Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register
Acute stroke impairments often result in poor long-term outcome for stroke survivors. The aim of this study was to estimate the trends over time in the prevalence of these acute stroke impairments. All first-ever stroke patients recorded in the South London Stroke Register (SLSR) between 2001 and 20...
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| description | Acute stroke impairments often result in poor long-term outcome for stroke survivors. The aim of this study was to estimate the trends over time in the prevalence of these acute stroke impairments.
All first-ever stroke patients recorded in the South London Stroke Register (SLSR) between 2001 and 2018 were included in this cohort study. Multivariable Poisson regression models with robust error variance were used to estimate the adjusted prevalence of 8 acute impairments, across six 3-year time cohorts. Prevalence ratios comparing impairments over time were also calculated, stratified by age, sex, ethnicity, and aetiological classification (Trial of Org 10172 in Acute Stroke Treatment [TOAST]). A total of 4,683 patients had a stroke between 2001 and 2018. Mean age was 68.9 years, 48% were female, and 64% were White. After adjustment for demographic factors, pre-stroke risk factors, and stroke subtype, the prevalence of 3 out of the 8 acute impairments declined during the 18-year period, including limb motor deficit (from 77% [95% CI 74%-81%] to 62% [56%-68%], p < 0.001), dysphagia (37% [33%-41%] to 15% [12%-20%], p < 0.001), and urinary incontinence (43% [39%-47%) to 29% [24%-35%], p < 0.001). Declines in limb impairment over time were 2 times greater in men than women (prevalence ratio 0.73 [95% CI 0.64-0.84] and 0.87 [95% CI 0.77-0.98], respectively). Declines also tended to be greater in younger patients. Stratified by TOAST classification, the prevalence of all impairments was high for large artery atherosclerosis (LAA), cardioembolism (CE), and stroke of undetermined aetiology. Conversely, small vessel occlusions (SVOs) had low levels of all impairments except for limb motor impairment and dysarthria. While we have assessed 8 key acute stroke impairments, this study is limited by a focus on physical impairments, although cognitive impairments are equally important to understand. In addition, this is an inner-city cohort, which has unique characteristics compared to other populations.
In this study, we found that stroke patients in the SLSR had a complexity of acute impairments, of which limb motor deficit, dysphagia, and incontinence have declined between 2001 and 2018. These reductions have not been uniform across all patient groups, with women and the older population, in particular, seeing fewer reductions. |
| doi_str_mv | 10.1371/journal.pmed.1003366 |
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All first-ever stroke patients recorded in the South London Stroke Register (SLSR) between 2001 and 2018 were included in this cohort study. Multivariable Poisson regression models with robust error variance were used to estimate the adjusted prevalence of 8 acute impairments, across six 3-year time cohorts. Prevalence ratios comparing impairments over time were also calculated, stratified by age, sex, ethnicity, and aetiological classification (Trial of Org 10172 in Acute Stroke Treatment [TOAST]). A total of 4,683 patients had a stroke between 2001 and 2018. Mean age was 68.9 years, 48% were female, and 64% were White. After adjustment for demographic factors, pre-stroke risk factors, and stroke subtype, the prevalence of 3 out of the 8 acute impairments declined during the 18-year period, including limb motor deficit (from 77% [95% CI 74%-81%] to 62% [56%-68%], p < 0.001), dysphagia (37% [33%-41%] to 15% [12%-20%], p < 0.001), and urinary incontinence (43% [39%-47%) to 29% [24%-35%], p < 0.001). Declines in limb impairment over time were 2 times greater in men than women (prevalence ratio 0.73 [95% CI 0.64-0.84] and 0.87 [95% CI 0.77-0.98], respectively). Declines also tended to be greater in younger patients. Stratified by TOAST classification, the prevalence of all impairments was high for large artery atherosclerosis (LAA), cardioembolism (CE), and stroke of undetermined aetiology. Conversely, small vessel occlusions (SVOs) had low levels of all impairments except for limb motor impairment and dysarthria. While we have assessed 8 key acute stroke impairments, this study is limited by a focus on physical impairments, although cognitive impairments are equally important to understand. In addition, this is an inner-city cohort, which has unique characteristics compared to other populations.
