Five-Year Recurrence Rate and the Predictors Following Stroke in the Mashhad Stroke Incidence Study

A Population-Based Cohort Study of Stroke in the Middle East

Maryam Salehi, Amin Amiri, Amanda G. Thrift, Moira K. Kapral, Luciano Sposato, Réza Behrouz, Jiming Fang, Ali Shoeibi, Peyman Hashemi, Mohammad Taghi Farzadfard, Naghmeh Mokhber, Mahmoud Reza Azarpazhooh

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)

Abstract

Background: Little is known about the risk of recurrent stroke in low- and middle-income countries. This study was designed to identify the long-term risk of stroke recurrence and its associated factors. Methods: From November 21, 2006 for a period of 1 year, 624 patients with first-ever stroke (FES) were registered from the residents of 3 neighborhoods in Mashhad, Iran. Patients were followed up for the next 5 years after the index event for any stroke recurrence or death. We used competing risk analysis and cause-specific Cox proportional hazard models to estimate the cumulative incidence of stroke recurrence and its associated variables. Results: The cumulative incidence of stroke recurrence was 14.5% by the end of 5 years, with the largest rate during the first year after FES (5.6%). Only advanced age (adjusted hazard ratio [HR] 1.02; 95% CI 1.01–1.04) and severe stroke (National Institutes of Health Stroke Scale score >20; HR 2.23; 95% CI 1.05–4.74) were independently associated with an increased risk of 5-year recurrence. Case fatality at 30 days after first recurrent stroke was 43.2%, which was significantly greater than the case fatality at 30 days after FES of 24.7% (p = 0.001). Conclusion: A substantial number of our patients either died or had stroke recurrences during the study period. Advanced age and the severity of the index stroke significantly increased the risk of recurrence. This is an important finding for health policy makers and for designing preventive strategies in people surviving their stroke.

Original languageEnglish
Article number485509
Pages (from-to)18-22
Number of pages5
JournalNeuroepidemiology
Volume50
Issue number1-2
DOIs
Publication statusPublished - 10 Jan 2018

Keywords

  • Iran
  • Middle East
  • Recurrence rate
  • Stroke

Cite this

Salehi, Maryam ; Amiri, Amin ; Thrift, Amanda G. ; Kapral, Moira K. ; Sposato, Luciano ; Behrouz, Réza ; Fang, Jiming ; Shoeibi, Ali ; Hashemi, Peyman ; Farzadfard, Mohammad Taghi ; Mokhber, Naghmeh ; Azarpazhooh, Mahmoud Reza. / Five-Year Recurrence Rate and the Predictors Following Stroke in the Mashhad Stroke Incidence Study : A Population-Based Cohort Study of Stroke in the Middle East. In: Neuroepidemiology. 2018 ; Vol. 50, No. 1-2. pp. 18-22.
@article{77e3a938c3b24d9c85aae5a210799105,
title = "Five-Year Recurrence Rate and the Predictors Following Stroke in the Mashhad Stroke Incidence Study: A Population-Based Cohort Study of Stroke in the Middle East",
abstract = "Background: Little is known about the risk of recurrent stroke in low- and middle-income countries. This study was designed to identify the long-term risk of stroke recurrence and its associated factors. Methods: From November 21, 2006 for a period of 1 year, 624 patients with first-ever stroke (FES) were registered from the residents of 3 neighborhoods in Mashhad, Iran. Patients were followed up for the next 5 years after the index event for any stroke recurrence or death. We used competing risk analysis and cause-specific Cox proportional hazard models to estimate the cumulative incidence of stroke recurrence and its associated variables. Results: The cumulative incidence of stroke recurrence was 14.5{\%} by the end of 5 years, with the largest rate during the first year after FES (5.6{\%}). Only advanced age (adjusted hazard ratio [HR] 1.02; 95{\%} CI 1.01–1.04) and severe stroke (National Institutes of Health Stroke Scale score >20; HR 2.23; 95{\%} CI 1.05–4.74) were independently associated with an increased risk of 5-year recurrence. Case fatality at 30 days after first recurrent stroke was 43.2{\%}, which was significantly greater than the case fatality at 30 days after FES of 24.7{\%} (p = 0.001). Conclusion: A substantial number of our patients either died or had stroke recurrences during the study period. Advanced age and the severity of the index stroke significantly increased the risk of recurrence. This is an important finding for health policy makers and for designing preventive strategies in people surviving their stroke.",
keywords = "Iran, Middle East, Recurrence rate, Stroke",
author = "Maryam Salehi and Amin Amiri and Thrift, {Amanda G.} and Kapral, {Moira K.} and Luciano Sposato and R{\'e}za Behrouz and Jiming Fang and Ali Shoeibi and Peyman Hashemi and Farzadfard, {Mohammad Taghi} and Naghmeh Mokhber and Azarpazhooh, {Mahmoud Reza}",
year = "2018",
month = "1",
day = "10",
doi = "10.1159/000485509",
language = "English",
volume = "50",
pages = "18--22",
journal = "Neuroepidemiology",
issn = "0251-5350",
publisher = "Karger",
number = "1-2",

