Temporal Trends in Sex Differences With Regard to Stroke Incidence

Background and Purpose— We evaluated temporal trends in stroke incidence between men and women to determine whether changes in the distribution of vascular risk factors have influenced sex differences in stroke epidemiology. Methods— Patients with first-ever stroke including ischemic stroke, spontaneous intracerebral hemorrhage, subarachnoid hemorrhage, and undetermined stroke between 1987 and 2012 were identified through the population-based registry of Dijon, France. Incidence rates were calculated for age groups, sex, and stroke subtypes. Sex differences and temporal trends (according to 5-year time periods) were evaluated by calculating incidence rate ratios (IRRs) with Poisson regress…

Population-Based Validation of the iScore for Predicting Mortality and Early Functional Outcome in Ischemic Stroke Patients

<b><i>Background:</i></b> We aimed to determine the accuracy of the iScore for predicting mortality and early disability following ischemic stroke in a French population-based study. <b><i>Methods:</i></b> All patients with acute ischemic stroke were identified among residents of the city of Dijon, France, between 2006 and 2011, using a population-based stroke registry. The 30-day iScore and 1-year iScore were calculated. A logistic regression model was used to assess the performance of the iScore for predicting both 30-day and 1-year mortality, and poor functional outcome at discharge (modified Rankin Scale score of 3-6). The discrimination a…

Stroke care organization overcomes the deleterious ‘weekend effect’ on 1-month stroke mortality: a population-based study

Background and purpose Suffering a stroke during the weekend is associated with a poorer prognosis. The impact of implementing a dedicated stroke care network in Dijon, France, in 2003 on 30-day mortality in strokes/transient ischaemic attacks (TIA) occurring during weekends/bank holidays was evaluated. Methods All cases of stroke and TIA from 1985 to 2010 were identified from a population-based registry, using multiple overlapping sources of information. Demographics and clinical data were recorded. Cox regression models were used to evaluate associations between day of onset (weekdays versus weekends/bank holidays) and 30-day all-cause mortality. Data were stratified according to time per…

Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry

Recent data have suggested that stroke incidence in young people may be rising. In this population-based study, we aimed to determine whether the incidence of stroke in people aged55 years old had changed over the last three decades.All cases of first-ever stroke (ischaemic stroke, spontaneous intracerebral haemorrhage, and undetermined stroke) occurring in Dijon, France, from 1985 to 2011 were prospectively collected from a population-based registry. Incidence rates were calculated and temporal trends were analysed by age groups and stroke subtypes using a Poisson regression to estimate incidence rate ratios (IRR). Risk factors and premorbid treatments were analysed.Over the 27-year study …

iScore for predicting institutional care after ischemic stroke: a population-based study.

Background We assessed whether the iScore could predict the need for poststroke institutional care. Methods Patients with acute ischemic stroke living in Dijon, France, were recorded between 2006 and 2011, using a population-based stroke registry. The iScore was calculated for each patient. A logistic regression model was used to assess the performance of the iScore for predicting the need for placement in a care institution. The discrimination and calibration of the model were assessed using the c statistic and the Hosmer–Lemeshow goodness-of-fit test, respectively. Results Of the 1199 patients recorded, 124 were excluded because of early death and 95 because of missing for variables inclu…

Évaluation de la qualité des données du programme de médicalisation des systèmes d’information pour la mesure de l’incidence hospitalière de l’accident vasculaire cérébral

One-year survival of demented stroke patients: data from the Dijon Stroke Registry, France (1985-2008)

Background and purpose:  Dementia is a frequent condition after stroke that may affect the prognosis of patients. Our aim was to determine whether post-stroke dementia was a predictor of 1-year case-fatality and to evaluate factors that could influence survival in demented stroke patients. Methods:  From 1985 to 2008, all first-ever strokes were recorded in the population-based stroke registry of Dijon, France (150 000 inhabitants). Dementia was diagnosed during the first month following stroke, according to DSM-III and DSM-IV criteria. Survival was evaluated at 1 year and multivariate analyses were performed using Cox proportional hazards to identify independent predictive factors. Results…

Hospitalization Within the First Year After Stroke

Background and Purpose— This population-based study aimed to identify unplanned hospitalization within the first year after stroke to determine factors associated with it and consequences on survival. Methods— All first-ever acute strokes occurring in Dijon, France, from 2009 to 2011, were prospectively collected from a population-based registry. Demographics and clinical data, including stroke severity measured by the National Institutes of Health Stroke Scale and disability after stroke, were recorded. For each patient, the first unplanned hospitalization that occurred within 1 year after stroke was retrieved by linking data with the national French Hospital Discharge Database. Predictor…

Impact of the Ageing Population on the Burden of Stroke: The Dijon Stroke Registry.

