Iranian Journal of Neurology 2017. 16(4):201-209.

Ten-year trend in stroke incidence and its subtypes in Isfahan, Iran during 2003-2013
Ahmad Bahonar, Alireza Khosravi, Fariborz Khorvash, Mohammadreza Maracy, Shahram Oveisgharan, Noushin Mohammadifard, Mohammad Saadatnia, Fatemeh Nouri, Nizal Sarrafzadegan


Background: As there was no evidence of long-term studies on stroke trend, stroke subtypes and its relationships to stroke risk factors and demographic characteristics in Iran, we aimed to evaluate 10-year trend of stroke incidence and stroke subtypes in Isfahan, Iran.

Methods: In a hospital-based retrospective study, 24186 cases with the first-ever stroke were analyzed. We assessed the incidence trend of annual stroke and its subtypes [ischemic stroke )IS(, subarachnoid hemorrhage (SAH), and intracranial hemorrhage )ICH(] during the years 2003 to 2013 by sex, and studied the association of demographic and major stroke risk factors with incidence and mortality rate of stroke.

Results: The mean age was 69.46 ± 14.87 years, and 49.29% of patients were women. IS was the most frequent type among all the types of strokes (76.18%). Stroke and its subtypes had decreasing incidence trend during the study period, except for SAH that increased. In addition, stroke and its subtypes had decreasing mortality trend during the study period, except for SAH that did not change anymore. Stroke mortality and incidence rates were lower in urban inhabitants compared to residents of rural areas [odds ratio (OR) = 0.763, P < 0.001].

Conclusion: Despite the relatively high incidence of stroke over the study period, the incidence rate of stroke, especially ICH subtype, had a decreasing trend over the last decade in Isfahan. However, given the current young population in Iran, we can expect that the incidence of stroke would have an escalating trend in future.


Risk Factors; Incidence; Mortality; Stroke; Trend

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Adamson J, Beswick A, Ebrahim S. Is stroke the most common cause of disability? J Stroke Cerebrovasc Dis 2004; 13(4): 171-7.

Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3(11): e442.

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(4): 355-69.

Reeves MJ, Bushnell CD, Howard G, Gargano JW, Duncan PW, Lynch G, et al. Sex differences in stroke: Epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol 2008; 7(10):915-26.

Koifman J, Hall R, Li S, Stamplecoski M, Fang J, Saltman AP, et al. The association between rural residence and stroke care and outcomes. J Neurol Sci 2016; 363: 16-20.

Johnston SC, Mendis S, Mathers CD.Global variation in stroke burden and mortality: Estimates from monitoring, surveillance, and modelling. Lancet Neurol 2009; 8(4): 345-54.

Noroozian M. The elderly population in Iran: An ever growing concern in the health system. Iran J Psychiatry Behav Sci 2012; 6(2): 1-6.

Azarpazhooh MR, Etemadi MM, Donnan GA, Mokhber N, Majdi MR, Ghayour- Mobarhan M, et al. Excessive incidence of stroke in Iran: Evidence from the Mashhad Stroke Incidence Study (MSIS), a population-based study of stroke in the Middle East. Stroke 2010; 41(1): e3-e10.

Truelsen T, Heuschmann PU, Bonita R, Arjundas G, Dalal P, Damasceno A, et al. Standard method for developing stroke registers in low-income and middle- income countries: Experiences from a feasibility study of a stepwise approach to stroke surveillance (STEPS Stroke). Lancet Neurol 2007; 6(2): 134-9.

World Health Organization.Cerebrovascular disorders: A clinical and research classification. Geneva, Switzerland: WHO; 1978.

Sun Xg, Wang YL, Zhang N, Wang T, Liu YH, Jin X, et al. Incidence and trends of stroke and its subtypes in Changsha, China from 2005 to 2011. J Clin Neurosci2014; 21(3): 436-40.

Segi M, Kurihara M. Cancer mortality for selected sites in 24 countries, No. 6 (1966-1967). Tokyo, Japan: Japan Cancer Society; 1972.

Robson B, Purdie G, Cram F, Simmonds S. Age standardisation-an indigenous standard? Emerg Themes Epidemiol 2007; 4: 3.

Koton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, Gottesman RF, et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA2014; 312(3): 259-68.

Santalucia P, Baviera M, Cortesi L, Tettamanti M, Marzona I, Nobili A, et al. Epidemiologic Trends in hospitalized ischemic stroke from 2002 to 2010: Results from a large Italian population- based study. J Stroke Cerebrovasc Dis 2015; 24(8): 1917-23.

Cui R, Iso H, Yamagishi K, Saito I, Kokubo Y, Inoue M, et al. Trends in the proportions of stroke subtypes and coronary heart disease in the Japanese men and women from 1995 to 2009. Atherosclerosis 2016; 248: 219-23.

Dehghani Firoozabadi M, Kazemi T, Sharifzadeh G, Dadbeh S, Dehghan P. Stroke in Birjand, Iran: A hospital-based study of acute stroke. Iran Red Crescent Med J 2013; 15(3): 264-8.

Cabral NL, Goncalves AR, Longo AL, Moro CH, Costa G, Amaral CH, et al. Trends in stroke incidence, mortality and case fatality rates in Joinville, Brazil:1995-2006. J Neurol Neurosurg Psychiatry 2009; 80(7): 749-54.

Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, Wolfe CD, et al. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: Data from a multicenter multinational hospital-based registry. Stroke 2003; 34(5): 1114-9.

O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): A case-control study. Lancet 2016; 388(10046): 761-75.

Gorgui J, Gorshkov M, Khan N, Daskalopoulou SS. Hypertension as a risk factor for ischemic stroke in women. Can J Cardiol 2014; 30(7): 774-82.

van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: Diagnosis, causes and management. Brain 2001; 124(Pt 2):249-78.

Appelros P, Stegmayr B, Terent A. Sex differences in stroke epidemiology: A systematic review. Stroke 2009; 40(4):1082-90.

Persky RW, Turtzo LC, McCullough LD.Stroke in women: Disparities and outcomes. Curr Cardiol Rep 2010; 12(1):6-13.

Sarfo FS, Akassi J, Awuah D, Adamu S, Nkyi C, Owolabi M, et al. Trends in stroke admission and mortality rates from

to 2013 in central Ghana. J NeurolSci 2015; 357(1-2): 240-5.

Gonzalez-Perez A, Gaist D, Wallander MA, McFeat G, Garcia-Rodriguez LA. Mortality after hemorrhagic stroke: Data from general practice (The Health Improvement Network). Neurology 2013;81(6): 559-65.

Smajlovic D. Strokes in young adults: Epidemiology and prevention. Vasc Health Risk Manag 2015; 11: 157-64.


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