30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies

Feigin, Valery L., Krishnamurthi, Rita V., Barker-Collo, Suzanne, McPherson, Kathryn M., Barber, P. Alan, Parag, Varsha, Arroll, Bruce, Bennett, Derrick A., Tobias, Martin, Jones, Amy, Witt, Emma, Brown, Paul, Abbott, Max, Bhattacharjee, Rohit, Rush, Elaine, Suh, Flora Minsun, Theadom, Alice, Rathnasabapathy, Yogini, Ao, Braden Te, Parmar, Priya G., Anderson, Craig and Bonita, Ruth (2015) 30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies. PLoS One, 10 8: e0134609-e0134609. doi:10.1371/journal.pone.0134609


Author Feigin, Valery L.
Krishnamurthi, Rita V.
Barker-Collo, Suzanne
McPherson, Kathryn M.
Barber, P. Alan
Parag, Varsha
Arroll, Bruce
Bennett, Derrick A.
Tobias, Martin
Jones, Amy
Witt, Emma
Brown, Paul
Abbott, Max
Bhattacharjee, Rohit
Rush, Elaine
Suh, Flora Minsun
Theadom, Alice
Rathnasabapathy, Yogini
Ao, Braden Te
Parmar, Priya G.
Anderson, Craig
Bonita, Ruth
Title 30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies
Journal name PLoS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2015-08-01
Year available 2015
Sub-type Article (original research)
DOI 10.1371/journal.pone.0134609
Open Access Status DOI
Volume 10
Issue 8
Start page e0134609
End page e0134609
Total pages 28
Place of publication San Francisco, CA United States
Publisher Public Library of Science
Collection year 2016
Language eng
Formatted abstract
Background
Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years.

Methods
Four stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years) of Auckland NZ in 1981–1982, 1991–1992, 2002–2003 and 2011–2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution.

Results
5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in frequency of current smoking among stroke patients.

Conclusions
In this unique temporal series of studies spanning 30 years, stroke incidence, early case-fatality and 1-year mortality have declined, but ethnic disparities in risk and outcome for stroke persisted suggesting that primary stroke prevention remains crucial to reducing the burden of this disease.
Keyword Northern Manhattan Stroke
Case Fatality Rates
Regional Community Stroke
Risk Factors
Subarachnoid Hemorrhage
Ethnic Disparities
Global Burden
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Psychology Publications
 
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