Stroke hospitalization trends of the working-aged in Finland

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Abstract

Background

The age-standardized incidence of stroke has decreased globally but, for reasons unknown, conflicting results have been observed regarding trend in incidence of major stroke subtypes in young adults. We studied these trends among people of working age in a population-based setting in Finland, where cardiovascular risk factor profiles have developed favorably.

Methods

All hospitalizations for stroke in 2004–2005 and 2013–2014 for persons 18–64 years of age were identified from a national register. The search included all hospitals that provide acute stroke care on mainland Finland.

Results

Hospitalizations for both intracerebral hemorrhage (ICH; -15.2%; p = 0.0008) and subarachnoid hemorrhage (SAH; -26.5%; p<0.0001) decreased overall and for both sexes separately. Concerning IS, hospitalizations decreased only for men (-6.3%; p = 0.0190) but not for women or overall. However, there was an increase in IS hospitalizations in men 35–44 years of age (+37.5%; p = 0.0019). The length of stay (LOS) of IS patients declined in nearly all subgroups (overall -20.8%, p<0.0001) whereas no change in LOS was observed for patients with ICH or SAH. In-hospital mortality decreased in patients with IS (-42.8%; p = 0.0092) but remained unchanged in patients with ICH or SAH.

Conclusions

Stroke hospitalizations of young people declined in Finland, except for men 35–44 years of age for whom IS hospitalizations increased. Declining LOS and in-hospital mortality of IS patients suggests admission of less severe cases, improved care or both.

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Most cited references 22

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The global burden of hemorrhagic stroke: a summary of findings from the GBD 2010 study.

Rita V Krishnamurthi, Andrew E Moran, Mohammad Forouzanfar … (2014)

This report summarizes the findings of the GBD 2010 (Global Burden of Diseases, Injuries, and Risk Factors) study for hemorrhagic stroke (HS). Multiple databases were searched for relevant studies published between 1990 and 2010. The GBD 2010 study provided standardized estimates of the incidence, mortality, mortality-to-incidence ratios (MIR), and disability-adjusted life years (DALY) lost for HS (including intracerebral hemorrhage and subarachnoid hemorrhage) by age, sex, and income level (high-income countries [HIC]; low- and middle-income countries [LMIC]) for 21 GBD 2010 regions in 1990, 2005, and 2010. In 2010, there were 5.3 million cases of HS and over 3.0 million deaths due to HS. There was a 47% increase worldwide in the absolute number of HS cases. The largest proportion of HS incident cases (80%) and deaths (63%) occurred in LMIC countries. There were 62.8 million DALY lost (86% in LMIC) due to HS. The overall age-standardized incidence rate of HS per 100,000 person-years in 2010 was 48.41 (95% confidence interval [CI]: 45.44 to 52.13) in HIC and 99.43 (95% CI: 85.37 to 116.28) in LMIC, and 81.52 (95% CI: 72.27 to 92.82) globally. The age-standardized incidence of HS increased by 18.5% worldwide between 1990 and 2010. In HIC, there was a reduction in incidence of HS by 8% (95% CI: 1% to 15%), mortality by 38% (95% CI: 32% to 43%), DALY by 39% (95% CI: 32% to 44%), and MIR by 27% (95% CI: 19% to 35%) in the last 2 decades. In LMIC countries, there was a significant increase in the incidence of HS by 22% (95% CI: 5% to 30%), whereas there was a significant reduction in mortality rates of 23% (95% CI: -3% to 36%), DALY lost of 25% (95% CI: 7% to 38%), and MIR by 36% (95% CI: 16% to 49%). There were significant regional differences in incidence rates of HS, with the highest rates in LMIC regions such as sub-Saharan Africa and East Asia, and lowest rates in High Income North America and Western Europe. The worldwide burden of HS has increased over the last 2 decades in terms of absolute numbers of HS incident events. The majority of the burden of HS is borne by LMIC. Rates for HS incidence, mortality, and DALY lost, as well as MIR decreased in the past 2 decades in HIC, but increased significantly in LMIC countries, particularly in those patients ≤75 years. HS affected people at a younger age in LMIC than in HIC. The lowest incidence and mortality rates in 2010 were in High Income North America, Australasia, and Western Europe, whereas the highest rates were in Central Asia, Southeast Asia, and sub-Saharan Africa. These results suggest that reducing the burden of HS is a priority particularly in LMIC. The GBD 2010 findings may be a useful resource for planning strategies to reduce the global burden of HS.

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Incidence of subarachnoid hemorrhage is decreasing together with decreasing smoking rates

Miikka Korja, Hanna Lehto, Seppo Juvela … (2016)

Neurology, 87(11), 1118-1123

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The global burden of ischemic stroke: findings of the GBD 2010 study.

