Oral Presentation Asia Pacific Stroke Conference 2024

Changes in incidence of major pathological types of stroke in the Auckland Regional Community Stroke Studies: 2010-2022 (106953)

Rita V Krishnamurthi 1 , Craig Anderson 2 , Bruce Arroll 3 , Alan Barber 4 , Suzanne Barker-Collo 5 , Derrick Bennett 6 , Paul Brown 7 , Dominique Cadilhac 8 , Jeroen Douwes 9 , Daniel Exeter 10 , Balakrishnan Nair 1 , Varsha Parag 11 , Anna Ranta 12 , Yogini Ratnasabapathy 13 , Illari Rautilin 1 , Andy Swain 14 , El-Shadan Tautolo 15 , Braden Te Ao 16 , Amanda Thrift 17 , Bronwyn Tunnage 1 , Valery L Feigin 1
  1. National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, Auckland, AUCKLAND, New Zealand
  2. Neurology & Mental Health , The George Institute for Global Health, Sydney, ACT , Australia
  3. General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand,
  4. University Research Centre for Brain Research, The University of Auckland, Auckland, New Zealand
  5. School of Psychology, University of Auckland, Auckland, New Zealand
  6. Nuffield Department of Population Health, University of Oxford , Oxford, United Kingdom
  7. UCM Health Services Research and Policy , University of California , Merced , United States of America
  8. Department of Medicine, Monash University, Clayton, ACT, Australia,
  9. Research Centre for Hauora and Health, Massey university, Wellington, New Zealand
  10. Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
  11. National Institute for Health Innovation (NIHI) , UniServices, The Univerisity of Auckland, Auckland, New Zealand
  12. Department of Medicine (Wellington) , University of Otago, Wellington , New Zealand
  13. Waitemata, Stroke Units, Geriatrics, Waitakere Hospital, Te Whatu Ora - Waitemata, Auckland, New Zealand
  14. Research and Education, Kia Ora te Tangata - Wellington Free Ambulance, Wellington , New Zealand
  15. AUT Pacific Health Research Centre , Auckland University of Technology,, Auckland, New Zealand
  16. School of Population Health, The University of Auckland, Auckland, New Zealand
  17. Faculty of Medicine, Nursing and Health Sciences , Monash University, Clayton, , Victoria,, Australia

Background: Monitoring temporal changes in the incidence of pathological stroke types (ischemic stroke [IS], intracerebral haemorrhage [ICH], and subarachnoid haemorrhage [SAH]) is important given their different risk factors, management, and prognoses. We report changes in these major stroke types between two Auckland Regional Community Stroke Studies (ARCOS).

Methods: ARCOS-IV (2010-2011) and ARCOS-V (2020-2021) are population-based studies of all new strokes in the Auckland region (aged >15 years) that captured the incidence of major pathological stroke types. Age-standardised incidence rate (per 100,000) ratios (IRR) with 95% confidence intervals (CIs) were calculated to assess temporal differences between studies by stroke type and ethnicity.

Results: In ARCOS-V, 1613 (78%) first-ever strokes were IS, 329 (16%) ICH, 110 (5%) SAH, and 9 (0.004%) undetermined. Between the two ARCOS studies, the IRR of IS (1.0 [95%CI 0.93-1.08]) showed no detectable change, while increases were observed in ICH (IRR=1.30 [1.09-1.55]) and SAH (IRR=1.11 [0.83-1.49]). Ethnic disparities were also observed with greater IRRs for ICH among Māori (1.91 [0.8-4.54]) and Pacific (1.61 [1.09-2.57]) peoples, and in SAH among Asian peoples (1.52 [0.72-3.20]). In ARCOS-V, Pacific peoples had the largest incidence of IS (143 [SE 0.1], followed by Māori (123 [0.1] while ICH was highest in Pacific (47 [SE 0.1]) (3.3-fold greater than in NZ Europeans).

Conclusions: Changes in stroke incidence varied by pathological types with increased rates for ICH and SAH but not IS. Māori and Pacific peoples had the largest rates and temporal increases in IS and ICH. Culturally appropriate primary prevention may reduce these disparities.