Incidence of stroke in the diabetic and non-diabetic population in Upper Austria (2008-2012) and
DOI:
https://doi.org/10.17713/ajs.v44i3.38Abstract
Abstract: Background and Purpose: Although it is generally known that diabetes has a negative effect on the stroke incidence, only a limited number of long-term population-based studies focus on the comparison of incidence rates of stroke in diabetics and non-diabetics. Hence, the aim of this study was to estimate the risk of stroke in the diabetic and the non-diabetic population with the help of incidence rates and effect measures. Methods: For this study, data from the Upper Austrian stroke register and the statutory Upper Austrian health insurance (1.3 million members) was used to analyse all first strokes from 2008-2012. This was done by assessing stroke incidence for the total, the diabetic and the non-diabetic population. The analysis was mainly conducted on an age/sex-specific basis. Moreover, age/sex-standardized incidence rates were calculated as well. In addition, effect measures like the relative risk, the attributable risk among exposed and the population attributable risk were computed. Results: Out of the total cohort of 1,319,761 subjects, 17,663 had a first stroke (mean age (Sd.): 71.6 (±14.3) years; 46.0 per cent male). Among these, 19.5 per cent were classified as diabetics. Concerning the stroke standardized incidence rates of the Upper Austrian population (per 100,000 person years), the following results were obtained for the diabetic and the non-diabetic population respectively: men: 571.9 (95%-confidence interval: 530.1-613.6), 319.3 (95%-confidence interval: 311.3-327.2); women: 600.9 (95%-confidence interval: 559.3-642.5), 343.5 (95%-confidence interval: 335.7-351.3). The age-standardised relative risk was found to be 1.79 (95%-confidence interval: 1.66-1.93) for men and 1.75 (95%-confidence interval: 1.63-1.88) for women. Attributable risks among exposed are as follows: men: 0.44 (95%-confidence interval: 0.40-0.48); women: 0.43 (95%-confidence interval: 0.39-0.47). For the population attributable risks 0.08 (95%-confidence interval: 0.04-0.11) was obtained for men and 0.07 (95%-confidence interval: 0.04-0.09) for women. Conclusion: This investigation showed that the stroke risk in the diabetic population is significantly higher compared to the non-diabetic population.
References
Almdal, T; Scharling, H.;Jensen, J. S.;Vestergaard, H. (2004). The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke and death: A population-based study of 13,000 men and women with 20 years of follow-up. Archives of Internal Medicin, 164(13), 1422-1426.
Breslow, N. E.; Day, N. E. (1980). Statistical Methods in Cancer Research - Volume 1 – The analysis of case-control studies. Lyon, International Agency for Research on Cancer.
Breslow, N. E.; Day, N. E. (1987). Statistical Methods in Cancer Research - Volume 2 – The design and analysis of cohort studies. Lyon, International Agency for Research on Cancer.
Bundesministerium für Gesundheit (Hrsg), (2012). Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme 10. Revision – BMG-Version 2013, Wien. (http://bmg.gv.at/cms/home/attachments/1/1/2/CH1241/CMS1287572751172/icd-10_bmg_2013_-_systematisches_verzeichnis.pdf [accessed on 26/07/13]
Chen, H. F.; Lee, S. P.; Li, C. Y. (2009). Sex differences in the incidence of hemorrhagic and ischemic stroke among diabetics in Taiwan. Journal Womens Health, 18 (5), 647-654.
Cole, P.; MacMahon, B., (1971). Attributable risk percent in case-control studies. British Journal of Preventive & Social Medicine, 25, 242-244
Diabetes Care and Research in Europe, (1989). The Saint Vincent Declaration. World Health Organization, ICP/CLR 034.
Esteve, J.; Benhamou, E.; Raymond, L. (1994). Descriptive Epidemiology. 4 ed.. Lyon, International Agency for Research on Cancer.
Fisz, M. (1989). Wahrscheinlichkeitsrechnung und Mathematische Statistik. Berlin, VEB Deutscher Verlag der Wissenschaften.
Grysiewiez, R.; Thomas, K.; Pandey, D. K. (2008). Epidemiology of ischemic and hemorrhagic stroke: Incidence, prevalence, mortality and risk factors. Neurologic clinics, 26 (4), 871–895.
