Background: Population-based data, which continuously monitors time trends in stroke epidemiology are limited. We investigated the incidence of pathological and etiological stroke subtypes over a 16 year time period. Methods: Data were collected within the Erlangen Stroke Project (ESPro), a prospective, population-based stroke register in Germany covering a total study population of 105,164 inhabitants (2010). Etiology of ischemic stroke was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results: Between January 1995 and December 2010, 3,243 patients with first-ever stroke were documented. The median age was 75 and 55% were females. The total stroke incidence decreased over the 16 year study period in men (Incidence Rate Ratio 1995-1996 vs. 2009-2010 (IRR) 0.78; 95% CI 0.58-0.90) but not in women. Among stroke subtypes, a decrease in ischemic stroke incidence (IRR 0.73; 95% CI 0.57-0.93) and of large artery atherosclerotic stroke (IRR 0.27; 95% CI 0.12-0.59) was found in men and an increase of stroke due to small artery occlusion in women (IRR 2.33; 95% CI 1.39-3.90). Conclusions: Variations in time trends of pathological and etiological stroke subtypes were found between men and women that might be linked to gender differences in the development of major vascular risk factors in the study population.

Keywords:
Stroke, Epidemiology, Incidence, Time trends, Register
1.
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, O'Donnell M, Venketasubramanian N, Barker-Collo S, Lawes CM, Wang W, Shinohara Y, Witt E, Ezzati M, Naghavi M, Murray C; Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group: Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet 2014;383:245-254.
2.
Kolominsky-Rabas PL, Heuschmann PU, Marschall D, Emmert M, Baltzer N, Neundorfer B, Schoffski O, Krobot KJ: Lifetime cost of ischemic stroke in Germany: results and national projections from a population-based stroke registry: the Erlangen Stroke Project. Stroke 2006;37:1179-1183.
3.
Hallstrom B, Jonsson AC, Nerbrand C, Norrving B, Lindgren A: Stroke incidence and survival in the beginning of the 21st century in southern Sweden: comparisons with the late 20th century and projections into the future. Stroke 2008;39:10-15.
4.
Heuschmann PU, Grieve AP, Toschke AM, Rudd AG, Wolfe CD: Ethnic group disparities in 10-year trends in stroke incidence and vascular risk factors: the South London Stroke Register (SLSR). Stroke 2008;39:2204-2210.
5.
Wang Y, Rudd AG, Wolfe CD: Age and ethnic disparities in incidence of stroke over time: the South London Stroke Register. Stroke 2013;44:3298-3304.
6.
Rothwell PM, Coull AJ, Giles MF, Howard SC, Silver LE, Bull LM, Gutnikov SA, Edwards P, Mant D, Sackley CM, Farmer A, Sandercock PA, Dennis MS, Warlow CP, Bamford JM, Anslow P: Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet 2004;363:1925-1933.
7.
Kleindorfer DO, Khoury J, Moomaw CJ, Alwell K, Woo D, Flaherty ML, Khatri P, Adeoye O, Ferioli S, Broderick JP, Kissela BM: Stroke incidence is decreasing in whites but not in blacks: a population-based estimate of temporal trends in stroke incidence from the greater Cincinnati/Northern Kentucky Stroke Study. Stroke 2010;41:1326-1331.
8.
Carter K, Anderson C, Hacket M, Feigin V, Barber PA, Broad JB, Bonita R: Trends in ethnic disparities in stroke incidence in Auckland, New Zealand, during 1981 to 2003. Stroke 2006;37:56-62.
9.
Bejot Y, Daubail B, Jacquin A, Durier J, Osseby GV, Rouaud O, Giroud M: Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry. J Neurol Neurosurg Psychiatry 2014;85:509-513.
10.
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. Toast. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35-41.
11.
Kolominsky-Rabas PL, Sarti C, Heuschmann PU, Graf C, Siemonsen S, Neundoerfer B, Katalinic A, Lang E, Gassmann KG, von Stockert TR: A prospective community-based study of stroke in Germany - the Erlangen Stroke Project (ESPro) incidence and case fatality at 1, 3, and 12 months. Stroke 1998;29:2501-2506.
12.
Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU: Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke 2001;32:2735-2740.
13.
Hatano S: Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ 1976;54:541-553.
14.
Feigin V, Hoorn SV: How to study stroke incidence. Lancet 2004;363:1920.
15.
Doll R, Cook P: Summarizing indices for comparison of cancer incidence data. Int J Cancer 1967;2:269-279.
16.
Fay MP, Feuer EJ: Confidence intervals for directly standardized rates: a method based on the gamma distribution. Stat Med 1997;16:791-801.
17.
Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 2009;8:355-369.
18.
Kulesh SD, Filina NA, Frantava NM, Zhytko NL, Kastsinevich TM, Kliatskova LA, Shumskas MS, Hilz MJ, Schwab S, Kolominsky-Rabas PL: Incidence and case-fatality of stroke on the East border of the European union: the Grodno Stroke Study. Stroke 2010;41:2726-2730.
19.
Kulesh SD, Kastsinevich TM, Kliatskova LA, Sauchanka ME, Filina NA, Shumskas MS, Schwab S, Hilz MJ, Kolominsky-Rabas PL: Long-term outcome after stroke in Belarus: the Grodno stroke study. Stroke 2011;42:3274-3276.
20.
Benatru I, Rouaud O, Durier J, Contegal F, Couvreur G, Bejot Y, Osseby GV, Ben Salem D, Ricolfi F, Moreau T, Giroud M: Stable stroke incidence rates but improved case-fatality in Dijon, France, from 1985 to 2004. Stroke 2006;37:1674-1679.
21.
Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M, Kastarinen M, Poulter N, Primatesta P, Rodriguez-Artalejo F, Stegmayr B, Thamm M, Tuomilehto J, Vanuzzo D, Vescio F: Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003;289:2363-2369.
22.
Diederichs C, Neuhauser H: Regional variations in hypertension prevalence and management in Germany: results from the German Health Interview and Examination Survey (DEGS1). J Hypertens 2014;32:1405-1413; discussion 1414.
23.
Prugger C, Heidrich J, Wellmann J, Dittrich R, Brand SM, Telgmann R, Breithardt G, Reinecke H, Scheld H, Kleine-Katthofer P, Heuschmann PU, Keil U: Trends in cardiovascular risk factors among patients with coronary heart disease: results from the EUROASPIRE I, II, and III surveys in the Munster region. Dtsch Arztebl Int 2012;109:303-310.
24.
de Looze M, ter Bogt T, Hublet A, Kuntsche E, Richter M, Zsiros E, Godeau E, Vollebergh W: Trends in educational differences in adolescent daily smoking across Europe, 2002-10. Eur J Public Health 2013;23:846-852.
25.
Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ: An evidence-based causative classification system for acute ischemic stroke. Ann Neurol 2005;58:688-697.
26.
Hajat C, Heuschmann PU, Coshall C, Padayachee S, Chambers J, Rudd AG, Wolfe CD: Incidence of etiological subtypes of stroke in a multi-ethnic population based study: the South London Stroke Register. J Neurol Neurosurg Psychiatry 2010;82:527-533.
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2015
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