Journal of Stroke and Cerebrovascular Diseases
Original ArticlesDevelopment and validation of a model to estimate stroke incidence in a population*,**
Section snippets
The stroke model
The models assumptions were derived from published studies in the stroke medical literature and through discussions with opinion leaders in stroke epidemiology throughout the world.8, 9, 10, 11 A Medline search using the queries, stroke, epidemiology, incidence, and prevalence resulted in over 100 relevant articles, which provided information that was used to develop the models logic. Statistical information was also obtained from the following organizations: the American Heart Association, the
Model software
This proprietary model uses a Microsoft Windows operating system and requires data entry of the defined population over the age of 45 years by age and gender in 10-year increments. Risk factor prevalence is entered for all risk factors. Outputs of the model include predicted baseline annual first strokes and total annual first strokes (after adjusting for the effect of risk factors).
Results
The two cohort populations differed in their risk factor prevalence profiles, cohort size, and demographics (Tables 1 and 2).The Copenhagen cohort (Table 1) for the time periods evaluated was approximately 13,000, while the NOMASS cohort (Table 2) was comprised of 806 and 1060 participants for 1995 and 1996, respectively.
The NOMASS cohort was predominantly Caribbean-Hispanic (46% in 1995 and 40% in 1996) and African American (33% and 35%, respectively), while the Copenhagen cohort was
Discussion
Accurate epidemiological data are required to optimize planning for health care services, such as training of specialists, types of hospital and support services provided, implementation of public health programs, etc. Most countries lack accurate data regarding the true burden of stroke in their populations. Additionally, measures using hospitalization rates or administrative claims are not always an accurate reflection of stroke incidence.20, 21, 22 We present a model that utilizes commonly
Conclusion
As populations age, the impact of stroke on the population and the resultant economics of health care will grow. Although the ranking of stroke as a cause of death may not change in the near-term, acute stroke and its attendant disability is projected to increase worldwide in the next two decades. Our stroke model appears to be a useful tool for estimating annual first strokes within a population. This evidence-based model can be utilized by health care policy-makers and educators to predict
Acknowledgements
The authors would like to thank Dave Laitenen, MPH, for his analytic and technical assistance.
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Supported by Boehringer Ingelheim, GmbH, Ingelheim, Germany. The Northem Manhattan Stroke Study is supported by grants from NINDS (R01 NS 27517, 29993). The majority of the work was performed at Protocare Sciences in Santa Monica, CA.
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Address reprint requests to: Carol Zaher, MD, MBA, MPH, Protocare Sciences, 2400 Broadway, Suite 100, Santa Monica, CA 90404.