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The South
London Stroke Register: the incidence and case fatality of stroke in a
multi-ethnic population
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Funded
by:
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Northern and
Yorkshire R&D, Special Trustees, Guy's and St Thomas' Hospitals NHS
Trust,
Stanley-Thomas Johnson Foundation 1995-2003
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Department of Health 2003 -2008
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Study team:
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Dr Anthony Rudd
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Catherine Coshall
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Prof Charles Wolfe*
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Sarah Hanratty
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Dr Mehool Patel
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Nigel Smeeton
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Objective:
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To identify socio-demographic differences in the
incidence of the subtypes of first-ever stroke.
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Design:
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A prospective community stroke register (ongoing)
using multiple notification sources. Pathological, Bamford and mechanistic
classifications of stroke. Standardisation of rates was to European and
World populations and adjusted for age, sex, social class in multivariate
analysis.
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Setting:
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A multi-ethnic population of 234,533 in South
London, of which 21% are Black.
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Current Overview
of Results:
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Of the 1,254 cases registered, the incidence rate
per thousand population was 1.33 (crude) (95% CI 1.26 to 1.41), 1.28
(European adjusted) (95% CI 1.2 to 1.35) with a 2.18 (95%CI 1.86 to
2.56)(p<0.0001) adjusted incidence rate ratio in the Black population.
The average age of stroke was 71.7 years with blacks being 11.3yrs younger
(p<0.0001).
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Pathological diagnosis was confirmed in 1,107
(88.6%) with 862 (68.7%) infarction, 168 (13%) primary intracerebral
haemorrhage and 77 (6.1%) subarachnoid haemorrhage. Of the cerebral infarction
cases 189 (22%) were total anterior circulatory, 250 (29%) partial
anterior, 141 (16%) posterior and 282 (32.7%) lacunar infarcts. There were
no significant differences in survival at six months between ethnic groups
with 36.7% overall, 39% White and 27% Black. For all subtypes of stroke,
there was a significant increase risk in the black group except for POCI
and unclassified strokes.
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The incidence rate ratio (IRR) for men compared
to women was 1.34 (95%CI 1.19 to 1.50)(p<0.001). The socio-economic
status IRR for manual versus non-manual was 1.64 (95%CI 1.22 to
2.23)(p<0.0001).
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Conclusions:
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The incidence of stroke is significantly higher
in the black population which has implications for stroke prevention programmes.
The differences in survival between ethnic groups also requires further
investigation. Age, social class and ethnic group all independently
influence the risk of stroke. These inequalities need to be addressed
through Our Healthier Nation targets, although it remains unclear how to
achieve substantial reductions in risk in these groups.
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