Pub Date : 2024-10-01Epub Date: 2024-05-26DOI: 10.1177/17474930241255560
Sara Álvarez-Zaballos, Pilar Vázquez-Alen, Patricia Muñoz, Arístides de Alarcón, Encarnación Gutiérrez Carretero, Ana Álvarez-Uría, Mª Carmen Fariñas, Raquel Rodríguez-García, Miguel Ángel Goenaga, Guillermo Cuervo, Antonio Plata-Ciezar, Carmen Hidalgo-Tenorio, Gonzalo Aldamiz-Echevarría, Manuel Martínez-Sellés
Background: Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national cohort of IE.
Methods: Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021.
Results: Out of 5667 IE cases, 1125 had acute stroke (19.8%): 818 ischemic strokes (811 cardioembolic strokes (193 with hemorrhagic transformation), 4 transient ischemic attacks, 3 lacunar infarctions), 127 intracranial hemorrhages, and 27 other neurological complications (cerebral abscesses, encephalitis, and meningitis). Compared to patients without stroke, those with stroke had a similar mean age (69 years) but were more frequently female (68.2% vs 63.7%, p = 0.04) and had a higher incidence of intracardiac complications (35% vs 30%, p = 0.01), surgical indication (69.9% vs 65.9%, p = 0.001), in-hospital mortality (40.9% vs 22.0%, p < 0.001), and 1-year mortality (46.2% vs 27.9%, p < 0.001). The following variables were independently associated with stroke: mitral location (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.34-1.8, p < 0.001), vascular phenomenon (OR = 2.9, 95% CI = 2.4-3.6, p = 0.0001), acute renal failure (OR = 1.2, 95% CI = 1.0-1.4, p = 0.021), septic shock (OR = 1.3, 95% CI = 1.1-1.6, p = 0.007), sepsis (OR = 1.3, 95% CI = 1.1-1.6, p = 0.005), surgery indicated but not performed (OR = 1.4, 95% CI = 1.2-1.7, p < 0.001), community-acquired IE (OR = 1.2, 95% CI = 1-1.4, p = 0.017), and peripheral embolization (OR = 1.6, 95% CI = 1.4-1.9, p < 0.001). Stroke was an independent predictor of in-hospital (OR = 2.1, 95% CI = 1.78-2.51, p < 0.001) and 1-year mortality (hazard ratio = 1.9, 95% CI = 1.6-2.5).
Conclusion: One-fifth of patients with IE have concomitant stroke. Stroke is associated with mortality.
{"title":"Prevalence and prognostic impact of stroke in a national cohort of infective endocarditis.","authors":"Sara Álvarez-Zaballos, Pilar Vázquez-Alen, Patricia Muñoz, Arístides de Alarcón, Encarnación Gutiérrez Carretero, Ana Álvarez-Uría, Mª Carmen Fariñas, Raquel Rodríguez-García, Miguel Ángel Goenaga, Guillermo Cuervo, Antonio Plata-Ciezar, Carmen Hidalgo-Tenorio, Gonzalo Aldamiz-Echevarría, Manuel Martínez-Sellés","doi":"10.1177/17474930241255560","DOIUrl":"10.1177/17474930241255560","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national cohort of IE.</p><p><strong>Methods: </strong>Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021.</p><p><strong>Results: </strong>Out of 5667 IE cases, 1125 had acute stroke (19.8%): 818 ischemic strokes (811 cardioembolic strokes (193 with hemorrhagic transformation), 4 transient ischemic attacks, 3 lacunar infarctions), 127 intracranial hemorrhages, and 27 other neurological complications (cerebral abscesses, encephalitis, and meningitis). Compared to patients without stroke, those with stroke had a similar mean age (69 years) but were more frequently female (68.2% vs 63.7%, p = 0.04) and had a higher incidence of intracardiac complications (35% vs 30%, p = 0.01), surgical indication (69.9% vs 65.9%, p = 0.001), in-hospital mortality (40.9% vs 22.0%, p < 0.001), and 1-year mortality (46.2% vs 27.9%, p < 0.001). The following variables were independently associated with stroke: mitral location (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.34-1.8, p < 0.001), vascular phenomenon (OR = 2.9, 95% CI = 2.4-3.6, p = 0.0001), acute renal failure (OR = 1.2, 95% CI = 1.0-1.4, p = 0.021), septic shock (OR = 1.3, 95% CI = 1.1-1.6, p = 0.007), sepsis (OR = 1.3, 95% CI = 1.1-1.6, p = 0.005), surgery indicated but not performed (OR = 1.4, 95% CI = 1.2-1.7, p < 0.001), community-acquired IE (OR = 1.2, 95% CI = 1-1.4, p = 0.017), and peripheral embolization (OR = 1.6, 95% CI = 1.4-1.9, p < 0.001). Stroke was an independent predictor of in-hospital (OR = 2.1, 95% CI = 1.78-2.51, p < 0.001) and 1-year mortality (hazard ratio = 1.9, 95% CI = 1.6-2.5).</p><p><strong>Conclusion: </strong>One-fifth of patients with IE have concomitant stroke. Stroke is associated with mortality.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Heat and heatwave have been associated with stroke morbidity, but it is still unclear whether immigrants from different geographic regions and patients with comorbidity are more vulnerable to heat and heatwave.
Methods: Time-stratified case-crossover design combined with generalized additive quasi-Poisson models were used to quantify the relative risks (RRs) of heat and heatwave on first-ever stroke morbidity during 0-7 lag days. Attributable fractions (AFs) were estimated to assess the first-ever stroke morbidity burden due to heat and heatwave. Stratified analyses for sex, age, disease subtypes, resident characteristics, and comorbidity type were performed to identify potential modification effects.
