The Incidence of Stroke by Socioeconomic Status, Age, Sex, and Stroke Subtype: A Nationwide Study in Korea

서수라,김철웅,김수영,이상이,윤태호,박형근,이승은 대한예방의학회 2014 Journal of Preventive Medicine and Public Health Vol.47 No.2

Objectives: To date, studies have not comprehensively demonstrated the relationship between stroke incidence and socioeconomic status. This study investigated stroke incidence by household income level in conjunction with age, sex, and stroke subtype in Korea. Methods: Contributions by the head of household were used as the basis for income levels. Household income levels for 21 766 036 people were classified into 6 groups. The stroke incidences were calculated by household income level, both overall within income categories and further by age group, sex, and stroke subtype. To present the inequalities among the six ranked groups in a single value, the slope index of inequality and relative index of inequality were calculated. Results: In 2005, 57 690 people were first-time stroke patients. The incidences of total stroke for males and females increased as the income level decreased. The incidences of stroke increased as the income level decreased in those 74 years old and under, whereas there was no difference by income levels in those 75 and over. Intracerebral hemorrhage for the males represented the highest inequality among stroke subtypes. Incidences of subarachnoid hemorrhage did not differ by income levels. Conclusions: The incidence of stroke increases as the income level decreases, but it differs according to sex, age, and stroke subtype. The difference in the relative incidence is large for male intracerebral hemorrhage, whereas the difference in the absolute incidence is large for male ischemic stroke.

뇌졸중 환자의 이차예방 이행 순응도 : 서울 ·경기지역 주민을 대상으로

고임석,김형철,권석범,황성희,권기한,김성민,송홍기,이병철 대한신경과학회 1999 대한신경과학회지 Vol.17 No.4

Stroke-Specific Predictors of Major Bleeding in Anticoagulated Patients With Stroke and Atrial Fibrillation: A Nationwide Multicenter Registry-Based Study

정다다,송태진,김범준,허성혁,정진만,오경미,김치경,Sungwook Yu,박광열,김정민,박종호,박만석,김준태,황양하,김용재,정종원,방오영,김경문,서우근,최재철 대한신경과학회 2023 Journal of Clinical Neurology Vol.19 No.5

Background and Purpose The congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack (CHA2DS2-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol (HAS-BLED) scores have been validated in estimating the risks of ischemic stroke and major bleeding, respectively, in patients with atrial fibrillation (AF). This study investigated stroke-specific predictors of major bleeding in patients with stroke and AF who were taking oral anticoagulants (OACs). Methods Subjects were selected from patients enrolled in the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION) nationwide multicenter registry between 2013 and 2015. Patients were excluded if they were not taking OACs, had no brain imaging data, or had intracranial bleeding directly related to the index stroke. Major bleeding was defined according to International Society of Thrombosis and Haemostasis criteria. Cox regression analyses were performed to assess the associations between clinical variables and major bleeding and Kaplan-Meier estimates were performed to analyze event-free survival. Results Of a total of 3,213 patients, 1,414 subjects (mean age of 72.6 years, 52.5% males) were enrolled in this study. Major bleeding was reported in 34 patients during the median follow-up period of 1.73 years. Multivariable analysis demonstrated that initial National Institutes of Health Stroke Scale scores (hazard ratio [HR] 1.07, p=0.006), hypertension (HR 3.18, p=0.030), persistent AF type (HR 2.51, p=0.016), and initial hemoglobin level (HR 0.74, p=0.001) were independently associated with major bleeding risk. Except for hypertension, these associations remained significant after adjusting for the HAS-BLED score. Intracranial atherosclerosis presented a trend of association without statistical significance (HR 2.21, p=0.050). Conclusions This study found that major bleeding risk was independently associated with stroke-specific factors in anticoagulated patients with stroke and AF. This has the clinical implication that baseline characteristics of patients with stroke and AF should be considered in secondary prevention, which would bring the net clinical benefit of balancing recurrent stroke prevention with minimal bleeding complications.