<b><i>Background:</i></b> We aimed to evaluate the impact of the ageing population on temporal trends in burden of stroke and to provide projections for the coming years. <b><i>Methods:</i></b> Stroke cases (ischemic strokes, spontaneous intracerebral hemorrhages, or undetermined strokes) were prospectively identified between 1987 and 2015 in Dijon, France, using a population-based registry. Age-standardized incidence rates of first-ever and recurrent stroke were calculated, and their temporal trends were assessed using age- and sex-adjusted annual incidence rate ratios (RR). <b><i>Results:</i></b> The population of Dij…

Evaluation of the Possible Impact of a Care Network for Stroke and Transient Ischemic Attack on Rates of Recurrence

We aimed to demonstrate that a stroke network is able to reduce the proportion of recurrent cerebrovascular events. In 2003, we set up a care network with the aim to reduce the proportion of stroke recurrence. For the statistical analysis, recurrent cerebrovascular events observed from 1985 to 2002 within the population of Dijon made it possible to model trends using Poisson logistic regression. From 1985 to 2002, we recorded 172 recurrent cerebrovascular events which were used to model trends before the creation of the care network. Within the period 2003–2007, we observed 162 recurrent cerebrovascular events compared with 196.7 expected cerebrovascular events with a significant standardiz…

Stroke associated with giant cell arteritis: a population-based study

Background Giant cell arteritis (GCA) is the most common vasculitis in people ≥50 years and can be associated with stroke. We aimed to evaluate the epidemiology and characteristics of stroke in patients with GCA. Methods All patients with a biopsy-proven diagnosis of GCA were identified among residents of the city of Dijon, France (152 000 inhabitants), between 2001 and 2012 using a prospective database. Among these, patients who suffered from stroke were retrieved by crossing data from the population-based Dijon Stroke Registry. Demographics and clinical features were recorded. We considered that the stroke was GCA-related if the stroke revealed GCA or occurred between the onset of symptom…

Influence of Preexisting Cognitive Impairment on Clinical Severity of Ischemic Stroke: The Dijon Stroke Registry.

Background and Purpose— The ongoing ageing population is associated with an increasing number of patients with stroke who have preexisting cognitive impairment. This study aimed to evaluate clinical severity in patients with ischemic stroke according to prestroke cognitive status. Methods— Patients with ischemic stroke were prospectively identified among residents of Dijon, France using a population-based registry (2013–2017). Prestroke cognitive status (no impairment, mild cognitive impairment [MCI], or dementia) was recorded, and severity at stroke onset was measured using the National Institutes of Health Stroke Scale (NIHSS) score. Association between prestroke cognitive status and sev…

Comparative epidemiology of stroke and acute myocardial infarction: the Dijon Vascular Project (DIVA)

Despite a common pathophysiological mechanism (ie, atherosclerosis) and similar vascular risk factors, few reliable studies have compared the epidemiology of stroke and acute myocardial infarction (AMI).All first ever cases of stroke and AMI in Dijon, France (151 846 inhabitants) from 2001 to 2006 were prospectively recorded. The 30 day case fatality rates (CFRs) and vascular risk factors were assessed in both groups.Over the 6 years, 1660 events (1020 strokes and 640 AMI) were recorded. Crude incidence of stroke was higher than that of AMI (112 vs 70.2/100 000/year; p0.001). With regard to sex, the relative incidence of stroke compared with AMI was 0.88 (95% CI 0.60 to 1.29; p = 0.51) in w…

Epidemiology of stroke in Europe and trends for the 21st century

International audience; Despite major improvements in primary prevention and acute treatment over the last decades, stroke is still a devastating disease. At the beginning of the 21st century, the age-standardized incidence of stroke in Europe ranged from 95 to 290/100,000 per year, with one-month case-fatality rates ranging from 13 to 35%. Approximately 1.1 million inhabitants of Europe suffered a stroke each year, and ischemic stroke accounted for approximately 80% of cases. Although global stroke incidence is declining, rates observed in young adults are on the rise, thus suggesting a need for strategies to improve prevention. In addition, because of the ageing population, the absolute n…

Temporal trends in the premorbid use of preventive treatments in patients with acute ischemic cerebrovascular events and a history of vascular disease: The Dijon Stroke Registry (1985–2010)

Although secondary prevention in patients with arterial vascular diseases has improved, a gap between recommendations and clinical practice may exist.We aimed to evaluate temporal trends in the premorbid use of preventive treatments in patients with ischemic cerebrovascular events (ICVE) and prior vascular disease.Patients with acute ICVE (ischemic stroke/TIA) were identified through the population-based stroke registry of Dijon, France (1985-2010). Only those with history of arterial vascular disease were included and were classified into four groups: patients with previous coronary artery disease only (CAD), previous peripheral artery disease only (PAD), previous ICVE only, and patients w…