Results: Heat and heatwave were associated with first-ever stroke morbidity, with the AF of 2.535% (95% empirical confidence interval (eCI) = 0.748, 4.205) and 2.409% (95% confidence interval (CI) = 1.228, 3.400), respectively. Among northern and southern immigrants, the AF for heat was 2.806% (0.031, 5.069) and 2.798% (0.757, 4.428), respectively, and the AF for heatwave was 2.918% (0.561, 4.618) and 2.387% (1.174, 3.398), respectively, but the effects of both on natives were statistically insignificant. Among patients with hypertension, dyslipidemia, or diabetes, the AF for heat was 3.318% (1.225, 5.007), 4.237% (1.037, 6.770), and 4.860% (1.171, 7.827), respectively, and the AF for heatwave was 2.960% (1.701, 3.993), 2.771% (0.704, 4.308), and 2.652% (0.653, 4.185), respectively. However, the effects of both on patients without comorbidity were statistically insignificant.
Conclusion: Heat and heatwave are associated with an increased risk of first-ever stroke morbidity among immigrants and those with comorbid hypertension, dyslipidemia, or diabetes, with the effects primarily due to non-native individuals.
Data access statement: The author(s) are not authorized to share the data.
{"title":"Modification effects of immigration status and comorbidities on associations of heat and heatwave with stroke morbidity.","authors":"Chenlu Yang, Yike Li, Cunrui Huang, Yonglin Hou, Dandan Chu, Junzhe Bao","doi":"10.1177/17474930241263725","DOIUrl":"10.1177/17474930241263725","url":null,"abstract":"<p><strong>Background: </strong>Heat and heatwave have been associated with stroke morbidity, but it is still unclear whether immigrants from different geographic regions and patients with comorbidity are more vulnerable to heat and heatwave.</p><p><strong>Methods: </strong>Time-stratified case-crossover design combined with generalized additive quasi-Poisson models were used to quantify the relative risks (RRs) of heat and heatwave on first-ever stroke morbidity during 0-7 lag days. Attributable fractions (AFs) were estimated to assess the first-ever stroke morbidity burden due to heat and heatwave. Stratified analyses for sex, age, disease subtypes, resident characteristics, and comorbidity type were performed to identify potential modification effects.</p><p><strong>Results: </strong>Heat and heatwave were associated with first-ever stroke morbidity, with the AF of 2.535% (95% empirical confidence interval (eCI) = 0.748, 4.205) and 2.409% (95% confidence interval (CI) = 1.228, 3.400), respectively. Among northern and southern immigrants, the AF for heat was 2.806% (0.031, 5.069) and 2.798% (0.757, 4.428), respectively, and the AF for heatwave was 2.918% (0.561, 4.618) and 2.387% (1.174, 3.398), respectively, but the effects of both on natives were statistically insignificant. Among patients with hypertension, dyslipidemia, or diabetes, the AF for heat was 3.318% (1.225, 5.007), 4.237% (1.037, 6.770), and 4.860% (1.171, 7.827), respectively, and the AF for heatwave was 2.960% (1.701, 3.993), 2.771% (0.704, 4.308), and 2.652% (0.653, 4.185), respectively. However, the effects of both on patients without comorbidity were statistically insignificant.</p><p><strong>Conclusion: </strong>Heat and heatwave are associated with an increased risk of first-ever stroke morbidity among immigrants and those with comorbid hypertension, dyslipidemia, or diabetes, with the effects primarily due to non-native individuals.</p><p><strong>Data access statement: </strong>The author(s) are not authorized to share the data.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-07-31DOI: 10.1177/17474930241259940
Leng Chieh Lin, Tsong-Hai Lee, Yen Chu Huang, Yuan Hsiung Tsai, Jen Tsung Yang, Lan Yan Yang, Yu-Bin Pan, Meng Lee, Kuan-Fu Chen, Yu-Cheng Hung, Hsien-Hung Cheng, I-Neng Lee, Ming Hsueh Lee, Tefa Chiu, Yeu-Jhy Chang, Zhong Ning Leonard Goh, Chen-June Seak
Rationale: Early neurological deterioration (END) within 72 h of stroke onset is associated with poor prognosis. Optimizing hydration might reduce the risk of END.
Aims: This study aimed to determine in acute ischemic stroke patients if enhanced hydration versus standard hydration reduced the incidence of major (primary) and minor (secondary) END, as well as whether it increased the incidence of early neurological improvement (secondary), at 72 h after admission.
Sample size estimate: A total of 244 participants per arm.
Methods and design: A prospective, double-blinded, multicenter, parallel-group, randomized controlled trial conducted at four hospitals from April 2014 to July 2020, with data analyzed in August 2020. The sample size estimated was 488 participants (244 per arm). Ischemic stroke patients with measurable neurological deficits of onset within 12 h of emergency department presentation and blood urea nitrogen/creatinine (BUN/Cr) ratio ⩾ 15 at point of admission were enrolled and randomized to 0.9% sodium chloride infusions of varying rates-enhanced hydration (20 mL/kg body weight, one-third given via bolus and remainder over 8 h) versus standard hydration (60 mL/h for 8 h), followed by maintenance infusion of 40-80 mL/h for the subsequent 64 h. The primary outcome measure was the incidence of major END at 72 h after admission, defined as an increase in National Institutes of Health Stroke Scale of ⩾ 4 points from baseline.
Results: Overall, 487 participants were randomized (median age 67 years; 287 females). At 72 h, 7 (2.9%) in the enhanced hydration arm and 5 (2.0%) in the standard hydration developed major END (p = 0.54). The incidence of minor END and early neurological improvement did not differ between treatment arms.
Conclusion and relevance: Enhanced hydration did not reduce END or improve short-term outcomes in acute ischemic stroke.
