Registry-based stroke research in Taiwan: past and future

Cheng-Yang Hsieh,Darren Philbert Wu3,,Sheng-Feng Sung 한국역학회 2018 Epidemiology and Health Vol.40 No.-

Stroke registries are observational databases focusing on the clinical information and outcomes of stroke patients. They play an important role in the cycle of quality improvement. Registry data are collected from real-world experiences of stroke care and are suitable for measuring quality of care. By exposing inadequacies in performance measures of stroke care, research from stroke registries has changed how we manage stroke patients in Taiwan. With the success of various quality improvement campaigns, mortality from stroke and recurrence of stroke have decreased in the past decade. After the implementation of a nationwide stroke registry, researchers have been creatively expanding how they use and collect registry data for research. Through the use of the nationwide stroke registry as a common data model, researchers from many hospitals have built their own stroke registries with extended data elements to meet the needs of research. In collaboration with information technology professionals, stroke registry systems have changed from web-based, manual submission systems to automated fill-in systems in some hospitals. Furthermore, record linkage between stroke registries and administrative claims databases or other existing databases has widened the utility of registry data in research. Using stroke registry data as the reference standard, researchers have validated several algorithms for ascertaining the diagnosis of stroke and its risk factors from claims data, and have also developed a claims-based index to estimate stroke severity. By making better use of registry data, we believe that we will provide better care to patients with stroke.

A Comparison Between Stroke Patients Admitted to Oriental Hospital in the Years 1987 and 1994

Lee Kyung-sup,Cho, Ki-ho,Kim, Young-suk,Ko, Chang-nam,Moon Sang-kwan,Bae Hyung-sup INSTITUTE OF ORIENTAL MEDICINE KYUNG-HEE UNIVERSIT 1998 JOURNAL OF ORIENTAL MEDICINE Vol.3 No.1

The characteristics of stroke slightly vary as time changes. To compare the characteristics of stroke between the 1980s and 1990s we investigated the clinical records of stroke patients in 1987 and 1994. The subjects of this study consisted of the 1971 patients who were admitted as stroke patients to the Kyunghee University Oriental Medicine Hospital during these two years. There were 1092 stroke patients admitted from May, 1987 to April, 1988 and 879 stroke patients admitted between May, 1994 and April, 1995. The results were as follows. The frequency of cerebral infarction was 77.9% in 1987 and 79.9% in 1994. The male to female ratio of stroke patients was 1.4:1 in 1987 and 1.6:1 in 1994. The occurrence rate of stroke in both 1987 and 1994 were highest in patients in their 60s, followed by those in their 50s, 70s and older, in their 40s, and finally their 30s and below. We especially found that the rate of patients in their 70s and over increased from 17.8% in 1987 to 25.3% in 1994, which was remarkable in cerebral infarction patients. The most common disease preceding a stroke was hypertension, followed by heart disease and diabetes in 1987, and in 1994 hypertension was the most common, followed by diabetes and heart disease. The rate of recurrence among cerebral hemorrhage, that was 12% in 1987 and 24.7% in 1994. The most frequent complications of stroke in 1987 and 1994 were pneumonia and urinary tract infection, respectively. The prescriptions used most frequently during admission were Chungpaesagan-tang followed by Sunghyangjungki-san, Yangyeksanhwa-tang etc. in both 1987 and 1994. When patients were getting better, prescriptions for invigorating Qi and enriching the blood(補氣血) were used more frequently. In conclusion, the most remarkable change of stroke patients from 1987 to 1994 was an increase in occupancy rate of aged patients, especially those in their 70s and older. So we suggest that more research are needed on the stroke of aged man, along with many other subjects on stroke.

Serum persistent organic pollutants levels and stroke risk

Lim, Jung-eun,Lee, Sunju,Lee, Sunmi,Jee, Sun Ha Elsevier 2018 Environmental pollution Vol.233 No.-

