Vol. 38, No. 1, 2012
Issue release date: January 2012
Free Access
Neuroepidemiology 2012;38:30–40
Methods in Neuroepidemiology
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Methodology of the Global and Regional Burden of Stroke Study

aNational Institute for Stroke and Applied Neuroscience, School of Rehabilitation and Occupation Studies, Auckland University of Technology, bDepartment of Psychology, Faculty of Science, cSchool of Population Health, and dDepartment of Medicine, University of Auckland, Auckland, and eSchool of Psychology, Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand
email Corresponding Author

 goto top of outline Key Words

  • Stroke
  • Disability
  • Systematic review
  • Epidemiology
  • Global health
  • Methodology

 goto top of outline Abstract

Background: Setting priorities for the prevention of stroke requires an empirical understanding of the pattern of disease burden and exposure to major risk factors. In this manuscript we aim to report the methodology of a systematic review of the epidemiological literature on stroke and how this information will be synthesized to produce updated estimates of the global burden of stroke. Methods: We will use multi-state models implemented in the software program DisMod III to estimate age-specific prevalence, incidence, and early case-fatality (defined as either 28-day, 30-day or 1-month case fatality) for stroke by the 21 global burden of disease (GBD) regions as well as by gender and pathological stroke type based on information obtained from a systematic review. We conducted a two-stage search strategy in order to identify studies published between 1980 and 2011 for the GBD stroke review. Eligible studies: (a) distinguished between stroke and transient ischaemic attack (TIA); (b) distinguished between 1st ever and recurrent stroke; (c) reported on age-specific rates; (d) if reported, provided survival status within 28 days, 30 days or 1 month of onset for fatal and non-fatal events; (e) specified methods for ascertaining stroke cases, and (f) described imaging modalities to determine stroke subtypes. Details of included studies were recorded on a detailed data extraction form by trained reviewers. We will gather information on demographics, natural history and clinical outcomes (e.g. Rankin scale, Glasgow Coma Scale), after stroke which will be used to facilitate the estimation of epidemiological parameters. Reporting and methodological quality was rated. Populations were coded as urban, rural, or combined and studies classified as national, sub-national, healthcare system-based, or community level. Studies published in non-English languages were translated and coded centrally. Discussion: In international health research, there is a crucial need for accurate assessment of global health patterns. A thorough GBD reassessment of stroke will ensure that global health policy decisions are based on the most up-to-date, valid and reliable epidemiological information available.

Copyright © 2011 S. Karger AG, Basel

 goto top of outline References
  1. O’Donnell MJ, Xavier D, Liu L, et al: Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376:112–123.
  2. Strong K, Mathers C, Bonita R: Preventing stroke: saving lives around the world. Lancet Neurol 2007;6:182–187.
  3. Johnston SC, Mendis S, Mathers CD: Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol 2009;8:345–354.
  4. Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 2009;8:355–369.
  5. Truelsen T, Bonita R, Jamrozik K: Surveillance of stroke: a global perspective. Int J Epidemiol 2001;30(suppl 1):S11–S16.
  6. Beaglehole R, Saracci R, Panico S: Cardiovascular diseases: causes, surveillance and prevention. Int J Epidemiol 2001;30(suppl 1):S1–S4.

