Estimates of Outcomes Up to Ten Years after Stroke: Analysis from the Prospective South London Stroke Register
Background:
Although stroke is acknowledged as a long-term condition, population
estimates of outcomes longer term are lacking. Such estimates would be
useful for planning health services and developing research that might
ultimately improve outcomes. This burden of disease study provides
population-based estimates of outcomes with a focus on disability,
cognition, and psychological outcomes up to 10 y after initial stroke event
in a multi-ethnic European population.
Methods and Findings:
Data were collected from the population-based South London Stroke Register, a
prospective population-based register documenting all first in a lifetime
strokes since 1 January 1995 in a multi-ethnic inner city population. The
outcomes assessed are reported as estimates of need and included disability
(Barthel Index <15), inactivity (Frenchay Activities Index <15),
cognitive impairment (Abbreviated Mental Test < 8 or Mini-Mental State
Exam <24), anxiety and depression (Hospital Anxiety and Depression Scale
>10), and mental and physical domain scores of the Medical Outcomes Study
12-item short form (SF-12) health survey. Estimates were stratified by age,
gender, and ethnicity, and age-adjusted using the standard European
population. Plots of outcome estimates over time were constructed to examine
temporal trends and sociodemographic differences. Between 1995 and 2006,
3,373 first-ever strokes were registered: 20%–30% of
survivors had a poor outcome over 10 y of follow-up. The highest rate of
disability was observed 7 d after stroke and remained at around 110 per
1,000 stroke survivors from 3 mo to 10 y. Rates of inactivity and cognitive
impairment both declined up to 1 y (280/1,000 and 180/1,000 survivors,
respectively); thereafter rates of inactivity remained stable till year
eight, then increased, whereas rates of cognitive impairment fluctuated till
year eight, then increased. Anxiety and depression showed some fluctuation
over time, with a rate of 350 and 310 per 1,000 stroke survivors,
respectively. SF-12 scores showed little variation from 3 mo to 10 y after
stroke. Inactivity was higher in males at all time points, and in white
compared to black stroke survivors, although black survivors reported better
outcomes in the SF-12 physical domain. No other major differences were
observed by gender or ethnicity. Increased age was associated with higher
rates of disability, inactivity, and cognitive impairment.
Conclusions:
Between 20% and 30% of stroke survivors have a poor range of
outcomes up to 10 y after stroke. Such epidemiological data demonstrate the
sociodemographic groups that are most affected longer term and should be
used to develop longer term management strategies that reduce the
significant poor outcomes of this group, for whom effective interventions
are currently elusive.
:
Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Estimates of Outcomes Up to Ten Years after Stroke: Analysis from the Prospective South London Stroke Register. PLoS Med 8(5): e32767. doi:10.1371/journal.pmed.1001033
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001033
Souhrn
Background:
Although stroke is acknowledged as a long-term condition, population
estimates of outcomes longer term are lacking. Such estimates would be
useful for planning health services and developing research that might
ultimately improve outcomes. This burden of disease study provides
population-based estimates of outcomes with a focus on disability,
cognition, and psychological outcomes up to 10 y after initial stroke event
in a multi-ethnic European population.
Methods and Findings:
Data were collected from the population-based South London Stroke Register, a
prospective population-based register documenting all first in a lifetime
strokes since 1 January 1995 in a multi-ethnic inner city population. The
outcomes assessed are reported as estimates of need and included disability
(Barthel Index <15), inactivity (Frenchay Activities Index <15),
cognitive impairment (Abbreviated Mental Test < 8 or Mini-Mental State
Exam <24), anxiety and depression (Hospital Anxiety and Depression Scale
>10), and mental and physical domain scores of the Medical Outcomes Study
12-item short form (SF-12) health survey. Estimates were stratified by age,
gender, and ethnicity, and age-adjusted using the standard European
population. Plots of outcome estimates over time were constructed to examine
temporal trends and sociodemographic differences. Between 1995 and 2006,
3,373 first-ever strokes were registered: 20%–30% of
survivors had a poor outcome over 10 y of follow-up. The highest rate of
disability was observed 7 d after stroke and remained at around 110 per
1,000 stroke survivors from 3 mo to 10 y. Rates of inactivity and cognitive
impairment both declined up to 1 y (280/1,000 and 180/1,000 survivors,
respectively); thereafter rates of inactivity remained stable till year
eight, then increased, whereas rates of cognitive impairment fluctuated till
year eight, then increased. Anxiety and depression showed some fluctuation
over time, with a rate of 350 and 310 per 1,000 stroke survivors,
respectively. SF-12 scores showed little variation from 3 mo to 10 y after
stroke. Inactivity was higher in males at all time points, and in white
compared to black stroke survivors, although black survivors reported better
outcomes in the SF-12 physical domain. No other major differences were
observed by gender or ethnicity. Increased age was associated with higher
rates of disability, inactivity, and cognitive impairment.
Conclusions:
Between 20% and 30% of stroke survivors have a poor range of
outcomes up to 10 y after stroke. Such epidemiological data demonstrate the
sociodemographic groups that are most affected longer term and should be
used to develop longer term management strategies that reduce the
significant poor outcomes of this group, for whom effective interventions
are currently elusive.
:
Please see later in the article for the Editors' Summary
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