<P><B>Abstract</B></P> <P>Knowledge of environmental risk factors for stroke and their role are limited. We performed a case-cohort study to evaluate the association between serum persistent organic pollutants (POPs) level and stroke risk.</P> <P>526 subcohort members and 111 stroke incidence cases were identified from the Korean Cancer Prevention Study-II. Serum levels of POPs were measured using gas chromatography/high-resolution mass spectrometry. The hazard ratios (HRs) for stroke (ischemic, hemorrhagic, and all stroke types) were estimated using the weighted Cox regression model. Age, sex, body mass index, smoking status, physical activity, family history of cardiovascular disease, and hypertension were adjusted in the weighted Cox regression model.</P> <P>After adjusting for potential confounding factors, increased risk for stroke was observed among participants with serum concentration of p,p'-DDE in the highest tertile compared to those in the lowest tertile (HR = 4.10, 95% CI: 1.58, 10.59). A similar association was estimated for PCB118 (HR = 2.33, 95% CI: 1.04, 5.22), PCB156 (HR = 3.42, 95% CI: 1.42, 8.23), and PCB138 (HR = 3.80, 95% CI: 1.48, 9.76). For TEQ, stroke was three times as likely to occur among subjects with TEQ in the highest tertile compared to those in the lowest tertile (HR = 3.12, 95% CI: 1.27, 7.65). PCBs were positively associated with ischemic stroke, but not with hemorrhagic stroke.</P> <P>Elevated serum POPs levels were associated with an increased risk of stroke, especially ischemic stroke.</P> <P><B>Highlights</B></P> <P> <UL> <LI> This study is the first prospective study of the association between serum POPs level and stroke risk. </LI> <LI> Serum levels of 32 PCBs and 19 OCPs were measured. </LI> <LI> Several POPs levels were associated with an increased risk of developing stroke. </LI> <LI> Increased stroke risk was observed among participants with TEQ in the highest tertile compared to those in the lowest tertile. </LI> <LI> PCBs were positively associated with ischemic stroke but not with hemorrhagic stroke. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

Seasonal Variation of Acute Stroke- Hospital Based Study -

윤상필,정우상,문상관,조기호,김영석,배형섭 대한한의학회 2008 대한한의학회지 Vol.29 No.2

Objectives: This study aimed to investigate the seasonal variation in stroke types, ischemic stroke subtypes, stroke risk factors and Sasang constitutions. Methods: 226 patients with acute stroke within 14 days onset were included, who were admitted to Kyunghee Oriental Medical Center from November 2005 to October 2006. The year was subdivided into four parts: spring (March-May); summer (June-August); fall (September-November); and winter (December-February). Stroke types, ischemic stroke subtypes, stroke risk factors and Sasang constitutions in the four groups were examined. Results: Ischemic stroke was most frequent in summer, whereas hemorrhagic stroke was most frequent in winter. There was no significant difference in seasonal variation of stroke. The frequency of ischemic heart disease among stroke risk factors was significantly high in spring (p=0.031). The frequency of hypertension, diabetes mellitus, atrial fibrillation, and hyperlipidemia did not differ among seasons. There was no significant difference in Sasang constitution among seasons. Frequency of small vessel occlusion was highest in summer. Large artery atherosclerosis was frequent in spring and summer,but seasonal variation of ischemic stroke subtypes did not show statistical difference. Conclusion: Acute stroke demonstrates seasonal characteristics according to stroke types, ischemic stroke subtypes, risk factors for stroke, and Sasang constitutions. These results have important clinical implications in stroke prevention. Objectives: This study aimed to investigate the seasonal variation in stroke types, ischemic stroke subtypes, stroke risk factors and Sasang constitutions. Methods: 226 patients with acute stroke within 14 days onset were included, who were admitted to Kyunghee Oriental Medical Center from November 2005 to October 2006. The year was subdivided into four parts: spring (March-May); summer (June-August); fall (September-November); and winter (December-February). Stroke types, ischemic stroke subtypes, stroke risk factors and Sasang constitutions in the four groups were examined. Results: Ischemic stroke was most frequent in summer, whereas hemorrhagic stroke was most frequent in winter. There was no significant difference in seasonal variation of stroke. The frequency of ischemic heart disease among stroke risk factors was significantly high in spring (p=0.031). The frequency of hypertension, diabetes mellitus, atrial fibrillation, and hyperlipidemia did not differ among seasons. There was no significant difference in Sasang constitution among seasons. Frequency of small vessel occlusion was highest in summer. Large artery atherosclerosis was frequent in spring and summer,but seasonal variation of ischemic stroke subtypes did not show statistical difference. Conclusion: Acute stroke demonstrates seasonal characteristics according to stroke types, ischemic stroke subtypes, risk factors for stroke, and Sasang constitutions. These results have important clinical implications in stroke prevention.