{"title":"Enhanced versus standard hydration in acute ischemic stroke: REVIVE-A randomized clinical trial.","authors":"Leng Chieh Lin, Tsong-Hai Lee, Yen Chu Huang, Yuan Hsiung Tsai, Jen Tsung Yang, Lan Yan Yang, Yu-Bin Pan, Meng Lee, Kuan-Fu Chen, Yu-Cheng Hung, Hsien-Hung Cheng, I-Neng Lee, Ming Hsueh Lee, Tefa Chiu, Yeu-Jhy Chang, Zhong Ning Leonard Goh, Chen-June Seak","doi":"10.1177/17474930241259940","DOIUrl":"10.1177/17474930241259940","url":null,"abstract":"<p><strong>Rationale: </strong>Early neurological deterioration (END) within 72 h of stroke onset is associated with poor prognosis. Optimizing hydration might reduce the risk of END.</p><p><strong>Aims: </strong>This study aimed to determine in acute ischemic stroke patients if enhanced hydration versus standard hydration reduced the incidence of major (primary) and minor (secondary) END, as well as whether it increased the incidence of early neurological improvement (secondary), at 72 h after admission.</p><p><strong>Sample size estimate: </strong>A total of 244 participants per arm.</p><p><strong>Methods and design: </strong>A prospective, double-blinded, multicenter, parallel-group, randomized controlled trial conducted at four hospitals from April 2014 to July 2020, with data analyzed in August 2020. The sample size estimated was 488 participants (244 per arm). Ischemic stroke patients with measurable neurological deficits of onset within 12 h of emergency department presentation and blood urea nitrogen/creatinine (BUN/Cr) ratio ⩾ 15 at point of admission were enrolled and randomized to 0.9% sodium chloride infusions of varying rates-enhanced hydration (20 mL/kg body weight, one-third given via bolus and remainder over 8 h) versus standard hydration (60 mL/h for 8 h), followed by maintenance infusion of 40-80 mL/h for the subsequent 64 h. The primary outcome measure was the incidence of major END at 72 h after admission, defined as an increase in National Institutes of Health Stroke Scale of ⩾ 4 points from baseline.</p><p><strong>Results: </strong>Overall, 487 participants were randomized (median age 67 years; 287 females). At 72 h, 7 (2.9%) in the enhanced hydration arm and 5 (2.0%) in the standard hydration developed major END (p = 0.54). The incidence of minor END and early neurological improvement did not differ between treatment arms.</p><p><strong>Conclusion and relevance: </strong>Enhanced hydration did not reduce END or improve short-term outcomes in acute ischemic stroke.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT02099383, https://clinicaltrials.gov/study/NCT02099383).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-07-31DOI: 10.1177/17474930241262638
Paula da Cruz Peniche, Christina Danielli Coelho de Morais Faria, Patricia Hall, Caitriona Fingleton, Louise McPhillips, Rebecca Gaetz, Aaron Roche, Laura McCann, Padraig O'Beaglaoich, Diarmuid Murphy, Julianne Hickey, Olive Lennon
Background: Impactful, evidence-based solutions in surveillance, prevention, acute care, and rehabilitation for stroke survivors are required to address the high global burden of stroke. Patient and public involvement (PPI), where patients, their families, and the public are actively involved as research partners, enhances the relevance, credibility, and impact of stroke-related research.
Aims: This scoping review, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Scoping Review guidelines, aims to identify and summarize how PPI is currently implemented and reported in empirical stroke research using a participatory approach.
Summary of review: A comprehensive search strategy was developed and implemented across Medline, CINAHL, EMBASE, PsynchINFO, and Cochrane electronic databases, supplemented by gray literature searches. Empirical stroke research articles in the English language, published from 2014 up to 2023, and documenting PPI activity were included. Of the 18,143 original articles identified, 2824 full-text manuscripts matching from this time window were screened. Only 2% (n = 72) of these directly reported embedded PPI activity in empirical research. The majority were qualitative in design (60%) and conducted in high-income countries (96%). Only one included study originated from a developing country, where the burden of stroke is highest. Most studies (94%) provided some information about the activities carried out with their PPI partners, mainly centered on the study design (57%) and management (64%), with only 4% of studies integrating PPI across all research cycle phases from funding application to dissemination. When studies were examined for compliance with the Guidance for Reporting Involvement of Patients and the Public (GRIPP) short-form checklist, only 11% of included studies were 100% compliant. Twenty-one studies (29%) reported barriers and facilitators to including PPI in stroke research. Organization, authentic partnership, and experienced PPI representatives were common facilitators and identified barriers reflected concerns around adequate funding, time required, and diversity in perspectives. A positive reporting bias for PPI impact was observed, summarized as keeping the patient perspective central to the research process, improved care of study participants, validation of study findings, and improved communication/lay-summaries of complex research concepts.
Conclusions: PPI is underutilized and inconsistently reported in current empirical stroke research. PPI must become more widely adopted, notably in low- and middle-income countries. Consensus-driven standards for inclusion of PPI by funding organizations and publishers are required to support its widespread adoption.
