Ischemic stroke incidence in Santa Coloma de Gramenet (ISISCOG), Spain. A community-based study

María Teresa Alzamora¹^,2^,3 , Marta Sorribes⁴ , Antonio Heras¹ , Nicolás Vila^*⁵ , Marisa Vicheto¹ , Rosa Forés¹ , José Sánchez-Ojanguren⁶ and Amparo Sancho⁷ for the "ISISCOG Study Group" and Guillem Pera³

¹GPS Riu Nord-Riu Sud, Institut Català de la Salut, Major 49, 08921 Santa Coloma de Gramenet, Spain

²Department of Medicine, Universitat Autònoma de Barcelona, Spain

³Research Unit Barcelonés Nord Maresme, ICS-IDIAP Jordi Gol, Camí del Mig 36, 08303 Mataró, Spain

⁴GPS Numància, Institut Català de la Salut, Numància 23, 08029 Barcelona, Spain

⁵Unitat de Neurociències, Institut Català de la Salut, Hospital Germans Trias i Pujol, Carretera del Canyet s/n, Badalona, Spain

⁶Esperit Sant Hospital, Mossen Pons i Rabadà s/n, 08923 Santa Coloma de Gramenet, Spain

⁷GPS Can Mariné, Institut Català de la Salut, Sant Carles 79, 08921 Santa Coloma de Gramenet, Spain

author email corresponding author email* Contributed equally

BMC Neurology 2008, 8:5doi:10.1186/1471-2377-8-5


Published:	27 March 2008

Abstract

Background

In Spain, stroke is one of the major causes of death and the main cause of severe disability in people over 65 years. We analyzed the incidence of ischemic stroke, stroke subtypes, case fatality and disability at 90 days after the event in a Spanish population.

Methods

A prospective community-based register of ischemic strokes was established in Santa Coloma de Gramenet (Barcelona) [116,220 inhabitants of all ages, according to the municipal census of December 31,2001], from January 1 to December 31, 2003.

Standard definitions and case finding methods were used to identify all cases in all age groups. Every patient underwent a complete clinical evaluation and systematic tests including neuroimaging (CT/MRI) and vascular studies (carotid duplex ultrasound intra and extracranial and MR angiography).

Results

Over a one year period, 196 ischemic strokes were registered [107 men; median age = 76 years (range 39–98)], being the first event in 159 patients (81.1%) and a recurrent stroke in 37 (18.9%). After age-adjustment to the European population, the incidence of ischemic stroke per 100,000 inhabitants was 172 (95% CI, 148–196); 219 (176–261) in men and 133 (105–160) in women, with an annual incidence for first ischemic stroke of 139 (118–161); 165 (128–201) in men and 115 (89–140) in women. The incidence of stroke increased with age.

Stroke subtypes (TOAST classification criteria) were lacunar in 28.8%, atherothrombotic in 18.6%, cardioembolic in 26.6% and undetermined in 26.0% of patients. At 90 days, the case-fatality was 12%, and among survivors, moderate-to-severe disability was present in 45 % at 3 months.

Conclusion

This prospective community-based study shows one of the lowest incidences of stroke in Europe, as well as one of the lowest case fatality and disability rates at 90 days after stroke.