Seasonal Variation of Acute Stroke;Hospital Based Study

Yun, Sang-Pil,Jung, Woo-Sang,Moon, Sang-Kwan,Cho, Ki-Ho,Kim, Young-Suk,Bae, Hyung-Sup The Society of Korean Medicine 2008 대한한의학회지 Vol.29 No.2

Objectives: This study aimed to investigate the seasonal variation in stroke types, ischemic stroke subtypes, stroke risk factors and Sasang constitutions. Methods: 226 patients with acute stroke within 14 days onset were included, who were admitted to Kyunghee Oriental Medical Center from November 2005 to October 2006. The year was subdivided into four parts: spring (March-May); summer (June-August); fall (September-November); and winter (December-February). Stroke types, ischemic stroke subtypes, stroke risk factors and Sasang constitutions in the four groups were examined. Results: Ischemic stroke was most frequent in summer, whereas hemorrhagic stroke was most frequent in winter. There was no significant difference in seasonal variation of stroke. The frequency of ischemic heart disease among stroke risk factors was significantly high in spring (p=0.031). The frequency of hypertension, diabetes mellitus, atrial fibrillation, and hyperlipidemia did not differ among seasons. There was no significant difference in Sasang constitution among seasons. Frequency of small vessel occlusion was highest in summer. Large artery atherosclerosis was frequent in spring and summer,but seasonal variation of ischemic stroke subtypes did not show statistical difference. Conclusion: Acute stroke demonstrates seasonal characteristics according to stroke types, ischemic stroke subtypes, risk factors for stroke, and Sasang constitutions. These results have important clinical implications in stroke prevention.

도시 중년 성인이 인지하는 뇌졸중 생활습관 위험요인과 뇌졸중 인식

송희영,허혜경,박소미 대한임상건강증진학회 2012 Korean Journal of Health Promotion Vol.12 No.1

Background: Modifying risk factors and improving stroke awareness in the general community have been emphasized for preventing stroke. This study aimed to explore modifiable lifestyle risk factors and the awareness of stroke and to compare scores for stroke knowledge according to lifestyle risk factors and recognition of important indicators among adults in urban areas. Methods: A cross-sectional study was conducted with a total of 196 participants aged 40 to 65 selected by a convenient sampling of community cultural centers, churches, and recreational groups. Participants completed a structured questionnaire including general characteristics, risk factors of stroke, and awareness of stroke including general knowledge, risk factors, reactions to warning symptoms, and knowledge on personal risk factors of stroke such as body weight, blood pressure, blood sugar, and cholesterol level. Results: Less than 30% of the participants engaged in regular physical activity and low fat diet and 33% of the participants were classified as having 'higher' level of knowledge on stroke. Knowledge on their personal risk factors of stroke were generally poor. Scores for knowledge on stroke were not different for lifestyle risk factors and knowing whether their body weight and blood pressure level were within normal limits. Meanwhile, scores for knowledge on stroke were significantly higher among those knowing whether their blood sugar and cholesterol level were within normal limits. Conclusions: There is a need to improve stroke awareness among community adults by providing more targeted information on warning symptoms, risk factors of stroke, and important indicators of major conditions related to stroke and their contribution to stroke prevention. 연구배경: 본 연구는 지역사회 성인에서 뇌졸중의 생활습관 위험요인 분포와 뇌졸중의 경고증상, 위험요인 및 뇌졸중 발생 시 대처 그리고 뇌졸중 위험질환 관련 주요 지표인 혈압, 체중, 혈당 및 혈중 콜레스테롤에 대한 개인의인지를 포함한 뇌졸중에 대한 인식을 확인하고자 시도되었다. 방법: 본 연구는 횡단적 서술조사 연구로 연구대상자는선정기준에 따라 두 개의 중소도시 지역에서 연구의 목적을 이해하고 참여에 동의한 196명(평균 연령 44.81세)을 편의표집 하였다. 연구자 소속 대학의 연구윤리위원회의 승인을 거친 후 대상자에게 참여자 권리 보호에 대해 설명후 동의서에 서명하도록 하였다. 일반적 특성과 뇌졸중의위험요인, 뇌졸중의 정의와 경고증상, 위험요인 및 발생 시대처, 그리고 뇌졸중 위험질환 관련 지표인 혈압, 체중, 혈당 및 혈중 콜레스테롤에 대한 인지를 묻는 구조화된 설문지를 배부하고 자가보고 하도록 하였다. 결과: 대상자 중 30% 이하에서 현재 규칙적인 신체활동과 저지방 식이를 하고 있었고 뇌졸중 지식은 평균 16.42점으로 대상자 중 33%가 뇌졸중의 정의, 경고증상 및 위험요인을 잘 알고 있는 ‘높은’ 지식 집단이었다. 체중, 혈당및 혈중 콜레스테롤의 정상 범주 여부에 대해서 대부분의대상자들이 모른다고 응답하였고 일반적 특성, 뇌졸중 위험요인, 혈압과 체중 인지 여부에 따른 지식의 차이는 유의하지 않았다. 자신의 혈당과 혈중 콜레스테롤이 정상 범주에 속하는지를 알고 있는 대상자에서 뇌졸중 지식이 유의하게 높았다. 결론: 본 연구는 지역사회 성인에서 규칙적 신체활동과저지방 식이조절을 증진하고 뇌졸중 경고증상, 위험요인및 뇌졸중 위험요인 관련 주요 지표에 대한 인지를 보완하여 뇌졸중 인식의 증진이 필요함을 제시하고 있다. 이를위해 지역사회 중년 성인 대상으로 개인의 혈당과 혈중 콜레스테롤과 같은 주요 지표와 뇌졸중 위험과의 관련성을포함한 뇌졸중 인식과 다양한 생활습관 위험요인 조절을 증진할 수 있는 중재의 개발 및 효과검증 연구가 필요하다.