背景:要解决中风给全球带来的沉重负担,需要在监测、预防、急性期治疗和康复方面为中 风幸存者提供有影响力的循证解决方案。患者和公众参与(Patient and Public Involvement,PPI),即患者、患者家属和公众作为研究伙伴积极参与,可提高中风相关研究的相关性、可信度和影响力。目的:本范围界定综述遵循 PRISMA 范围界定综述指南,旨在确定和总结目前在实证中风研究中如何使用参与式方法实施和报告 PPI:制定并实施了全面的检索策略,涵盖 Medline、CINAHL、EMBASE、PsynchINFO 和 Cochrane 电子数据库,并辅以灰色文献检索。纳入了从 2014 年到 2023 年发表的、记录 PPI 活动的英文脑卒中实证研究论文。在确定的 18,143 篇原始论文中,筛选了 2,824 篇与该时间窗口匹配的全文手稿。其中只有 2%(n=72)直接报告了实证研究中的嵌入式 PPI 活动。大多数研究采用定性设计(60%),在高收入国家进行(96%)。只有一项纳入的研究来自中风负担最重的发展中国家。大多数研究(94%)提供了一些有关与其 PPI 合作伙伴开展活动的信息,主要集中在研究设计(57%)和管理(64%)方面,只有 4% 的研究将 PPI 纳入了从资金申请到传播的所有研究周期阶段。在检查研究是否符合《患者和公众参与报告指南》(GRIPP2)简表清单时,只有 11% 的纳入研究 100%符合要求。21项研究(29%)报告了将患者和公众参与纳入卒中研究的障碍和促进因素。组织、真实的合作关系和经验丰富的 PPI 代表是常见的促进因素,已确定的障碍反映了对充足资金、所需时间和观点多样性的担忧。研究发现,PPI 的影响存在积极的报告偏差,概括为将患者视角置于研究过程的中心位置、改善对研究参与者的护理、验证研究结果以及改善复杂研究概念的沟通/非专业总结:结论:在目前的卒中实证研究中,PPI 未得到充分利用,报告也不一致。必须更广泛地采用 PPI,尤其是在中低收入国家。为支持 PPI 的广泛采用,资助机构和出版商需要制定以共识为导向的 PPI 纳入标准。
{"title":"A scoping review of patient and public involvement in empirical stroke research.","authors":"Paula da Cruz Peniche, Christina Danielli Coelho de Morais Faria, Patricia Hall, Caitriona Fingleton, Louise McPhillips, Rebecca Gaetz, Aaron Roche, Laura McCann, Padraig O'Beaglaoich, Diarmuid Murphy, Julianne Hickey, Olive Lennon","doi":"10.1177/17474930241262638","DOIUrl":"10.1177/17474930241262638","url":null,"abstract":"<p><strong>Background: </strong>Impactful, evidence-based solutions in surveillance, prevention, acute care, and rehabilitation for stroke survivors are required to address the high global burden of stroke. Patient and public involvement (PPI), where patients, their families, and the public are actively involved as research partners, enhances the relevance, credibility, and impact of stroke-related research.</p><p><strong>Aims: </strong>This scoping review, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Scoping Review guidelines, aims to identify and summarize how PPI is currently implemented and reported in empirical stroke research using a participatory approach.</p><p><strong>Summary of review: </strong>A comprehensive search strategy was developed and implemented across Medline, CINAHL, EMBASE, PsynchINFO, and Cochrane electronic databases, supplemented by gray literature searches. Empirical stroke research articles in the English language, published from 2014 up to 2023, and documenting PPI activity were included. Of the 18,143 original articles identified, 2824 full-text manuscripts matching from this time window were screened. Only 2% (n = 72) of these directly reported embedded PPI activity in empirical research. The majority were qualitative in design (60%) and conducted in high-income countries (96%). Only one included study originated from a developing country, where the burden of stroke is highest. Most studies (94%) provided some information about the activities carried out with their PPI partners, mainly centered on the study design (57%) and management (64%), with only 4% of studies integrating PPI across all research cycle phases from funding application to dissemination. When studies were examined for compliance with the Guidance for Reporting Involvement of Patients and the Public (GRIPP) short-form checklist, only 11% of included studies were 100% compliant. Twenty-one studies (29%) reported barriers and facilitators to including PPI in stroke research. Organization, authentic partnership, and experienced PPI representatives were common facilitators and identified barriers reflected concerns around adequate funding, time required, and diversity in perspectives. A positive reporting bias for PPI impact was observed, summarized as keeping the patient perspective central to the research process, improved care of study participants, validation of study findings, and improved communication/lay-summaries of complex research concepts.</p><p><strong>Conclusions: </strong>PPI is underutilized and inconsistently reported in current empirical stroke research. PPI must become more widely adopted, notably in low- and middle-income countries. Consensus-driven standards for inclusion of PPI by funding organizations and publishers are required to support its widespread adoption.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-07-31DOI: 10.1177/17474930241264685
Andrew Smyth, Graeme J Hankey, Peter Langhorne, Catriona Reddin, Danuta Ryglewicz, Annika Rosengren, Dennis Xavier, Michelle Canavan, Shahram Oveisgharan, Xingyu Wang, Patricio Lopez Jaramillo, Albertino Damasceno, Anna Czlonkowska, Helle Klingenberg Iversen, Fernando Lanas, Salim Yusuf, Martin O'Donnell
Background: Stroke is a leading global cause of death and disability. Daily tea/coffee intake is consumed by > 50% of populations and may represent an important population-level exposure. Therefore, it is first essential that we better understand the associations between the tea/coffee intake and stroke.
Aims: This research aims to generate hypotheses about the global associations between tea and coffee intake and stroke. These insights will identify interventions for stroke prevention that can be further explored using alternative study designs.
Methods: INTERSTROKE is a large international matched case-control study of first stroke from 32 countries. Participants were asked "how many cups do you drink each day?" of coffee, green tea, black tea, and other tea. Multivariable conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between intake and stroke.