    External Resources

  7. Murray CJL, Lopez AD: The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020. Cambridge, Harvard University Press, 1996.
  8. Mathers CD, Lopez AD, Murray CJL: The Burden of Disease and Mortality by Condition, Data, Methods, and Results for 2001. Global Burden of Disease and Risk Factors. Oxford University Press and The World Bank, 2006.
  9. Murray CJ, Lopez AD, Black R, et al: Global burden of disease 2005: call for collaborators. Lancet 2007;370:109–110.
  10. Murray CJL, Lopez AD: Global and Regional Descriptive Epidemiology of Disability: Incidence, Prevalence, Heath Expectancies and Years Lived with Disability: The Global Burden of Disease. Cambridge, Harvard University Press, 1996, pp 201–246.
  11. Hatano S: Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ 1976;54:541–553.
  12. Albers GW, Caplan LR, Easton JD, et al: Transient ischemic attack – proposal for a new definition. N Engl J Med 2002;347:1713–1716.
  13. Warlow CP, Dennis MS, van Gijn J, et al: What caused this transient or persisting ischemic event?; in Warlow CP, Dennis MS, van Gijn J, et al (eds): Stroke: A Practical Guide to Management, ed 1. Oxford, Blackwell Science, 2001, pp 223–300.
  14. Zhao D, Liu J, Wang W, et al: Epidemiological transition of stroke in China: twenty-one-year observational study from the Sino-MONICA-Beijing Project. Stroke 2008;39:1668–1674.
  15. de Freitas GR, Bogousslavsky J: Ischemic stroke syndromes: clinical features, anatomy, vascular territories, and prognosis; in Adams HP (ed): Handbook of Cerebrovascular Diseases, ed 2. New York, Marcel Dekker, 2005, pp 43–71.
  16. Lawes CM, Bennett DA, Feigin VL, Rodgers A: Blood pressure and stroke: an overview of published reviews. Stroke 2004;35:1024.
  17. Chang K-C: Intracerebral hemorrhage; in Adams HP (ed): Handbook of Cerebrovascular Diseases, ed 2. New York, Marcel Dekker, 2005, pp 73–80.
  18. Malmgren R, Warlow C, Bamford J, Sandercock P: Geographical and secular trends in stroke incidence. Lancet 1987;ii:1196–1200.
  19. Lovblad KO, Altrichter S, Viallon M, et al: Neuro-imaging of cerebral ischemic stroke. J Neuroradiol 2008;35:197–209.
  20. Lovblad KO, Baird AE: Actual diagnostic approach to the acute stroke patient. Eur Radiol 2006;16:1253–1269.
  21. Castillo PR, Miller DA, Meschia JF: Choice of neuroimaging in perioperative acute stroke management. Neurol Clin 2006;24:807–820.
  22. Bamford J, Dennis M, Sandercock P, Burn J, Warlow C: The frequency, causes and timing of death within 30 days of a first stroke: the Oxfordshire Community Stroke Project. J Neurol Neurosurg Psychiatry 1990;53:824–829.
  23. Phillips LH, Whisnant JP, Reagan TJ: Sudden death from stroke. Stroke 1977;8:392–395.
  24. Thomas AC, Knapman PA, Krikler DM, Davies MJ: Community study of the causes of ‘natural’ sudden death. BMJ 1988;297:1453–1456.
  25. Asplund K, Hagg E, Helmers C, Lithner F, Strand T, Wester PO: The natural history of stroke in diabetic patients. Acta Med Scand 1980;207:417–424.
  26. Sacco RL, Wolf PA, Kannel WB, McNamara PM: Survival and recurrence following stroke: the Framingham study. Stroke 1982;13:290–295.
  27. Bamford J, Sandercock P, Jones L, Warlow C: The natural history of lacunar infarction: the Oxfordshire Community Stroke Project. Stroke 1987;18:545–551.
  28. Barer DH: The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry 1989;52:236–241.
  29. Patel M, Coshall C, Rudd AG, Wolfe CD: Natural history of cognitive impairment after stroke and factors associated with its recovery. Clin Rehabil 2003;17:158–166.
  30. Paul SL, Dewey HM, Sturm JW, Macdonell RA, Thrift AG: Prevalence of depression and use of antidepressant medication at 5-years poststroke in the North East Melbourne Stroke Incidence Study. Stroke 2006;37:2854–2855.
  31. Haacke C, Althaus A, Spottke A, Siebert U, Back T, Dodel R: Long-term outcome after stroke: evaluating health-related quality of life using utility measurements. Stroke 2006;37:193–198.
  32. Appelros P, Nydevik I, Viitanen M: Poor outcome after first-ever stroke: predictors for death, dependency, and recurrent stroke within the first year. Stroke 2003;34:122–126.
  33. Sturm JW, Donnan GA, Dewey HM, et al: Quality of life after stroke: the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2004;35:2340–2345.
