Secular Trends in Ischemic Stroke Characteristics in a Rapidly Developed Country

Abstract

Background— A dynamic change in industry, lifestyle, and healthcare structure brings a corresponding change in disease patterns. Limited data exist with respect to secular trends in stroke epidemiology in Korea, a rapidly developed country. Methods and Results— We analyzed individual patient data registered the Korean Stroke Registry, a nationwide hospital-based stroke database, between January 2002 and November 2010. Mortality data were obtained from a national death certificate system. Linear or logistic regression analyses were performed to assess secular trends. A total of 46 098 patients were included in this study. Mean±SD age was 66.1±12.3 years, and 57.6% of the patients were men. Over the 9-year period, patient ages steadily increased by 0.24 year annually ( P <0.001). Risk factor proportions of hypertension, diabetes, smoking, and prior stroke declined slightly ( P <0.05 for all). However, dyslipidemia frequency showed a complex pattern of an initial decline and then an increase. For relative proportions of subtypes, cardioembolism increased, small vessel occlusion decreased, and large artery atherosclerosis remained stable. Still, intracranial stenosis overwhelms extracranial stenosis, but extracranial stenosis is on the rise. Arrival within 3 hours increased from 20% to 29%, and reperfusion therapy increased from 5.3% to 7.0%. Age-adjusted all-cause mortality did not decrease at 30 days but decreased at 1 year over time. Conclusions— During the first decade of 21st century, stroke characteristics in Korea changed, likely because of increased lifespan, westernized lifestyle, and improved public awareness. Stroke experts need to cope with these distinguishing trends to establish a better strategy for prevention and acute therapy.