Results: We included 13,462 cases and 13,488 controls from INTERSTROKE; mean age was 61.7 (13.4) years and 59.6% (n = 16,010) were male. Overall, 19.4% (n = 5239) did not consume tea/coffee, 47.0% (n = 12,666) consumed tea only, 14.9% (n = 4024) consumed coffee alone, and 18.6% (n = 5021) consumed both, with significant regional variations. After multivariable adjustment, there was no association between low/moderate coffee intake and stroke, but high consumption (> 4/day) was associated with higher odds of all stroke (OR = 1.37 (95% CI = 1.06-1.77)) or ischemic stroke (OR = 1.32 (95% CI = 1.00-1.74)). Tea consumption was associated with lower odds of all (OR = 0.81 (95% CI = 0.69-0.94) for highest intake) or ischemic stroke (OR = 0.81 (95% CI = 0.68-0.98) for highest intake).
Conclusions: High coffee consumption was associated with higher odds of all or ischemic stroke; low-moderate coffee had no association with stroke. In contrast, tea consumption was associated with lower odds of stroke. These associations suggest that individuals consider avoiding high coffee consumption (⩾ five cups/day) to impact future stroke risk.
Data access statement: The design and rationale of INTERSTROKE was published previously. Individual participant data, or other documents are not available.
背景:中风是导致死亡和残疾的全球主要原因。每日摄入茶/咖啡的人群超过 50%,可能是重要的人群暴露。因此,我们首先必须更好地了解茶/咖啡摄入量与中风之间的关联。目的:本研究旨在就茶和咖啡摄入量与中风之间的全球关联提出假设。这些见解将确定预防中风的干预措施,可通过其他研究设计进一步探讨:INTERSTROKE是一项针对32个国家首次中风患者的大型国际匹配病例对照研究。参与者被问及 "您每天喝多少杯咖啡、绿茶、红茶和其他茶?研究采用多变量条件逻辑回归法估算摄入量与中风之间关系的几率比(OR)和 95% 置信区间(CI):我们纳入了来自 INTERSTROKE 的 13,462 例病例和 13,488 例对照;平均年龄为 61.7 (13.4) 岁,59.6%(n=16,010)为男性。总体而言,19.4%(n=5239)的人不喝茶/咖啡,47.0%(n=12666)的人只喝茶,14.9%(n=4024)的人只喝咖啡,18.6%(n=5021)的人既喝茶又喝咖啡,地区差异显著。经多变量调整后,低度/中度咖啡摄入量与中风之间没有关联,但高摄入量(>4/天)与较高的所有中风(OR 1.37 (95%CI 1.06-1.77))或缺血性中风(OR 1.32 (95%CI 1.00-1.74))几率有关。结论:大量饮用咖啡与所有中风(最高摄入量的 OR 为 0.81(95% CI 为 0.69-0.94))或缺血性中风(最高摄入量的 OR 为 0.81(95% CI 为 0.68-0.98))的几率较低有关:结论:大量饮用咖啡与较高的全部或缺血性中风几率有关;中低浓度咖啡与中风无关。相比之下,饮茶与中风的几率较低有关。这些关联表明,个人应考虑避免饮用大量咖啡(>=5 杯/天),以影响未来的中风风险:INTERSTROKE的设计和原理已于之前公布。未提供单个参与者数据或其他文件。
{"title":"Tea and coffee consumption and risk of acute stroke: The INTERSTROKE Study.","authors":"Andrew Smyth, Graeme J Hankey, Peter Langhorne, Catriona Reddin, Danuta Ryglewicz, Annika Rosengren, Dennis Xavier, Michelle Canavan, Shahram Oveisgharan, Xingyu Wang, Patricio Lopez Jaramillo, Albertino Damasceno, Anna Czlonkowska, Helle Klingenberg Iversen, Fernando Lanas, Salim Yusuf, Martin O'Donnell","doi":"10.1177/17474930241264685","DOIUrl":"10.1177/17474930241264685","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a leading global cause of death and disability. Daily tea/coffee intake is consumed by > 50% of populations and may represent an important population-level exposure. Therefore, it is first essential that we better understand the associations between the tea/coffee intake and stroke.</p><p><strong>Aims: </strong>This research aims to generate hypotheses about the global associations between tea and coffee intake and stroke. These insights will identify interventions for stroke prevention that can be further explored using alternative study designs.</p><p><strong>Methods: </strong>INTERSTROKE is a large international matched case-control study of first stroke from 32 countries. Participants were asked \"how many cups do you drink each day?\" of coffee, green tea, black tea, and other tea. Multivariable conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between intake and stroke.</p><p><strong>Results: </strong>We included 13,462 cases and 13,488 controls from INTERSTROKE; mean age was 61.7 (13.4) years and 59.6% (n = 16,010) were male. Overall, 19.4% (n = 5239) did not consume tea/coffee, 47.0% (n = 12,666) consumed tea only, 14.9% (n = 4024) consumed coffee alone, and 18.6% (n = 5021) consumed both, with significant regional variations. After multivariable adjustment, there was no association between low/moderate coffee intake and stroke, but high consumption (> 4/day) was associated with higher odds of all stroke (OR = 1.37 (95% CI = 1.06-1.77)) or ischemic stroke (OR = 1.32 (95% CI = 1.00-1.74)). Tea consumption was associated with lower odds of all (OR = 0.81 (95% CI = 0.69-0.94) for highest intake) or ischemic stroke (OR = 0.81 (95% CI = 0.68-0.98) for highest intake).</p><p><strong>Conclusions: </strong>High coffee consumption was associated with higher odds of all or ischemic stroke; low-moderate coffee had no association with stroke. In contrast, tea consumption was associated with lower odds of stroke. These associations suggest that individuals consider avoiding high coffee consumption (⩾ five cups/day) to impact future stroke risk.</p><p><strong>Data access statement: </strong>The design and rationale of INTERSTROKE was published previously. Individual participant data, or other documents are not available.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-10-09DOI: 10.1177/17474930241291618
Hugh S Markus
{"title":"Exercise to prevent stroke and dementia-World Stroke Day 2024.","authors":"Hugh S Markus","doi":"10.1177/17474930241291618","DOIUrl":"10.1177/17474930241291618","url":null,"abstract":"","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1177/17474930241282521
Veronika Hyytiäinen, Leena Ala-Mursula, Petteri Oura, Markus Paananen, Ville Karhunen, Harri Rusanen, Mirjam I Geerlings, Jouko Miettunen, Ina Rissanen
Background and aims: The incidence of cerebrovascular disease (CVD) is rising among young adults (< 55 years). The risk for CVD starts to form in early childhood and is comprised of genetic and environmental risk factors. The aim of this study is to investigate the relationship between early family socioeconomic status (SES), inherited risk, and CVD until midlife.
