Journal article
Differing definitions of first-ever stroke influence incidence estimates more than trends: a study using linked administrative data
Neuroepidemiology, Vol.57(6), pp.423-432
2023
PMID: 37751719
Abstract
Introduction
Researchers apply varying definitions when measuring stroke incidence using administrative data. We aimed to investigate the sensitivity of incidence estimates to varying definitions of stroke and lookback periods and to provide updated incidence rates and trends for Western Australia (WA).
Methods
We used linked state-wide hospital and death data from 1985 to 2017 to identify incident strokes from 2005 to 2017. A standard definition was applied which included strokes coded as the principal hospital diagnosis or the underlying cause of death, with a 10-year lookback used to clear prevalent cases. Alternative definitions were compared against the standard definition by percentage difference in case numbers. Age-standardised incidence rates were calculated, and age- and sex-adjusted Poisson regression models were used to estimate incidence trends.
Results
The standard definition with a 10-year lookback period captured 31,274 incident strokes. Capture increased by 19.3% when including secondary diagnoses, 4.1% when including nontraumatic subdural and extradural haemorrhage, and 8.1% when including associated causes of death. Excluding death records reduced capture by 11.1%. A 20-year lookback reduced over-ascertainment by 2.0%, and a 1-year lookback increased capture by 13.3%. Incidence declined 0.6% annually (95% confidence interval -0.9, -0.3). Annual reductions were similar for most definitions except when death records were excluded (-0.1%, CI: -0.4, 0.2) and with the shortest lookback periods (greatest annual reduction).
Conclusion
Stroke incidence has declined in WA. Differing methods of identifying stroke influence estimates of incidence to a greater extent than estimates of trends. Reductions in stroke incidence over time are primarily driven by declines in fatal strokes.
Details
- Title
- Differing definitions of first-ever stroke influence incidence estimates more than trends: a study using linked administrative data
- Authors/Creators
- David Youens - The University of Western AustraliaJudith Katzenellenbogen - The University of Western AustraliaRathina Srinivasa Ragavan - Monash UniversityNita Sodhi-Berry - The University of Western AustraliaJennie Carson - The University of Western AustraliaDawit Zemedikun - The University of Western AustraliaAmanda G. Thrift - Monash UniversityValery Feigin - Auckland University of TechnologyLee Nedkoff - The University of Western Australia
- Publication Details
- Neuroepidemiology, Vol.57(6), pp.423-432
- Publisher
- Karger
- Number of pages
- 10
- Grant note
- GNT1182071 / National Health and Medical Research Council Synergy Grant
- Identifiers
- 991005884843507891
- Copyright
- ©2023 The Author(s).
- Murdoch Affiliation
- Ngangk Yira Institute for Change
- Language
- English
- Resource Type
- Journal article
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