Smoking Status and Severity of Ischemic Stroke. A Population-Based Study

We aimed to investigate the impact of smoking status on clinical severity in patients with ischemic stroke event (IS). Patients were prospectively identified among residents of the city of Dijon, France (ca. 151,000 inhabitants), using a population-based registry, between 2006 and 2011. Demographic and clinical data were recorded. The initial clinical severity was quantified by the means of the National Institutes of Health Stroke Scale (NIHSS). Multivariable ordinal logistic regression was used to assess the effect of smoking status on severity. Among the 1,056 recorded patients with IS, data about smoking status were available for 973 (92.1%), of whom 658 (67.3%) were non-smokers, 187 (19…

Increasing Burden of Stroke: The Dijon Stroke Registry (1987–2012)

<b><i>Background:</i></b> We aimed to provide a representation of the global burden of stroke. <b><i>Methods:</i></b> All cases of stroke were prospectively identified through the population-based registry of Dijon, France (1987–2012). Attack rates and mortality rates (defined as stroke leading to death within 30 days) were standardized to the European standard. Sex differences and temporal trends were evaluated by calculating rate ratios (RRs). <b><i>Results:</i></b> In all, 5,285 stroke cases (52.7% women) were recorded. The standardized attack rate was 98.2/100,000/year and the mortality rate was 12/100,000/year, and…

Prevalence and prognostic value of headache on early mortality in acute stroke: The Dijon Stroke Registry

Objective To evaluate the prevalence of headache at onset and its association with 1-month mortality in stroke patients. Methods All patients with stroke in Dijon, France (2006–2011), were prospectively identified using a population-based registry. Cox regression models were used to evaluate the association between headache and 30-day all-cause mortality. Results Among 1411 stroke patients, data about headache were obtained for 1391 (98.6%) of whom 1185 had an ischemic stroke (IS), 201 had an intracerebral hemorrhage (ICH) and five had a stroke of undetermined etiology. Headache was found in 253 (18.2%) patients and was more frequent in those with ICH than in those with IS (46.3% vs 13.5%, …

The Impact of World and European Football Cups on Stroke in the Population of Dijon, France: A Longitudinal Study from 1986 to 2006

Background: Acute stress may trigger vascular events. We aimed to investigate whether important football competitions involving the French football team increased the occurrence of stroke. Methods: We retrospectively retrieved data of fatal and nonfatal stroke during 4 World Football Cups (1986, 1998, 2002, and 2006) and 4 European Championships (1992, 1996, 2000, and 2004), based on data from the population-based Stroke Registry of Dijon, France. One period of exposure was analyzed: the period of competition extended to 15 days before and after the competitions. The number of strokes was compared between exposed and unexposed corresponding periods of preceding and following years using Poi…

Incidence and outcome of cerebrovascular events related to cervical artery dissection: the Dijon Stroke Registry.

Background Reliable epidemiological data on the true incidence of cerebrovascular events related to spontaneous cervical artery dissection, including stroke and transient ischemic attack, are scarce. Aims To evaluate the incidence, characteristics, and outcome of cerebrovascular events due to cervical artery dissection. Methods All cerebrovascular events (stroke and transient ischemic attack) occurring in Dijon, France, from 2006 to 2011, were retrieved from a population-based registry. Patients with a cervical artery dissection were identified. Incidence rates, baseline characteristics, and outcome at three-months were described. Results Among the 1368 patients with cerebrovascular events,…

Temporal trends in early case-fatality rates in patients with intracerebral hemorrhage.

Objective:To assess whether temporal trends in very early (within 48 hours) case-fatality rates may differ from those occurring between 48 hours and 30 days in patients with spontaneous intracerebral hemorrhage (ICH).Methods:All cases of ICH that occurred in Dijon, France (151,000 inhabitants), were prospectively collected between 1985 and 2011, using a population-based registry. Time trends in 30-day case fatality were analyzed in 3 periods: 1985–1993, 1994–2002, and 2003–2011. Cox regression models were used to evaluate associations between time periods and case fatality within 48 hours and between 48 hours and 30 days, after adjustments for demographics, risk factors, severity, and ICH l…

Factors associated with early recurrence at the first evaluation of patients with transient ischemic attack.

Abstract We aimed to identify factors easily collected at admission in patients with transient ischemic attack (TIA) that were associated with early recurrence, so as to guide clinicians’ decision-making about hospitalization in routine practice. From September 2011 to January 2013, all TIA patients who were referred to the University Hospital of Dijon, France, were identified. Vascular risk factors and clinical information were collected. The etiology of the TIA was defined according to the results of complementary examinations performed at admission as follows: large artery atherosclerosis (LAA-TIA) TIA, TIA due to atrial fibrillation (AF-TIA), other causes, and undetermined TIA. Logistic…