Methods: In the Northern Finland Birth Cohort 1966 of 12,058 children, individuals were followed from gestational period up to 54 years. We used previously published early family SES clusters, based on latent class analysis of a wide set of prenatally collected variables. We investigated inherited risk with polygenic risk score (PRS) and parental CVDs during follow-up. The associations of the five distinct clusters, inherited risk, and consequent risk for various types of CVDs until middle age were analyzed with Cox regression. All analyses were conducted first in the whole sample and then stratified by sex as is recommended in cardiovascular studies.
Results: During the follow-up of 586,943 person-years, 512 CVDs occurred. No clear association between SES clusters and CVD were found. Higher PRS associated with any CVD (hazard ratio (HR) per 1 SD increase: 1.15; 95% confidence interval (CI): 1.02-1.31), and ischemic CVD (HR: 1.21; 1.05-1.40). We found no combined associations of early family SES and inherited risk for CVD.
Conclusions: Inherited risk was associated with the risk for CVD in mid-life in Finnish population. We found no clear connection with early family SES and CVD. Being born to a specific SES group did not increase the effect of inherited risk.
Data access statement: NFBC1966 data are available from the University of Oulu, Infrastructure for Population Studies for researchers who meet the criteria for accessing confidential data. In the use of data, we follow the EU general data protection regulation (679/2016) and Finnish Data Protection Act. Permission to use the data can be applied for research purposes from https://www.oulu.fi/nfbc.
{"title":"Clusters of parental socioeconomic status in early childhood and inherited risk for cerebrovascular disease until mid-life-Northern Finland Birth Cohort 1966.","authors":"Veronika Hyytiäinen, Leena Ala-Mursula, Petteri Oura, Markus Paananen, Ville Karhunen, Harri Rusanen, Mirjam I Geerlings, Jouko Miettunen, Ina Rissanen","doi":"10.1177/17474930241282521","DOIUrl":"10.1177/17474930241282521","url":null,"abstract":"<p><strong>Background and aims: </strong>The incidence of cerebrovascular disease (CVD) is rising among young adults (< 55 years). The risk for CVD starts to form in early childhood and is comprised of genetic and environmental risk factors. The aim of this study is to investigate the relationship between early family socioeconomic status (SES), inherited risk, and CVD until midlife.</p><p><strong>Methods: </strong>In the Northern Finland Birth Cohort 1966 of 12,058 children, individuals were followed from gestational period up to 54 years. We used previously published early family SES clusters, based on latent class analysis of a wide set of prenatally collected variables. We investigated inherited risk with polygenic risk score (PRS) and parental CVDs during follow-up. The associations of the five distinct clusters, inherited risk, and consequent risk for various types of CVDs until middle age were analyzed with Cox regression. All analyses were conducted first in the whole sample and then stratified by sex as is recommended in cardiovascular studies.</p><p><strong>Results: </strong>During the follow-up of 586,943 person-years, 512 CVDs occurred. No clear association between SES clusters and CVD were found. Higher PRS associated with any CVD (hazard ratio (HR) per 1 SD increase: 1.15; 95% confidence interval (CI): 1.02-1.31), and ischemic CVD (HR: 1.21; 1.05-1.40). We found no combined associations of early family SES and inherited risk for CVD.</p><p><strong>Conclusions: </strong>Inherited risk was associated with the risk for CVD in mid-life in Finnish population. We found no clear connection with early family SES and CVD. Being born to a specific SES group did not increase the effect of inherited risk.</p><p><strong>Data access statement: </strong>NFBC1966 data are available from the University of Oulu, Infrastructure for Population Studies for researchers who meet the criteria for accessing confidential data. In the use of data, we follow the EU general data protection regulation (679/2016) and Finnish Data Protection Act. Permission to use the data can be applied for research purposes from https://www.oulu.fi/nfbc.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1177/17474930241283167
Lauri Bishop, Scott C Brown, Hannah E Gardener, Antonio J Bustillo, D Akeim George, Gillian Gordon Perue, Karlon H Johnson, Neva Kirk-Sanchez, Negar Asdaghi, Carolina M Gutierrez, Tatjana Rundek, Jose G Romano
Background and purpose: Social determinants of health (SDOH), including social networks, impact disability and quality of life post-stroke, yet the direct influence of SDOH on functional change remains undetermined. We aimed to identify which SDOH predict change on the modified Rankin Scale (mRS) within 90 days after stroke hospitalization.
Methods: Stroke patients from the Transitions of Care Stroke Disparities Study (TCSDS) were enrolled from 12 hospitals in the Florida Stroke Registry. TCSDS aims to identify disparities in hospital-to-home transitions after stroke. SDOH were collected by trained interviewers at hospital discharge. The mRS was assessed at discharge, 30- and 90-day post-stroke. Multinomial logistic regression models examined contributions of each SDOH to mRS improvement or worsening (compared to no change) from discharge to 30- and 90-day, respectively.