뇌졸중의 위험요인에 대한 환자-대조군 연구

백인경 ( In Kyoung Baek ),김윤식 ( Yoon Sik Kim ) 대전대학교 한의학연구소 2013 혜화의학회지 Vol.22 No.1

The purpose of this case-control study was to show the relationship between risk factor(Sex, Age, Martial Status, Educational Periods, Family history, Variables of Obesity, Smoking Status, Drinking Status, Past History, Blood Test) and the incidence of stroke. Methods: 788 stroke patients were enrolled as the case group and 450 non-stroke patients as control group from Sep.2006 to Dec.2010. Patients were hospitalized within 30 days after the onset of stroke. Risk factors and warning signs were obtained from personal interview by oriental medicine doctors who used CRF. Results: 1. Age was found to have significant relation with stroke(p<.0001). 2. Martial status(p<.0001, OR=0.44) and educational periods(p<.0001) were both significant risk factor for stroke. 3. As a result of reviewing the influence of family history, it was found to have no significant relation with stroke. Stroke was found to have significant relation with stroke(OR=1.50). 4. Female waist circumference(WC, p<.0001) and female waist-hip circumference ratio(WHR, p<.0001) were risk factors for stroke. On the other hand, male WC and male WHR showed no significant influence on stroke occurrence as an independent risk factor. 5. Both smoking status(p<.0001, current smoker OR=8.95) and drinking status(p<.0001, current drinker OR=2.50, former drinker OR=2.82) were significant risk factors for stroke. 6. As a result of reviewing the influence of past history, transient ischemic attack(p<.0001, OR=8.46), hypertension(p<.0001, OR=4.72), hyperlipidemia(0.0064), diabetes mellitus(p<.0001, OR=3.34), stroke(p<.0001, OR=50.26) were significant risk factors. On the other hand, ischemic heart disease(p=0.2332) was found to have no significant relation with stroke. 7. Increase of WBC, RBC, Platelet, TG, FBS and Cl- level were significant risk factor of stroke, On the other hand, decrease of Hgb, Hct, AST, HDL-chol, LDH, Na+ and K+ level were significant risk factor of stroke. T-chol and ALT level showed no significant influence on stroke occurrence.

대장암 환자에서 발생한 뇌졸중

김충린,김용미,전재용,김진천,권순억,김희철,최경효 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.2

Objective: To find the characteristics of stroke in colorectal cancer patients. Method: We retrospectively analyzed 32 patients of stroke in colorectal cancer who were operated from January 2001 to December 2002 by reviewing their charts and brain CTs or MRIs. The type, risk factor, localization and origin of stroke and the stage of colorectal cancer were analyzed. Results: The mean age was 69.2 years. TNM stage II (41%) was the most common. Twenty-three cases were ischemic stroke, four were hemorrhagic stroke and the others were unidentified. Diabetes (63%), hypertension (53%), cardiac disease (19%), and family history of stroke (9%) were observed in patients. The main cause of ischemic stroke was arterial thrombosis, and lacunar and middle cerebral infarction were more common in ischemic stroke. Conclusion: Several common risk factors between colorectal cancer and stroke were observed, and these risk factors are associated with the atherosclerosis of cerebral vascular system. To reduce the incidence of cerebrovascular disease and colorectal cancer, we may need to control those risk factors. Objective: To find the characteristics of stroke in colorectal cancer patients. Method: We retrospectively analyzed 32 patients of stroke in colorectal cancer who were operated from January 2001 to December 2002 by reviewing their charts and brain CTs or MRIs. The type, risk factor, localization and origin of stroke and the stage of colorectal cancer were analyzed. Results: The mean age was 69.2 years. TNM stage II (41%) was the most common. Twenty-three cases were ischemic stroke, four were hemorrhagic stroke and the others were unidentified. Diabetes (63%), hypertension (53%), cardiac disease (19%), and family history of stroke (9%) were observed in patients. The main cause of ischemic stroke was arterial thrombosis, and lacunar and middle cerebral infarction were more common in ischemic stroke. Conclusion: Several common risk factors between colorectal cancer and stroke were observed, and these risk factors are associated with the atherosclerosis of cerebral vascular system. To reduce the incidence of cerebrovascular disease and colorectal cancer, we may need to control those risk factors.

