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The evolution of stroke in Quebec

A 15-year perspective

From the Division of Clinical Epidemiology (N.E.M., L.N., S.S.D.) and Department of Neurology and Neurosurgery (R.C.), McGill University Health Center, Montreal, Quebec, Canada.

Address correspondence and reprint requests to Dr. Nancy E. Mayo, Division of Clinical Epidemiology, Royal Victoria Hospital, R4.29, 687 Pine Avenue West, Montreal, Quebec, Canada H3A 1A1; e-mail: nancy.mayo{at}mcgill.ca

Objective: To estimate changes in rates of cerebral infarction and intracerebral hemorrhage, comorbidity profile, and case fatality rates in Quebec over 15 years.

Methods: A population-based admission-to-discharge cohort study was conducted, selecting first stroke events from hospital discharge data (MedEcho) from 1988 to 2002.

Results: In this study (involving 101,831 persons with cerebral infarctions and 11,215 persons with intracerebral hemorrhages), there was a downturn in the rates of cerebral infarction over 15 years, especially during the last 5 years (32.5% decline for men and 25.5% for women). A concomitant increase in rates of intracerebral hemorrhage, 28% increase for men (2%/year) and 22% for women (1.6%/year), was also noted. Although age and comorbidity of the population increased, case fatality decreased over time. Age and type of stroke were strong predictors for early (7 days) and later (8 to 30 days) case fatality, whereas comorbidity was important only for later death. In-hospital bed stay declined dramatically over time for all discharge destinations.

Conclusions: A significant decrease in rates of cerebral infarction and a rise in rates of intracerebral hemorrhage were noted in Quebec over 15 years. Age and comorbidity of the population increased. Although stroke is increasingly a condition of the elderly, ill population, case fatality and in-hospital bed stay declined over time.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the April 3 issue to find the title link for this article.

This project was funded by the Canadian Stroke Network.

Disclosure: The authors report no conflicts of interest.

Received June 20, 2006. Accepted in final form November 30, 2006.

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