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Incidence, Early Case Fatality and Determinants of Stroke in Iran: Golestan Cohort Study Publisher Pubmed



Motamedgorji N1 ; Hariri S1 ; Masoudi S1 ; Sharafkhah M1 ; Nalini M2 ; Oveisgharan S3 ; Khoshnia M1 ; Motamedgorji N1 ; Gharavi A1 ; Etemadi A5 ; Poustchi H1 ; Zand R6, 7 ; Malekzadeh R8
Authors
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Authors Affiliations
  1. 1. Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
  3. 3. Rush Alzheimer Disease Research Center, Rush University Medical Center, Chicago, IL, United States
  4. 4. Iran University of Medical Sciences, Tehran, Iran
  5. 5. Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, United States
  6. 6. Neuroscience Institute, Penn State University, Hershey, PA, United States
  7. 7. Neuroscience Institute, Geisinger, Danville, PA, United States
  8. 8. Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

Source: Journal of Stroke and Cerebrovascular Diseases Published:2022


Abstract

Objectives: While few studies investigated the incidence of stroke in Iran, no Iranian cohort has estimated the standardized-incidence rate and early fatality of first-ever-stroke subtypes along with associated factors. Methods: Golestan Cohort Study is a prospective study launched in northeastern Iran in 2004, including 50,045 individuals aged 40-75 at baseline. Age-standardized incidence rate of first-ever-stroke was calculated per 100,000 person-years, according to World Standard Population. The 28-day case fatality was calculated by dividing the number of fatal first-ever-stroke during the first 28 days by total events. Cox proportional hazard models were conducted to assess incidence and fatality risk factors. We used Population Attributable Fractions to estimate the incidence and early fatality proportions reduced by ideal risk factor control. Results: 1,135 first-ever-strokes were observed during 8.6 (median) years follow-up. First-ever-stroke standardized incidence rate was estimated 185.2 (95% CI: 173.2-197.2) per 100,000 person-years. The 28-day case fatality was 44.1% (95% CI: 40.4-48.2). Hypertension and pre-stroke physical activity were the strongest risk factors associated with first-ever-stroke incidence (Hazard ratio: 2.83; 2.47-3.23) and 28-day case fatality (Hazard ratio: 0.59; 0.44-0.78), respectively. Remarkably, opium consumption was strongly associated with hemorrhagic stroke incidence (Hazard ratio: 1.52; 1.04-2.23) and ischemic stroke fatality (Hazard ratio: 1.44; 1.01-2.09). Overall, modifiable risk factors contributed to 83% and 61% of first-ever-stroke incidence and early fatality, respectively. Conclusion: Efficient risk factor control can considerably reduce stroke occurrence and fatality in our study. Establishing awareness campaigns and 24-hour stroke units seem necessary for improving the stroke management in this area. © 2022 Elsevier Inc.
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