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. 2020 Oct 9;17(10):e1003366.
doi: 10.1371/journal.pmed.1003366. eCollection 2020 Oct.

Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register

Amanda Clery  1 , Ajay Bhalla  1   2 , Anthony G Rudd  1   2 , Charles D A Wolfe  1   3   4 , Yanzhong Wang  1   3   4
Affiliations

Trends in prevalence of acute stroke impairments: A population-based cohort study using the South London Stroke Register

Amanda Clery et al. PLoS Med. .

Abstract

Background: Acute stroke impairments often result in poor long-term outcome for stroke survivors. The aim of this study was to estimate the trends over time in the prevalence of these acute stroke impairments.

Methods and findings: All first-ever stroke patients recorded in the South London Stroke Register (SLSR) between 2001 and 2018 were included in this cohort study. Multivariable Poisson regression models with robust error variance were used to estimate the adjusted prevalence of 8 acute impairments, across six 3-year time cohorts. Prevalence ratios comparing impairments over time were also calculated, stratified by age, sex, ethnicity, and aetiological classification (Trial of Org 10172 in Acute Stroke Treatment [TOAST]). A total of 4,683 patients had a stroke between 2001 and 2018. Mean age was 68.9 years, 48% were female, and 64% were White. After adjustment for demographic factors, pre-stroke risk factors, and stroke subtype, the prevalence of 3 out of the 8 acute impairments declined during the 18-year period, including limb motor deficit (from 77% [95% CI 74%-81%] to 62% [56%-68%], p < 0.001), dysphagia (37% [33%-41%] to 15% [12%-20%], p < 0.001), and urinary incontinence (43% [39%-47%) to 29% [24%-35%], p < 0.001). Declines in limb impairment over time were 2 times greater in men than women (prevalence ratio 0.73 [95% CI 0.64-0.84] and 0.87 [95% CI 0.77-0.98], respectively). Declines also tended to be greater in younger patients. Stratified by TOAST classification, the prevalence of all impairments was high for large artery atherosclerosis (LAA), cardioembolism (CE), and stroke of undetermined aetiology. Conversely, small vessel occlusions (SVOs) had low levels of all impairments except for limb motor impairment and dysarthria. While we have assessed 8 key acute stroke impairments, this study is limited by a focus on physical impairments, although cognitive impairments are equally important to understand. In addition, this is an inner-city cohort, which has unique characteristics compared to other populations.

Conclusions: In this study, we found that stroke patients in the SLSR had a complexity of acute impairments, of which limb motor deficit, dysphagia, and incontinence have declined between 2001 and 2018. These reductions have not been uniform across all patient groups, with women and the older population, in particular, seeing fewer reductions.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: YW is a member of the Editorial Board of PLOS Medicine, but had no role in the peer review of this paper.

Figures

Fig 1
Fig 1. Prevalence ratios for acute stroke impairments over time, crude and adjusted for age, sex, ethnicity, TOAST subtype, and pre-stroke risk factors (hypertension, MI, AF, TIA, diabetes, high cholesterol, and smoking status) (N = 3,381).
AF, atrial fibrillation; MI, myocardial infarction; TIA, transient ischaemic attack; TOAST, Trial of Org 10172 in Acute Stroke Treatment.
Fig 2
Fig 2. Prevalence* and prevalence ratios for acute stroke impairments over time, stratified by sex.
*Adjusted for age, ethnicity, TOAST classification, and pre-stroke risk factors (hypertension, MI, AF, TIA, diabetes, high cholesterol, and smoking status) (N = 3,381). AF, atrial fibrillation; MI, myocardial infarction; TIA, transient ischaemic attack; TOAST, Trial of Org 10172 in Acute Stroke Treatment.
Fig 3
Fig 3. Prevalence* and prevalence ratios for acute stroke impairments over time, stratified by age.
*Adjusted for sex, ethnicity, TOAST classification, and pre-stroke risk factors (hypertension, MI, AF, TIA, diabetes, high cholesterol, and smoking status) (N = 3,381). AF, atrial fibrillation; MI, myocardial infarction; TIA, transient ischaemic attack; TOAST, Trial of Org 10172 in Acute Stroke Treatment.
Fig 4
Fig 4. Prevalence* and prevalence ratios for acute stroke impairments over time, stratified by ethnicity.
*Adjusted for age, sex, TOAST classification, and pre-stroke risk factors (hypertension, MI, AF, TIA, diabetes, high cholesterol, and smoking status) (N = 3,381). AF, atrial fibrillation; MI, myocardial infarction; TIA, transient ischaemic attack; TOAST, Trial of Org 10172 in Acute Stroke Treatment.
Fig 5
Fig 5. Prevalence (adjusted for age, sex, and ethnicity) and prevalence ratios for acute stroke impairments over time, stratified by TOAST classification (N = 4,005).
CE, cardioembolism; LAA, large artery atherosclerosis; PICH, primary intracerebral haemorrhage; SAH, subarachnoid haemorrhage; SVO, small vessel occlusion; TOAST, Trial of Org 10172 in Acute Stroke Treatment; UND, undetermined aetiology.
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