  34. Jorgensen HS, Reith J, Nakayama H, Kammersgaard LP, Raaschou HO, Olsen TS: What determines good recovery in patients with the most severe strokes? The Copenhagen Stroke Study. Stroke 1999;30:2008–2012.
  35. Varona JF, Bermejo F, Guerra JM, Molina JA: Long-term prognosis of ischemic stroke in young adults: study of 272 cases. J Neurol 2004;251:1507–1514.
  36. Srikanth VK, Quinn SJ, Donnan GA, Saling MM, Thrift AG: Long-term cognitive transitions, rates of cognitive change, and predictors of incident dementia in a population-based first-ever stroke cohort. Stroke 2006;37:2479–2483.
  37. Vemmos KN, Bots ML, Tsibouris PK, et al: Prognosis of stroke in the south of Greece: 1 year mortality, functional outcome and its determinants: the Arcadia Stroke Registry. J Neurol Neurosurg Psychiatry 2000;69:595–5600.
  38. Indredavik B, Rohweder G, Naalsund E, Lydersen S: Medical complications in a comprehensive stroke unit and an early supported discharge service. Stroke 2008;39:414–420.
  39. Rocco A, Pasquini M, Cecconi E, et al: Monitoring after the acute stage of stroke: a prospective study. Stroke 2007;38:1225–1228.
  40. McLean DE: Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation. Arch Phys Med Rehabil 2004;85:466–469.
  41. Roth EJ, Lovell L, Harvey RL, Heinemann AW, Semik P, Diaz S: Incidence of and risk factors for medical complications during stroke rehabilitation. Stroke 2001;32:523–529.
  42. Langhorne P, Stott DJ, Robertson L, et al: Medical complications after stroke: a multicenter study. Stroke 2000;31:1223–1229.
  43. Davenport RJ, Dennis MS, Wellwood I, Warlow CP: Complications after acute stroke. Stroke 1996;27:415–420.
  44. Erhan H, Ochoa E, Borod J, Feinberg T: Consequences of right cerebrovascular accident on emotional functioning: diagnostic and treatment implications. CNS Spectr 2000;5:25–38.
  45. Feigin VL, Barker-Collo S, Parag V, et al: Auckland Stroke Outcomes Study. 1. Gender, stroke types, ethnicity, and functional outcomes 5 years poststroke. Neurology 2010;75:1597–1607.
  46. Barker-Collo S, Feigin VL, Parag V, Lawes CM, Senior H: Auckland Stroke Outcomes Study. 2. Cognition and functional outcomes 5 years poststroke. Neurology 2010;75:1608–1616.
  47. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting of observational studies. Internist (Berl) 2008;49:688–693.
  48. Sanderson S, Tatt ID, Higgins JP: Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol 2007;36:666–676.
  49. Shamliyan T, Kane RL, Dickinson S: A systematic review of tools used to assess the quality of observational studies that examine incidence or prevalence and risk factors for diseases. J Clin Epidemiol 2010;63:1061–1070.
  50. Hedges L, Olkin I: Statistical Methods for Meta-analysis. San Diego, Academic Press, 1985.
  51. Sterne JA, Egger M, Smith GD: Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis. BMJ 2001;323:101–105.
  52. Barendregt JJ, Van Oortmarssen GJ, Vos T, Murray CJ: A generic model for the assessment of disease epidemiology: the computational basis of DisMod II. Popul Health Metr 2003;1:4.
  53. Truelsen T, Begg S, Mathers C: Global Burden of Cerebrovascular Disease in the Year 2000. Geneva, World Health Organization, 2002.
  54. Katzenellenbogen JM, Begg S, Somerford P, et al: Disability burden due to stroke in Western Australia: new insights from linked data sources. Int J Stroke 2010;5:269–277.
  55. Institute for Health Metrics and Evaluation University of Washington: Global Burden of Diseases, Injuries and Risk Factors Study Operations Manual, 2009.
  56. Post PN, Stiggelbout AM, Wakker PP: The utility of health states after stroke: a systematic review of the literature. Stroke 2001;32:1425–1429.

 goto top of outline Author Contacts

Derrick A. Bennett
Clinical Trials Service Unit, Richard Doll Building, Old Road Campus
Roosevelt Drive
Oxford OX3 7LF (UK)
Tel. +44 1865 743949, E-Mail derrick.bennett@ctsu.ox.ac.uk

 goto top of outline Article Information

Received: February 16, 2011
Accepted: November 1, 2011
Published online: December 17, 2011
Number of Print Pages : 11
Number of Figures : 4, Number of Tables : 4, Number of References : 56

 goto top of outline Publication Details


Vol. 38, No. 1, Year 2012 (Cover Date: January 2012)

Journal Editor: Feigin V.L. (Auckland)
ISSN: 0251-5350 (Print), eISSN: 1423-0208 (Online)

For additional information: http://www.karger.com/NED

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