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.

Stroke Update 2009: 뇌졸중의 이차 예방

이용석 대한뇌졸중학회 2009 Journal of stroke Vol.11 No.2

In The Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial, recurrent stroke occurred in 9.0% receiving aspirin and extended-release dipyridamole (ASA-ERDP) and in 8.8% receiving clopidogrel [hazard ratio (HR) 1.01; 95% confidence interval (CI) 0.92 to 1.11]. There were more major hemorrhagic events among ASA-ERDP group (4.1% vs. 3.6%, P<0.05). Therapy with telmisartan did not significantly lower the rate of recurrent stroke, major cardiovascular events, or diabetes in spite of blood pressure (BP) lowering. In The Cilostazol versus Aspirin for Secondary Ischaemic Stroke Prevention (CASISP) trial comparing cilostazol with aspirin in patients with ischemic stroke, cilostazol showed non-significant trend to prevent recurrent stroke (HR 0.62; 95% CI 0.30-1.26). Symptomatic and aymptomatic hemorrhage was less frequent in cilostazol group. Three-year follow-up of The Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial showed that there was no difference between carotid artery stenting group and endarterectomy group. Two to four-year follow-up study of The Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) and Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial, in which patients with symptomatic carotid stenosis were included, also showed no difference of cardiovascular events including stroke. These results suggested that mid or long-term outcome is comparable between stenting and endarterectomy. Meta-analysis from 8,832 patients with statin therapy showed decreased incidence of recurrent ischemic stroke [relative risk (RR) 0.80; 95% CI 0.70-0.92], while increased risk of hemorrhagic stroke (RR 1.73; 95% CI 1.19-2.50) in statin group. Post-hoc analysis of Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study revealed that hemorrhagic stroke as an entry event, age, hypertension, ator-vastatin per se, and small vessel disease subtype increase the risk of intracerebral hemorrhage. (Korean J Stroke 2009;11:67-72)

Development and Evaluation of Mobile Application for Preventing Recurrence in Patients with Stroke

Young-Ju Jeong,Hee Sun Kim,Myung Ha Lee,Hyun Kyung Kim,Seok Hee Jeong,Hye Young Kim 한국성인간호학회 2021 성인간호학회 학술대회 Vol.2021 No.8

Aim(s): Stroke is one of the leading causes of death and serious disability worldwide. Recurrence of stroke accounts for 25-30% of all strokes, and recurrence of stroke is fatal and has a poorer prognosis than the first stroke. To prevent stroke recurrence, it is important to improve medication adherence and make lifestyle changes such as healthy diet and adequate physical activity. The purpose of this study was to develop a mobile application that can effectively implement health behaviors for preventing recurrence of stroke patients and apply it to stroke patients to confirm the effects. Method(s): A randomized controlled group pre-test-post design was used. Subjects were recruited from the outpatient neurology department of university hospital located in J City. Subjects were assigned to either an experimental group (n=27) or a control group (n=27). The mobile application for preventing stroke recurrence was developed based on social cognitive theory, and it consisted of providing stroke information, management of health lifestyle such as exercise, healthy diet, taking appropriate medication, and providing text messages and telephone counseling. The data were analyzed with descriptive analysis, chi-square test, independent t-test, Fisher’s exact test, Shapiro-Wilkes test, and Mann-Whitney U test. Result(s): After the eight week, the experimental group showed higher levels of medication adherence (U=210.00, p=.002), healthy eating habits (U=103.50, p<.001), and physical activity (U=18.00, p<.001) and showed lower levels of systolic pressure (U=246.00, p=.020), diastolic pressure (U=170.50, p<.001), body mass index (U=155.00, p<.001), and waist circumference (U=68.50, p<.001) than those in the control group. Interestingly, the affected-side grip strength (U=196.00, p=.002) was significantly better in the experimental group than in the control group. However, although the healthy-side grip strength (U=276.50, p=.064) increased in the experimental group, there was no significant difference between the two groups. Conclusion(s): The mobile application for stroke recurrence prevention was confirmed to be effective in improving the medication adherence, healthy eating habits and physical activity of stroke patients, and reducing blood pressure, body mass index, waist circumference and grip strength. Therefore, it is recommended to use the stroke recurrence prevention mobile application as a nursing intervention for the prevention of disease exacerbation or recurrence of stroke patients.