Recent Epidemiological Trends of Stroke

Park, Hyun-Seok,Kang, Myong-Jin,Huh, Jae-Taeck The Korean Neurosurgical Society 2008 Journal of Korean neurosurgical society Vol.43 No.1

Objective : Rapid increase in aged population and westernization of lifestyle have modified epidemiological status of stroke. The purpose of this study is to analyze changing trends of stroke epidemiology in South Korea. Methods : We reviewed retrospectively medical records of 1,124 cases diagnosed as stroke among 54,534 patients who visited the Emergency Medical Center at our hospital from January 1994 to December 1996 (Group A). Also, we evaluated 1,705 cases diagnosed as stroke among 55,381 patients who visited to the same hospital from January 2003 to December 2005 (Group B). The variable features of stroke, such as age, sex, seasonal variation and distribution of stroke subtypes were studied by comparing group A with B. Results : In group A, hemorrhagic stroke (67.9%) was more prevalent than ischemic stroke (32.1%). However, group B showed that the ratio of hemorrhagic stroke (40.3%) to ischemic stroke (59.6%) has been reversed. The highest incidence of stroke was noted in their sixties and seventies of age in group B, which was older than that of group A. In group A, male ischemic stroke (IS) patients outnumbered female patients (1.26:1). Moreover, this gender disproportion became higher in group B (1.53:1). In group A, the number of male intracerebral hermorrhage (ICH) patients were similar to that of female patients (0.97:1). However, male ICH patients outnumbered female patients in group B (1.23:1). As for subarachnoid hemorrhage (SAH), female patients outnumbered male patients more than two-fold in both groups. Both groups showed that the occurrence of ischemic stroke was highest in summer, but that of hemorrhagic stroke was the highest in winter. Conclusion : This study showed the changing trends of stroke in its distribution of subtypes. Multicenter prospective study using stroke registry would be required for the determination of national epidemiologic trends.

The Comparison of Risk Factors for Ischemic Stroke or Intracranial Hemorrhage in Korean Stroke Patients

Sun-Young Choi,Ji-In Kim,Shin-Woo Hwang 대한의생명과학회 2018 Biomedical Science Letters Vol.24 No.4

Stroke is a leading cause of death in the Korean population and remains a major health burden worldwide. The two main pathologic types of stroke are ischemic stroke and intracranial hemorrhage (ICH), but comparisons of risk factors for these have been limited. We under took a nationwide population-based study to analyze the relationship between these risk factor sand ischemic stroke and ICH. From January 2003 to December 2013, a total of 37,561 patients with newly diagnosed ischemic stroke or ICH were identified using the National Health Insurance Service data base as the study population. Multivariable logistic regression analysis was used to determine the association between baseline risk factors and presentation with ICH versus ischemic stroke. The incidence of ischemic stroke showed an increasing rend every year, while there was no significant change in the incidence of ICH. Of the several risk factors associated with stroke, old age (OR 2.35, 95% CI 2.12~2.49, P < 0.001) was more closely associated with ischemic stroke than ICH, whereas renal disease (OR 0.74, 95% CI 0.55~0.99, P = 0.04) and carotid disease (OR 0.25, 95% CI 0.17~0.35, P < 0.001) were more strongly associated with ICH. In addition, diabetes mellitus, dyslipidemia, hypertension, ischemic heart disease and male sex was associated with an increased risk of ischemic stroke. Old age was more strongly associated with ischemic stroke than ICH, while carotid stenosis and renal impairment were more closely associated with ICH risk. Classic risk factors for stroke have considerably different associations with the two main pathologic types of stroke.