In this study, we found that stroke patients in the SLSR had a complexity of acute impairments, of which limb motor deficit, dysphagia, and incontinence have declined between 2001 and 2018. These reductions have not been uniform across all patient groups, with women and the older population, in particular, seeing fewer reductions.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1003366</identifier><identifier>PMID: 33035232</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; Aged ; Aged, 80 and over ; Antihypertensives ; Blood pressure ; Brain Ischemia - complications ; Causes of ; Cerebral infarction ; Cholesterol ; Classification ; Cohort analysis ; Cohort Studies ; Complications and side effects ; Confidence intervals ; Coronary artery disease ; Data collection ; Deglutition disorders ; Diabetes ; Diabetes mellitus ; Dysarthria ; Dysphagia ; Ethnic Groups ; Ethnicity ; Etiology ; Female ; Fibrillation ; Forecasts and trends ; Heart diseases ; Hemorrhage ; Hospitals ; Humans ; Hypertension ; London - epidemiology ; Male ; Medicine and Health Sciences ; Middle Aged ; Minority & ethnic groups ; Movement disorders ; Myocardial infarction ; Occlusion ; Population ; Population studies ; Population-based studies ; Prevalence ; Registries ; Regression analysis ; Risk Factors ; Smoking ; Statistics ; Stroke ; Stroke (Disease) ; Stroke - epidemiology ; Subarachnoid hemorrhage ; Time Factors ; Transient ischemic attack ; Trends ; Urinary incontinence ; Vascular diseases ; Visual field</subject><ispartof>PLoS medicine, 2020-10, Vol.17 (10), p.e1003366</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Clery et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Clery et al 2020 Clery et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c764t-951908253600736b2aca03a98b40410624208ed7a2dc839672c4edcc3c1446ce3</citedby><cites>FETCH-LOGICAL-c764t-951908253600736b2aca03a98b40410624208ed7a2dc839672c4edcc3c1446ce3</cites><orcidid>0000-0001-8264-0981 ; 0000-0002-0768-1676 ; 0000-0002-7366-9982</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546484/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546484/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33035232$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Clery, Amanda</creatorcontrib><creatorcontrib>Bhalla, Ajay</creatorcontrib><creatorcontrib>Rudd, Anthony G</creatorcontrib><creatorcontrib>Wolfe, Charles D A</creatorcontrib><creatorcontrib>Wang, Yanzhong</creatorcontrib><title>Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>Acute stroke impairments often result in poor long-term outcome for stroke survivors. The aim of this study was to estimate the trends over time in the prevalence of these acute stroke impairments.
All first-ever stroke patients recorded in the South London Stroke Register (SLSR) between 2001 and 2018 were included in this cohort study. Multivariable Poisson regression models with robust error variance were used to estimate the adjusted prevalence of 8 acute impairments, across six 3-year time cohorts. Prevalence ratios comparing impairments over time were also calculated, stratified by age, sex, ethnicity, and aetiological classification (Trial of Org 10172 in Acute Stroke Treatment [TOAST]). A total of 4,683 patients had a stroke between 2001 and 2018. Mean age was 68.9 years, 48% were female, and 64% were White. After adjustment for demographic factors, pre-stroke risk factors, and stroke subtype, the prevalence of 3 out of the 8 acute impairments declined during the 18-year period, including limb motor deficit (from 77% [95% CI 74%-81%] to 62% [56%-68%], p < 0.001), dysphagia (37% [33%-41%] to 15% [12%-20%], p < 0.001), and urinary incontinence (43% [39%-47%) to 29% [24%-35%], p < 0.001). Declines in limb impairment over time were 2 times greater in men than women (prevalence ratio 0.73 [95% CI 0.64-0.84] and 0.87 [95% CI 0.77-0.98], respectively). Declines also tended to be greater in younger patients. Stratified by TOAST classification, the prevalence of all impairments was high for large artery atherosclerosis (LAA), cardioembolism (CE), and stroke of undetermined aetiology. Conversely, small vessel occlusions (SVOs) had low levels of all impairments except for limb motor impairment and dysarthria. While we have assessed 8 key acute stroke impairments, this study is limited by a focus on physical impairments, although cognitive impairments are equally important to understand. In addition, this is an inner-city cohort, which has unique characteristics compared to other populations.