Results: Of 1190 participants, median age was 64 years, 42% were women, 52% were non-Hispanic White, and 91% had an ischemic stroke. Those with a limited social support network had greater odds of functional decline at 30 days (aOR = 1.39, 1.17-1.66), adjusting for age and onset to arrival time and at 90 days (aOR = 1.50, 1.10-2.05) after adjusting for age. Results were consistent after further adjustment for additional SDOH and participant characteristics. Individuals living with a spouse/partner had reduced odds of functional decline at 90 days (aOR = 0.74, 0.57-0.98); however, results were inconsistent with more conservative modeling approaches.
Conclusion: The findings highlight the importance of SDOH, specifically having a greater number of individuals in your social network in functional recovery after stroke.
{"title":"The association between social networks and functional recovery after stroke.","authors":"Lauri Bishop, Scott C Brown, Hannah E Gardener, Antonio J Bustillo, D Akeim George, Gillian Gordon Perue, Karlon H Johnson, Neva Kirk-Sanchez, Negar Asdaghi, Carolina M Gutierrez, Tatjana Rundek, Jose G Romano","doi":"10.1177/17474930241283167","DOIUrl":"10.1177/17474930241283167","url":null,"abstract":"<p><strong>Background and purpose: </strong>Social determinants of health (SDOH), including social networks, impact disability and quality of life post-stroke, yet the direct influence of SDOH on functional change remains undetermined. We aimed to identify which SDOH predict change on the modified Rankin Scale (mRS) within 90 days after stroke hospitalization.</p><p><strong>Methods: </strong>Stroke patients from the Transitions of Care Stroke Disparities Study (TCSDS) were enrolled from 12 hospitals in the Florida Stroke Registry. TCSDS aims to identify disparities in hospital-to-home transitions after stroke. SDOH were collected by trained interviewers at hospital discharge. The mRS was assessed at discharge, 30- and 90-day post-stroke. Multinomial logistic regression models examined contributions of each SDOH to mRS improvement or worsening (compared to no change) from discharge to 30- and 90-day, respectively.</p><p><strong>Results: </strong>Of 1190 participants, median age was 64 years, 42% were women, 52% were non-Hispanic White, and 91% had an ischemic stroke. Those with a limited social support network had greater odds of functional decline at 30 days (aOR = 1.39, 1.17-1.66), adjusting for age and onset to arrival time and at 90 days (aOR = 1.50, 1.10-2.05) after adjusting for age. Results were consistent after further adjustment for additional SDOH and participant characteristics. Individuals living with a spouse/partner had reduced odds of functional decline at 90 days (aOR = 0.74, 0.57-0.98); however, results were inconsistent with more conservative modeling approaches.</p><p><strong>Conclusion: </strong>The findings highlight the importance of SDOH, specifically having a greater number of individuals in your social network in functional recovery after stroke.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1177/17474930241281120
Henrik Sørensen, Erik L Grove, Johanne Andersen Hojbjerg, Asger Andersen, Jens Erik Nielsen-Kudsk, Claus Z Simonsen
Background: Patent foramen ovale (PFO) has been associated with ischemic stroke and transient ischemic attack (TIA). Guidelines recommend PFO closure for stroke prevention in selected patients, but the risk of recurrent stroke remains high compared to the background population. We aimed to evaluate the causes of recurrent stroke/TIA and post-interventional complications in patients after PFO closure.
Methods: Patients from the Central Denmark Region who underwent PFO closure at Aarhus University Hospital between November 5, 2018, and May 12, 2023, following an ischemic stroke, TIA, amaurosis fugax, or retinal emboli were included. Data on patient demographics, risk factors, procedural details, post-interventional complications, and recurrent stroke/TIA were collected from electronic medical records.
Results: PFO closure was performed in 310 patients (median age: 49 years). During a median follow-up of 2.6 years (interquartile range: 1.5-3.6, 814 total patient-years), recurrent stroke/TIA was observed in 8 patients (2.6%), or 0.98 recurrent strokes per 100 patient-years. Recurrent stroke/TIA was more frequent in patients with hypertension (50.0% vs. 16.9%, p = 0.039). Recurrent stroke/TIA was related to thrombophilia or hematologic conditions entailing hypercoagulability in 62.5% of patients. New-onset atrial fibrillation was observed in 9.4% of patients within 45 days after the procedure. None of these patients subsequently developed an ischemic event. Other adverse outcomes were uncommon.
Conclusion: Rates of recurrent ischemic stroke/TIA after PFO closure were comparable to findings in previous trials. Pre-existing vascular risk factors (hypertension), and a hypercoagulable state were associated with recurrent ischemic stroke/TIA.