뇌졸중 위험지표로서의 일반혈액검사 소견에 대한 환자;대조군 연구

이현의,강경원,유병찬,방옥선,백경민,설인찬,김윤식,Lee, Hyon-Ui,Kang, Kyung-Won,Yu, Byeong-Chan,Bang, Ok-Sun,Baek, Kyung-Min,Seol, In-Chan,Kim, Yoon-Sik 대한한방내과학회 2007 大韓韓方內科學會誌 Vol.28 No.4

Objective : Stroke is one of the most common causes of death in Korea. This study was done to evaluate the association of complete blood count (CBC) with the risk of hemorrhagic stroke and ischemic stroke. Methods : In 217-case patients with ischemic stroke or hemorrhagic stroke and 146 healthy control subjects without stroke, hypertension, diabetes mellitus, hyperlipidemia, or ischemic heart disease and 160 controls without ischemic stroke or hemorrhagic stroke, we tested and compared white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hgb), hematocrit (Hct) and platelet. These data were statically analyzed by general linear models and binary logistic regression analysis to get each adjusted odds ratio. Results :The level of WBC was significantly higher in all cases. The level of RBC, Hct and Hgb was significantly lower in patients of ischemic stroke. The level of platelet was significantly higher in patients of ischemic stroke. Conclusion : These results suggest high WBC may be a risk factor of hemorrhagic stroke and ischemic stroke and low RBC, low Hct, low Hgb and high platelet may be risk factors of ischemic stroke in Koreans.

뇌졸중경고증상과 위험인자 인식도: 2010년 광주 지역주민 설문결과

이영훈,신민호,권순석,최진수,박만석,조기현,임영실 대한신경과학회 2012 대한신경과학회지 Vol.30 No.1

Background: A high level of public awareness of stroke may reduce the stroke risk. The aim of this study was to assess the public’s awareness of stroke warning signs and risk factors, and to determine the associated factors. Methods: The study population was 2492 community-dwelling adults aged 50 years and older who participated in the 2010baseline Dong-gu Study. Information regarding knowledge of stroke warning signs, stroke risk factors, and demographics was collected using standardized open- and closed-form questionnaires. Results: The stroke warning signs that were most frequently identified by respondents were “sudden numbness or weakness” (73.7%) and “sudden difficulty in speaking or in understanding speech” (73.6%). In multivariate analysis,incomplete awareness of stroke warning signs was significantly associated with a lower education level, no history of past stroke, and incorrect knowledge of the definition of stroke. Hypertension and stress were most commonly recognized as risk factors when open-ended questions were used (by 22.3% and 14.1% of the respondents, respectively) and also with close-ended questions (77.7% and 82.4%, respectively). In multivariate analysis, older age, current smoking, lower education level, and incorrect knowledge of the definition of stroke were associated with a worse awareness of stroke risk factors. Conclusions: A community-based program is needed to improve public awareness of the warning signs and risk factors for stroke. In order to reduce the risk of stroke, public health education and media efforts should focus on people who are older and have a lower level of education.