjusted for age, sex, and social class in multivariate analysis. SETTING: A multi-ethnic population of 234 533 in south London, of whom 21% are black. RESULTS: 612 strokes were registered. The crude annual incidence rate was 1.3 strokes per 1000 population per year (95% confidence interval 1.20 to 1.41) and 1.25 per 1000 population per year (1.15 to 1.35) age adjusted to the standard European population. Incidence rates adjusted for age and sex were significantly higher in black compared with white people (P<0.0001), with an incidence rate ratio of 2.21 (1.77 to 2.76). In multivariable analysis increasing age (P<0.0001), male sex (P<0.003), black ethnic group (P<0.0001), and lower social class (P<0.0001) in people aged 35-64 were independently associated with an increased incidence of stroke. CONCLUSIONS: Incidence rates of stroke are higher in the black population; this is not explained by confounders such as social class, age, and sex. Ethnic differences in genetic, physiological, and behavioural risk factors for stroke require further elucidation to aid development of effective strategies for stroke prevention in multi-ethnic communities.
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Trastornos Cerebrovasculares/etnología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Londres/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Clase SocialRESUMEN
BACKGROUND: Patients with asthma have an increased risk of death from causes other than asthma. A study was undertaken to identify whether severity of asthma, its treatment, or associated co-morbidity were associated with increased risk of death from other causes. METHODS: Eighty five deaths from all causes occurring within three years of discharge from hospital in a cohort of 2242 subjects aged 16-64 years admitted for asthma were compared with a random sample of 61 controls aged <45 years and 61 aged >/=45 years from the same cohort. RESULTS: Deaths from asthma were associated with a history of clinically severe asthma (OR 6.29 (95% CI 1.84 to 21.52)), chest pain (OR 3.78 (95% CI 1.06 to 13.5)), biochemical or haematological abnormalities at admission (OR 4.12 (95% CI 1.36 to 12.49)), prescription of ipratropium bromide (OR 4.04 (95% CI 1.47 to 11.13)), and failure to prescribe inhaled steroids on discharge (OR 3.45 (95% CI 1.35 to 9.10)). Deaths from chronic obstructive pulmonary disease (COPD) were associated with lower peak expiratory flow rates (OR 2.56 (95% CI 1.52 to 4.35) for each 50 l/min change), a history of smoking (OR 5.03 (95% CI 1.17 to 21.58)), prescription of ipratropium bromide (OR 7.75 (95% CI 2.21 to 27.14)), and failure to prescribe inhaled steroids on discharge (OR 3.33 (95% CI 0.95 to 11.10)). Cardiovascular deaths were more common among those prescribed ipratropium bromide on discharge (OR 3.55 (95% CI 1.05 to 11.94)) and less likely in those admitted after an upper respiratory tract infection (OR 0.21 (95% CI 0.05 to 0.95)). Treatment with ipratropium bromide at discharge was associated with an increased risk of death from asthma even after adjusting for peak flow, COPD and cardiovascular co-morbidity, ever having smoked, and age at onset of asthma. CONCLUSIONS: Prescription of inhaled steroids on discharge is important even for those patients with co-existent COPD and asthma. Treatment with ipratropium at discharge is associated with increased risk of death from asthma even after adjustment for a range of markers of COPD. These results need to be tested in larger studies.