Camille Lecoffre1, Christine de Peretti1, Amélie Gabet1, Olivier Grimaud1, France Woimant1, Maurice Giroud1, Yannick Béjot1, Valérie Olié2. 1. From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, France (M.G., Y.B.). 2. From the French Public Health Agency, Saint-Maurice, France (C.L., A.G., V.O.); Directorate for Research, Studies, Assessment and Statistics (DREES), Ministry of Social Affairs and Health, Paris, France (C.d.P.); French School of Public Health (EHESP), Rennes, France (O.G.); UPRES-EA-7449 REPERES, Rennes, France (O.G.); Agence Régionale de Santé Ile-de-France, Paris, France (F.W.); Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, France (F.W.); and the Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, France (M.G., Y.B.). valerie.olie@santepubliquefrance.fr.
Abstract
BACKGROUND AND PURPOSE: Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, <65 years old), an increase in the incidence of ischemic stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. METHODS: Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. RESULTS: From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients <65 years old and decreased by 1.5% in those aged ≥65 years. The rate of patients hospitalized for hemorrhagic stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. CONCLUSIONS: An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management.
BACKGROUND AND PURPOSE:Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, <65 years old), an increase in the incidence of ischemic stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. METHODS: Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. RESULTS: From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients <65 years old and decreased by 1.5% in those aged ≥65 years. The rate of patients hospitalized for hemorrhagic stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. CONCLUSIONS: An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management.
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