Time trends in incidence, comorbidity, and mortality of ischemic stroke in Denmark, 1996–2016

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Time trends in incidence, comorbidity, and mortality of ischemic stroke in Denmark, 1996–2016E

 

Adelina Yafasova, Emil Loldrup Fosbøl, Mia Nielsen Christiansen, Naja Emborg Vinding, Charlotte Andersson, Christina Kruuse, Søren Paaske Johnsen, Gunnar Hilmar Gislason, Christian Torp-Pedersen, Lars Køber, Jawad Haider Butt

First published August 14, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010647

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Abstract

Objective To examine whether the incidence, comorbidity, and mortality of first-time ischemic stroke changed in Denmark between 1996 and 2016 overall and according to age and sex using a nationwide cohort design.

Methods In this cohort study, 224,617 individuals ≥18 years admitted with first-time ischemic stroke between 1996 and 2016 were identified using Danish nationwide registries. We calculated annual age-standardized incidence rates and absolute 30-day and 1-year mortality risks. Further, we calculated annual incidence rate ratios using Poisson regression, odds ratios for 30-day mortality using logistic regression, and hazard ratios for 1-year mortality using Cox regression.

Results The overall age-standardized incidence rates of ischemic stroke per 1,000 person-years increased from 1996 (2.70 [95% CI, 2.65–2.76]) to 2002 (3.25 [95% CI, 3.20–3.31]) and then gradually decreased to below the initial level until 2016 (1.99 [95% CI, 1.95–2.02]). Men had higher incidence rates than women in all age groups except 18–34 and ≥85 years. Absolute mortality risk decreased between 1996 and 2016 (30-day mortality from 17.1% to 7.6% and 1-year mortality from 30.9% to 17.3%). Women between 55 and 64 and ≥85 years had higher mortality than men. Similar trends were observed for all analyses after multivariable adjustment. The prevalence of atrial fibrillation, hypertension, diabetes mellitus, and use of lipid-lowering medication increased during the study period.

Conclusions The age-standardized incidence of first-time hospitalization for ischemic stroke increased from 1996 to 2002 and then gradually decreased to below the initial level until 2016. Absolute 30-day and 1-year mortality risks decreased between 1996 and 2016. These findings correspond to increased stroke prevention awareness and introduction of new treatments during the study period.

• Received February 4, 2020.
• Accepted in final form June 1, 2020.

• © 2020 American Academy of Neurology