In this study, we found that stroke patients in the SLSR had a complexity of acute impairments, of which limb motor deficit, dysphagia, and incontinence have declined between 2001 and 2018. These reductions have not been uniform across all patient groups, with women and the older population, in particular, seeing fewer reductions.</description><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antihypertensives</subject><subject>Blood pressure</subject><subject>Brain Ischemia - complications</subject><subject>Causes of</subject><subject>Cerebral infarction</subject><subject>Cholesterol</subject><subject>Classification</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Complications and side effects</subject><subject>Confidence intervals</subject><subject>Coronary artery disease</subject><subject>Data collection</subject><subject>Deglutition disorders</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Dysarthria</subject><subject>Dysphagia</subject><subject>Ethnic Groups</subject><subject>Ethnicity</subject><subject>Etiology</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Forecasts and trends</subject><subject>Heart diseases</subject><subject>Hemorrhage</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>London - epidemiology</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Minority & ethnic groups</subject><subject>Movement disorders</subject><subject>Myocardial infarction</subject><subject>Occlusion</subject><subject>Population</subject><subject>Population studies</subject><subject>Population-based studies</subject><subject>Prevalence</subject><subject>Registries</subject><subject>Regression analysis</subject><subject>Risk Factors</subject><subject>Smoking</subject><subject>Statistics</subject><subject>Stroke</subject><subject>Stroke (Disease)</subject><subject>Stroke - epidemiology</subject><subject>Subarachnoid hemorrhage</subject><subject>Time Factors</subject><subject>Transient ischemic attack</subject><subject>Trends</subject><subject>Urinary incontinence</subject><subject>Vascular diseases</subject><subject>Visual field</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqVk12L1DAUhoso7rr6D0QDguDFjGmTpo0XwrD4MTC4sLN6GzLpaZuxTWqSLrv_3ozTXWZgBSUXCcnzvic5JydJXqZ4npIifb-1ozOymw89VPMUY0IYe5Scpjnls5QV7PHB-iR55v0W44xjjp8mJ4RgkmckO01urhyYyiNt0ODgWnZgFCBbI6nGAMgHZ38C0v0gtevBBP8BLdBgh7GTQVsz20gPFVK2tS5Eeqxu0ei1aVBoAa3tGFq0sqayBq33VpfQaB_APU-e1LLz8GKaz5Lvnz9dnX-drS6-LM8Xq5kqGA0znqccl1lOGMYFYZtMKomJ5OWGYppiltEMl1AVMqtUSTgrMkWhUoqolFKmgJwlr_e-Q2e9mJLmRUYLTllJSxyJ5Z6orNyKweleulthpRZ_NqxrhHRBqw4EqYCnPMdU5QWtGSlJXZS0rijggnPYRfs4RRs3sS4qZszJ7sj0-MToVjT2WhQ5ZbSk0eDNZODsrxF8-MuVJ6qJBRPa1DaaqV57JRaMZhmJb-eRmj1ANWAgRrYGah23j_j5A3wcFfRaPSh4dySITICb0MjRe7FcX_4H--3f2Ysfx-zbA7YF2YXW227c_U5_DNI9qJz13kF9X5UUi11H3WVa7DpKTB0VZa8OK3ovumsh8hvHXhpJ</recordid><startdate>20201009</startdate><enddate>20201009</enddate><creator>Clery, Amanda</creator><creator>Bhalla, Ajay</creator><creator>Rudd, Anthony G</creator><creator>Wolfe, Charles D A</creator><creator>Wang, Yanzhong</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope><orcidid>https://orcid.org/0000-0001-8264-0981</orcidid><orcidid>https://orcid.org/0000-0002-0768-1676</orcidid><orcidid>https://orcid.org/0000-0002-7366-9982</orcidid></search><sort><creationdate>20201009</creationdate><title>Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register</title><author>Clery, Amanda ; Bhalla, Ajay ; Rudd, Anthony G ; Wolfe, Charles D A ; Wang, Yanzhong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c764t-951908253600736b2aca03a98b40410624208ed7a2dc839672c4edcc3c1446ce3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antihypertensives</topic><topic>Blood pressure</topic><topic>Brain Ischemia - 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The aim of this study was to estimate the trends over time in the prevalence of these acute stroke impairments.