}

Salehi, M, Amiri, A, Thrift, AG, Kapral, MK, Sposato, L, Behrouz, R, Fang, J, Shoeibi, A, Hashemi, P, Farzadfard, MT, Mokhber, N & Azarpazhooh, MR 2018, 'Five-Year Recurrence Rate and the Predictors Following Stroke in the Mashhad Stroke Incidence Study: A Population-Based Cohort Study of Stroke in the Middle East', Neuroepidemiology, vol. 50, no. 1-2, 485509, pp. 18-22. https://doi.org/10.1159/000485509

Five-Year Recurrence Rate and the Predictors Following Stroke in the Mashhad Stroke Incidence Study : A Population-Based Cohort Study of Stroke in the Middle East. / Salehi, Maryam; Amiri, Amin; Thrift, Amanda G.; Kapral, Moira K.; Sposato, Luciano; Behrouz, Réza; Fang, Jiming; Shoeibi, Ali; Hashemi, Peyman; Farzadfard, Mohammad Taghi; Mokhber, Naghmeh; Azarpazhooh, Mahmoud Reza.

In: Neuroepidemiology, Vol. 50, No. 1-2, 485509, 10.01.2018, p. 18-22.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Five-Year Recurrence Rate and the Predictors Following Stroke in the Mashhad Stroke Incidence Study

T2 - A Population-Based Cohort Study of Stroke in the Middle East

AU - Salehi, Maryam

AU - Amiri, Amin

AU - Thrift, Amanda G.

AU - Kapral, Moira K.

AU - Sposato, Luciano

AU - Behrouz, Réza

AU - Fang, Jiming

AU - Shoeibi, Ali

AU - Hashemi, Peyman

AU - Farzadfard, Mohammad Taghi

AU - Mokhber, Naghmeh

AU - Azarpazhooh, Mahmoud Reza

PY - 2018/1/10

Y1 - 2018/1/10

N2 - Background: Little is known about the risk of recurrent stroke in low- and middle-income countries. This study was designed to identify the long-term risk of stroke recurrence and its associated factors. Methods: From November 21, 2006 for a period of 1 year, 624 patients with first-ever stroke (FES) were registered from the residents of 3 neighborhoods in Mashhad, Iran. Patients were followed up for the next 5 years after the index event for any stroke recurrence or death. We used competing risk analysis and cause-specific Cox proportional hazard models to estimate the cumulative incidence of stroke recurrence and its associated variables. Results: The cumulative incidence of stroke recurrence was 14.5% by the end of 5 years, with the largest rate during the first year after FES (5.6%). Only advanced age (adjusted hazard ratio [HR] 1.02; 95% CI 1.01–1.04) and severe stroke (National Institutes of Health Stroke Scale score >20; HR 2.23; 95% CI 1.05–4.74) were independently associated with an increased risk of 5-year recurrence. Case fatality at 30 days after first recurrent stroke was 43.2%, which was significantly greater than the case fatality at 30 days after FES of 24.7% (p = 0.001). Conclusion: A substantial number of our patients either died or had stroke recurrences during the study period. Advanced age and the severity of the index stroke significantly increased the risk of recurrence. This is an important finding for health policy makers and for designing preventive strategies in people surviving their stroke.

AB - Background: Little is known about the risk of recurrent stroke in low- and middle-income countries. This study was designed to identify the long-term risk of stroke recurrence and its associated factors. Methods: From November 21, 2006 for a period of 1 year, 624 patients with first-ever stroke (FES) were registered from the residents of 3 neighborhoods in Mashhad, Iran. Patients were followed up for the next 5 years after the index event for any stroke recurrence or death. We used competing risk analysis and cause-specific Cox proportional hazard models to estimate the cumulative incidence of stroke recurrence and its associated variables. Results: The cumulative incidence of stroke recurrence was 14.5% by the end of 5 years, with the largest rate during the first year after FES (5.6%). Only advanced age (adjusted hazard ratio [HR] 1.02; 95% CI 1.01–1.04) and severe stroke (National Institutes of Health Stroke Scale score >20; HR 2.23; 95% CI 1.05–4.74) were independently associated with an increased risk of 5-year recurrence. Case fatality at 30 days after first recurrent stroke was 43.2%, which was significantly greater than the case fatality at 30 days after FES of 24.7% (p = 0.001). Conclusion: A substantial number of our patients either died or had stroke recurrences during the study period. Advanced age and the severity of the index stroke significantly increased the risk of recurrence. This is an important finding for health policy makers and for designing preventive strategies in people surviving their stroke.

KW - Iran

KW - Middle East

KW - Recurrence rate

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=85040370102&partnerID=8YFLogxK

U2 - 10.1159/000485509

DO - 10.1159/000485509

M3 - Article

VL - 50

SP - 18

EP - 22

JO - Neuroepidemiology

JF - Neuroepidemiology

SN - 0251-5350

IS - 1-2

M1 - 485509

ER -