{"title":"Recurrent ischemic stroke/transient ischemic attack after patent foramen ovale closure: A cohort study.","authors":"Henrik Sørensen, Erik L Grove, Johanne Andersen Hojbjerg, Asger Andersen, Jens Erik Nielsen-Kudsk, Claus Z Simonsen","doi":"10.1177/17474930241281120","DOIUrl":"10.1177/17474930241281120","url":null,"abstract":"<p><strong>Background: </strong>Patent foramen ovale (PFO) has been associated with ischemic stroke and transient ischemic attack (TIA). Guidelines recommend PFO closure for stroke prevention in selected patients, but the risk of recurrent stroke remains high compared to the background population. We aimed to evaluate the causes of recurrent stroke/TIA and post-interventional complications in patients after PFO closure.</p><p><strong>Methods: </strong>Patients from the Central Denmark Region who underwent PFO closure at Aarhus University Hospital between November 5, 2018, and May 12, 2023, following an ischemic stroke, TIA, amaurosis fugax, or retinal emboli were included. Data on patient demographics, risk factors, procedural details, post-interventional complications, and recurrent stroke/TIA were collected from electronic medical records.</p><p><strong>Results: </strong>PFO closure was performed in 310 patients (median age: 49 years). During a median follow-up of 2.6 years (interquartile range: 1.5-3.6, 814 total patient-years), recurrent stroke/TIA was observed in 8 patients (2.6%), or 0.98 recurrent strokes per 100 patient-years. Recurrent stroke/TIA was more frequent in patients with hypertension (50.0% vs. 16.9%, p = 0.039). Recurrent stroke/TIA was related to thrombophilia or hematologic conditions entailing hypercoagulability in 62.5% of patients. New-onset atrial fibrillation was observed in 9.4% of patients within 45 days after the procedure. None of these patients subsequently developed an ischemic event. Other adverse outcomes were uncommon.</p><p><strong>Conclusion: </strong>Rates of recurrent ischemic stroke/TIA after PFO closure were comparable to findings in previous trials. Pre-existing vascular risk factors (hypertension), and a hypercoagulable state were associated with recurrent ischemic stroke/TIA.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.3,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1177/17474930241288033
Yusheng Zhou,Teresa Gisinger,Simon D Lindner,Valeria Raparelli,Colleen M Norris,Alexandra Kautzky-Willer,Louise Pilote
BACKGROUNDStroke is a leading cause of long-term disability among survivors. Past literature already investigated the biological sex differences in stroke outcome, still limited work on gender differences is published. Therefore, the study aimed at investigating whether biological sex and sociocultural gender of survivors play a role as determinants of disability and quality of life among stroke survivors across Europe and Canada.METHODSData were gathered from the European Health Information Survey (EHIS, n=316,333) and Canadian Community Health Survey (CCHS, n=127,462) datasets. Main outcomes of interest were disability, assessed through evaluating the impairment of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (iADL), and inpatient care needs, such as hospitalization or institutionalization. Multivariate logistic regression models were utilized to identify factors independently associated with outcomes. Federated analysis was conducted for cross-country comparisons. Data were adjusted for the country-specific Gender Inequality Index (GII), with higher score corresponding to more gender inequality towards femalesResults: Female survivors showed greater impairments in iADL (OR=1.73, 95% CI 1.53 - 1.96) and ADL (OR=1.25, 95% CI 1.09-1.44), without a corresponding increase in inpatient care needs. Socioeconomic factors such as marital status and income level were significant predictors of disability, with low income and being single/divorced associated with higher risks. The impact of sex was more pronounced in countries with higher GII, indicating the influence of gender inequality on stroke outcomes.INTERPRETATIONThe findings highlight the significant impact of biological sex and gender-related social determinants on post-stroke disability, with female sex and unfavorable socioeconomic conditions being associated with worse outcomes.
背景脑卒中是导致幸存者长期残疾的主要原因。过去的文献已经研究了中风结局中的生理性别差异,但有关性别差异的研究仍然有限。因此,本研究旨在调查欧洲和加拿大中风幸存者的生理性别和社会文化性别是否对残疾和生活质量起决定作用。方法数据收集自欧洲健康信息调查(EHIS,n=316,333)和加拿大社区健康调查(CCHS,n=127,462)数据集。主要研究结果为残疾(通过评估日常生活活动(ADL)和工具性日常生活活动(iADL)的损伤情况进行评估)和住院护理需求(如住院或入住养老院)。多变量逻辑回归模型用于识别与结果独立相关的因素。为了进行跨国比较,我们进行了联合分析。数据根据特定国家的性别不平等指数(GII)进行了调整,得分越高,说明女性遭受的性别不平等越严重:女性幸存者在 iADL(OR=1.73,95% CI 1.53 - 1.96)和 ADL(OR=1.25,95% CI 1.09-1.44)方面的损伤更大,但住院护理需求并未相应增加。婚姻状况和收入水平等社会经济因素是残疾的重要预测因素,其中低收入和单身/离婚与较高的风险相关。性别的影响在 GII 较高的国家更为明显,这表明性别不平等对中风后遗症的影响。
{"title":"Sex, Gender, and Stroke Recovery: Functional Limitations and Inpatient Care Needs in Canadian and European Survivors.","authors":"Yusheng Zhou,Teresa Gisinger,Simon D Lindner,Valeria Raparelli,Colleen M Norris,Alexandra Kautzky-Willer,Louise Pilote","doi":"10.1177/17474930241288033","DOIUrl":"https://doi.org/10.1177/17474930241288033","url":null,"abstract":"BACKGROUNDStroke is a leading cause of long-term disability among survivors. Past literature already investigated the biological sex differences in stroke outcome, still limited work on gender differences is published. Therefore, the study aimed at investigating whether biological sex and sociocultural gender of survivors play a role as determinants of disability and quality of life among stroke survivors across Europe and Canada.METHODSData were gathered from the European Health Information Survey (EHIS, n=316,333) and Canadian Community Health Survey (CCHS, n=127,462) datasets. Main outcomes of interest were disability, assessed through evaluating the impairment of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (iADL), and inpatient care needs, such as hospitalization or institutionalization. Multivariate logistic regression models were utilized to identify factors independently associated with outcomes. Federated analysis was conducted for cross-country comparisons. Data were adjusted for the country-specific Gender Inequality Index (GII), with higher score corresponding to more gender inequality towards femalesResults: Female survivors showed greater impairments in iADL (OR=1.73, 95% CI 1.53 - 1.96) and ADL (OR=1.25, 95% CI 1.09-1.44), without a corresponding increase in inpatient care needs. Socioeconomic factors such as marital status and income level were significant predictors of disability, with low income and being single/divorced associated with higher risks. The impact of sex was more pronounced in countries with higher GII, indicating the influence of gender inequality on stroke outcomes.INTERPRETATIONThe findings highlight the significant impact of biological sex and gender-related social determinants on post-stroke disability, with female sex and unfavorable socioeconomic conditions being associated with worse outcomes.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}