All first-ever stroke patients recorded in the South London Stroke Register (SLSR) between 2001 and 2018 were included in this cohort study. Multivariable Poisson regression models with robust error variance were used to estimate the adjusted prevalence of 8 acute impairments, across six 3-year time cohorts. Prevalence ratios comparing impairments over time were also calculated, stratified by age, sex, ethnicity, and aetiological classification (Trial of Org 10172 in Acute Stroke Treatment [TOAST]). A total of 4,683 patients had a stroke between 2001 and 2018. Mean age was 68.9 years, 48% were female, and 64% were White. After adjustment for demographic factors, pre-stroke risk factors, and stroke subtype, the prevalence of 3 out of the 8 acute impairments declined during the 18-year period, including limb motor deficit (from 77% [95% CI 74%-81%] to 62% [56%-68%], p < 0.001), dysphagia (37% [33%-41%] to 15% [12%-20%], p < 0.001), and urinary incontinence (43% [39%-47%) to 29% [24%-35%], p < 0.001). Declines in limb impairment over time were 2 times greater in men than women (prevalence ratio 0.73 [95% CI 0.64-0.84] and 0.87 [95% CI 0.77-0.98], respectively). Declines also tended to be greater in younger patients. Stratified by TOAST classification, the prevalence of all impairments was high for large artery atherosclerosis (LAA), cardioembolism (CE), and stroke of undetermined aetiology. Conversely, small vessel occlusions (SVOs) had low levels of all impairments except for limb motor impairment and dysarthria. While we have assessed 8 key acute stroke impairments, this study is limited by a focus on physical impairments, although cognitive impairments are equally important to understand. In addition, this is an inner-city cohort, which has unique characteristics compared to other populations.
In this study, we found that stroke patients in the SLSR had a complexity of acute impairments, of which limb motor deficit, dysphagia, and incontinence have declined between 2001 and 2018. These reductions have not been uniform across all patient groups, with women and the older population, in particular, seeing fewer reductions.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33035232</pmid><doi>10.1371/journal.pmed.1003366</doi><orcidid>https://orcid.org/0000-0001-8264-0981</orcidid><orcidid>https://orcid.org/0000-0002-0768-1676</orcidid><orcidid>https://orcid.org/0000-0002-7366-9982</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | PLoS medicine, 2020-10, Vol.17 (10), p.e1003366 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Public Library of Science (PLoS) |
| subjects | Age Aged Aged, 80 and over Antihypertensives Blood pressure Brain Ischemia - complications Causes of Cerebral infarction Cholesterol Classification Cohort analysis Cohort Studies Complications and side effects Confidence intervals Coronary artery disease Data collection Deglutition disorders Diabetes Diabetes mellitus Dysarthria Dysphagia Ethnic Groups Ethnicity Etiology Female Fibrillation Forecasts and trends Heart diseases Hemorrhage Hospitals Humans Hypertension London - epidemiology Male Medicine and Health Sciences Middle Aged Minority & ethnic groups Movement disorders Myocardial infarction Occlusion Population Population studies Population-based studies Prevalence Registries Regression analysis Risk Factors Smoking Statistics Stroke Stroke (Disease) Stroke - epidemiology Subarachnoid hemorrhage Time Factors Transient ischemic attack Trends Urinary incontinence Vascular diseases Visual field |
| title | Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-05T02%3A32%3A30IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Trends%20in%20prevalence%20of%20acute%20stroke%20impairments:%20A%20population-based%20cohort%20study%20using%20the%20South%20London%20Stroke%20Register&rft.jtitle=PLoS%20medicine&rft.au=Clery,%20Amanda&rft.date=2020-10-09&rft.volume=17&rft.issue=10&rft.spage=e1003366&rft.pages=e1003366-&rft.issn=1549-1676&rft.eissn=1549-1676&rft_id=info:doi/10.1371/journal.pmed.1003366&rft_dat=%3Cgale_plos_%3EA642234469%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2479468480&rft_id=info:pmid/33035232&rft_galeid=A642234469&rft_doaj_id=oai_doaj_org_article_3de919504c574f6383f784fd4e0799ee&rfr_iscdi=true |