뇌졸중 환자의 병원 내 사망과 관련된 인구학적 및 질병 과거력 요인에 대한 분석

김철규 대한뇌졸중학회 2006 Journal of stroke Vol.8 No.2

Background:Stroke is the 2nd leading cause of death in Korea. Our aim was to investigate the predictors of in-hospital death of stroke patients regarding the demographics and previous medical illeness. Method:Using the Korea nationwide insurance claim database between Jan 1 2003 and Dec 31 2003, we retrospectively identified stroke patients who were hospitalized and discharged with an International Classification of Disease (ICD) 10 code of stroke including‘subarachnoid hemorrhage (I60)’,‘intracerebral hemorrhage (I61) ’,‘other nontraumatic intracranial hemorrhage (I62) ’ and‘cerebral infarction (I63) ’. We collected the data of age, sex, medical security, and previous medical illness such as atrial fibrillation/flutter, other cardiac arrhythmia, ischemic heart disease, heart failure, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, malignancy, liver disease, renal failure and stroke. Case fatality was assessed by the national death certificate data of 2003. Logistic regression analysis was performed to identify the independent predictors for in-hospital death. Result:We identified 92,717 stroke patients including 65,440 (70.6%), and 27,277 (29.4%) hemorrhagic stroke. In-hospital mortalities were 6.4% for all stroke, 3.5% for non- hemorrhagic stroke, and 13.4% for hemorrhagic stroke.Older age, male, low socioeconomic status, history of renal failure and previous stroke were independent predictors of in-hospital death in both of non-hemorrhagic and hemorrhagic stroke. For non-hemorrhagic stroke, additional predictors were atrial fibrillation/ flutter and heart failure. For hemorrhagic stroke, malignancy, other cardiac arrhythmia, and diabetes mellitus were additional predictorsof in-hospitla death. Conclusion:To reduce the in-hospital stroke mortality, more efficienct strategy is required for high risk patients.(Korean Journal of Stroke 2006;8:179-186)

MyRisk_Stroke Calculator: A Personalized Stroke Risk Assessment Tool for the General Population

Lisa Nobel,Nancy E. Mayo,James Hanley,Lyne Nadeau,Stella S. Daskalopoulou 대한신경과학회 2014 Journal of Clinical Neurology Vol.10 No.1

Background and Purpose There is a variety of stroke risk factors, and engaging individualsin reducing their own personal risk is hugely relevant and could be an optimal disseminationstrategy. The aim of the present study was to estimate the stroke risk for specific combinationsof health- and lifestyle-related factors, and to develop a personalized stroke-risk assessmenttool for health professionals and the general population (called the MyRisk_Stroke Calculator). Methods This population-based, longitudinal study followed a historical cohort formed fromthe 1992 or 1998 Santé Québec Health Surveys with information for linkage to health administrative databases. Stroke risk factors were ascertained at the time of survey, and stroke was determined from hospitalizations and death records. Cox proportional hazards models were used,modeling time to stroke in relationship to all variables. Results A total of 358 strokes occurred among a cohort of 17805 persons (men=8181) whowere followed for approximately 11 years (i.e., –200000 person-years). The following regressionparameters were used to produce 10-year stroke-risk estimates and assign risk points: for age (1point/year after age 20 years), male sex (3 points), low education (4 points), renal disease (8points), diabetes (7 points), congestive heart failure (5 points), peripheral arterial disease (2points), high blood pressure (2 points), ischemic heart disease (1 point), smoking (8 points), >7alcoholic drinks per week (3 points), low physical activity (2 points), and indicators of anger (4points), depression (4 points), and anxiety (3 points). According to MyRisk_Stroke Calculator, aperson with <50, 75, and 90 risk points has a 10-year stroke risk of <3%, 28%, and >75%, respectively. Conclusions The MyRisk_Stroke Calculator is a simple method of disseminating information to the general population about their stroke risk.