Icks, A.; Scheer, M.; Genz, J.; Giani, G.; Glaeske, G.; Hoffmann, F. (2011), Stroke in the diabetic and non-diabetic population in Germany: relative and attributable risks, 2005-2007. Journal of Diabetes and its Complications, 25, 90-96.
Jeerakathil, T.; Johnson, J. A.; Simpson, S. H.; Majumdar, S. R. (2007). Short-term risk for stroke is doubled in persons with newly treated type 2 diabetes compared with persons without diabetes: A population-based cohort study. Stroke, 38 (6), 1739-1743.
Kahn, H. A.; Sempson, C. T. (1989). Statistical Methods in Epidemiology. New York, Oxford University Press.
Kissela, B. M.; Khoury, J.; Kleindorfer, D.; Woo, D.; Schneider, A.; Alwell, K.; Miller, R.; Ewing, I.; Moomaw, C. J.; Szaflarski, J. P.; Gebel, J.; Shukla, R.; Broderick, J. P. (2005). Epidemiology of Ischemic Stroke in Patients with Diabetes – The Greater Cincinnati/Northern Kentucky Stroke Study. Diabetes Care, 28 (2), 355-359.
Kolominsky-Rabas, P. L.;Sarti, C.; Heuschmann, P. U.; Graf, C.; Siemonsen, S.; Neundoerfer, B.; Katalinic, A.; Lang, E.; Gassmann, K. G.; von Stockert, T. (1998). A prospective community-based study of stroke in Germany: The Erlangen Stroke Project (SEPro). Incidence and case fatality at 1, 3 and 12 months. Stroke, 29 (12), 2501-2506.
Köster, I.; von Ferber, L.; Ihle, P.; Schubert, I.; Hauner, H. (2006). The cost burden of diabetes mellitus: the evidence from Germany-the CoDiM study. Köln, Springer-Verlag.
Krämer, W.; Gigerenzer, G. (2005). How to Confuse with Statistics or: The Use and Misuse of Conditional Probabilities. Statistical Science, 20 (3), 223-230.
Lackland, D.; Roccella, E.; Deutsch, A. et al. (2014). Factors Influencing the Decline in Stroke Mortality: A Statement from the American Heart Association/American Stroke Association. Stroke, 45:315-353, 326-327
Lin, M.; Chen, Y.; Sigal, R. J. (2007). Stroke associated with diabetes among Canadians: sex and age differences. Neuroepidemiology, 28 (1), 46-49.
National Stroke Association (2013). What is a stroke?
http://www.stroke.org/site/PageServer?pagename=stroke [accessed on 26/07/13].
Österreichische Schlaganfallgesellschaft (ÖGSF) (2010). Schlaganfallprävention bei Patienten mit Diabetes mellitus Typ 2 – Positionspapier Dezember 2010.
http://www.oegsf.at/aerzte/uploads/Positionspapiere/Positionspapier_Schlaganfallpraevention%20bei%20Patienten%20mit%20DM%20II_Version%20Dez%202010.pdf [accessed on 27/08/2013]
Ross, J. (2012). Nervous System, 4 ed.. Elsevier Health Sciences.
Truelsen, T.; Piechowski-Jóźwiak, B.; Bonita, R.; Mathers, C.; Bogousslavsky, J.; Boysen, G. (2006). Stroke incidence and prevalence in Europe: a review of available data. European Journal of Neurology, 13 (6), 581-598.
United Nations, Department od Economics and Social Affairs, 2012. World Population
Prospects. (http://esa.un.org/unpd/wpp/Excel-Data/population.htm)
Published
How to Cite
Issue
Section
The Austrian Journal of Statistics publish open access articles under the terms of the Creative Commons Attribution (CC BY) License.
The Creative Commons Attribution License (CC-BY) allows users to copy, distribute and transmit an article, adapt the article and make commercial use of the article. The CC BY license permits commercial and non-commercial re-use of an open access article, as long as the author is properly attributed.
Copyright on any research article published by the Austrian Journal of Statistics is retained by the author(s). Authors grant the Austrian Journal of Statistics a license to publish the article and identify itself as the original publisher. Authors also grant any third party the right to use the article freely as long as its original authors, citation details and publisher are identified.
Manuscripts should be unpublished and not be under consideration for publication elsewhere. By submitting an article, the author(s) certify that the article is their original work, that they have the right to submit the article for publication, and that they can grant the above license.