Derrick A Bennett, Rita V Krishnamurthi, Suzanne Barker-Collo … (2014)

This study sought to summarize the findings of the GBD 2010 (Global Burden of Diseases, Injuries, and Risk Factors) study for ischemic stroke (IS) and to report the impact of tobacco smoking on IS burden in specific countries. The GBD 2010 searched multiple databases to identify relevant studies published between 1990 and 2010. The GBD 2010 analytical tools were used to calculate region-specific IS incidence, mortality, mortality-to-incidence ratio, and disability-adjusted life years (DALY) lost, including 95% uncertainty intervals (UI). In 2010, there were approximately 11,569,000 incident IS events (63% in low- and middle-income countries [LMIC]), approximately 2,835,000 deaths from IS (57% in LMIC), and approximately 39,389,000 DALY lost due to IS (64% in LMIC). From 1990 to 2010, there was a significant increase in global IS burden in terms of absolute number of people with incident IS (37% increase), deaths from IS (21% increase), and DALY lost due to IS (18% increase). Age-standardized IS incidence, DALY lost, mortality, and mortality-to-incidence ratios in high-income countries declined by about 13% (95% UI: 6% to 18%), 34% (95% UI: 16% to 36%), and 37% (95% UI: 19% to 39%), 21% (95% UI: 10% to 27%), respectively. However, in LMIC there was a modest 6% increase in the age-standardized incidence of IS (95% UI: -7% to 18%) despite modest reductions in mortality rates, DALY lost, and mortality-to-incidence ratios. There was considerable variability among country-specific estimates within broad GBD regions. China, Russia, and India were ranked highest in both 1990 and 2010 for IS deaths attributable to tobacco consumption. Although age-standardized IS mortality rates have declined over the last 2 decades, the absolute global burden of IS is increasing, with the bulk of DALY lost in LMIC. Tobacco consumption is an important modifiable risk factor for IS, and in both 1990 and 2010, the top ranked countries for IS deaths that could be attributed to tobacco consumption were China, Russia, and India. Tobacco control policies that target both smoking initiation and smoking cessation can play an important role in the prevention of IS. In China, Russia, and India, even modest reductions in the number of current smokers could see millions of lives saved due to prevention of IS alone.

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Author and article information

Contributors

Jussi O. T. Sipilä:

ORCID: http://orcid.org/0000-0003-0183-9054

Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Writing – original draft

Jussi P. Posti: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing

Jori O. Ruuskanen: Role: Formal analysisRole: InvestigationRole: Writing – review & editing

Päivi Rautava: Role: Formal analysisRole: InvestigationRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing

Ville Kytö: Role: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing

Simona Sacco: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 1 August 2018

Publication date Collection: 2018

Volume: 13

Issue: 8

Electronic Location Identifier: e0201633

Affiliations

[1 ] Department of Neurology, North Karelia Central Hospital, Siun Sote, Joensuu, Finland

[2 ] Department of Neurology, Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland

[3 ] Department of Neurology, University of Turku, Turku, Finland

[4 ] Turku Brain Injury Centre, Turku University Hospital, Turku, Finland

[5 ] Department of Neurosurgery, Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland

[6 ] Department of Public Health, University of Turku, Turku, Finland

[7 ] Turku Clinical Research Centre, Turku University Hospital, Turku, Finland

[8 ] Heart Center, Turku University Hospital, Turku, Finland

[9 ] Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland

University of L’Aquila, ITALY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: jussi.sipila@ 123456utu.fi

Author information

Jussi O. T. Sipilä http://orcid.org/0000-0003-0183-9054

Article

Publisher ID: PONE-D-18-12465

DOI: 10.1371/journal.pone.0201633

PMC ID: 6070270

PubMed ID: 30067825

SO-VID: 66f7c341-c968-4d2d-af39-e20f196f7681

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 24 April 2018

Date accepted : 18 July 2018

Page count

Figures: 0, Tables: 5, Pages: 10

Funding

Funded by: Government’s Special Financial Transfer tied to academic research in Health Sciences (Finland) of the hospital district of Southwestern Finland

Award Recipient : Ville Kytö

Funded by: Finnish Cardiac Society

Award Recipient : Ville Kytö

This research was supported by the Government’s Special Financial Transfer tied to academic research in Health Sciences (Finland) of the hospital district of Southwestern Finland ( http://www.vsshp.fi/fi/tutkijoille/rahoitus/Sivut/default.aspx) and the Finnish Cardiac Society ( https://www.fincardio.fi/in-english/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability This manuscript is based on third-party data. Access to data is regulated by the Finnish law and the Finnish National Institute for Health and Welfare. Permission to conduct this study prohibits disclosing data to third parties without explicit permission from the Finnish National Institute for Health and Welfare. Those fulfilling the requirements for viewing confidential data as required by the Finnish law and the Finnish National Institute for Health and Welfare are able to access the data. Requests may be addressed to Mrs. Katariina Peltonen. Finnish National Institute for Health and Welfare. E-mail: katariina.peltonen@ 123456thl.fi . We also confirm that the authors did not have any special access privileges that others would not have.

Stroke hospitalization trends of the working-aged in Finland

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Abstract

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Conclusions

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Stroke MRI

Most cited references 22

The global burden of hemorrhagic stroke: a summary of findings from the GBD 2010 study.

Incidence of subarachnoid hemorrhage is decreasing together with decreasing smoking rates

The global burden of ischemic stroke: findings of the GBD 2010 study.

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