SUPPLEMENTAL SLIDES Epidemiology. General Information o Declines in death rates from cardiovascular...

SUPPLEMENTAL SLIDES

Epidemiology

General Information

o Declines in death rates from cardiovascular diseases (CVD) are largely responsible for the recent major improvement in life expectancy.

o Currently, the average life expectancy of people born in the US is now 76.6 years.

o Many factors have affected the decline in CVD mortality including:o more effective medical treatment for heart and

stroke patients; and o more emphasis on reducing the major controllable

risk factors (e.g., high blood pressure, smoking, high blood cholesterol, physical inactivity, overweight and obesity, and diabetes).

Stroke

o Prevalence is an estimate of how many people have a specific disease at a given point in time.

o This number is useful in assessing the level of medical and social care needed to cope with current cases.

o Among adults age 20 and older, the American Heart Association estimated the prevalence of stroke in 2005 as 5,800,000 (about 2,300,000 males and 3,400,000 females).

o Incidence is an estimate of the number of new cases of a disease that develop in a population in a one-year period.

o It is an indicator of the need for preventative measures.

Stroke

o Incidence figures from the American Heart Association estimate that each year about 780,000 people experience a new or recurrent stroke.

o About 600,000 of these are first attacks, and 180,000 are recurrent attacks.

o On average, every 40 seconds someone in the United States has a stroke and every 3 to 4 minutes someone dies of a stroke.

o Stroke accounted for about 1 of every 16 deaths in the United States in 2004 meaning that 150,074 (58,800 males, 91,274 females) person died of stroke in 2004.

o When considered separately from other CVDs, stroke ranks as the third leading cause of death behind diseases of the heart and cancer.

Stroke

o 87% of strokes are ischemic, with the athero-thrombotic etiology accounting for 61% of these strokes, followed by cerebral embolus at 24%.

o After ischemic strokes, 10% are intracerebral hemorrhage, and 3% are subarachnoid hemorrhage.

o Among persons ages 45–64 years, 8 to 12 percent of ischemic strokes and 37 to 38 percent of hemorrhagic strokes result in death within 30 days.

Age, Gender, Race, and Ethnicity

o 28% of people who experience a stroke in a given year are under the age of 65 years.

o For people over age 55, the incidence of a stroke more than doubles in each successive decade.

o The chance of having a stroke before age 70 is 1 in 20 for both genders.

o Men’s stroke incidence rates are greater than women’s at younger ages but not at older ages.

o The male/female incidence ratio is 1.25 at ages 55–64; 1.50 for ages 65–74; 1.07 at ages 75–84 and 0.76 at age 85 and older.

o At older ages, the incidence is higher in women than in men.


o Each year, about 60,000 more women than men have a stroke.

o At all ages, more women (61.5%) than men (38.5%) die of stroke.

o Blacks have almost twice the risk of first-ever stroke compared with whites.

o The age-adjusted stroke incidence rates at ages 45–84 years are 6.6 per 1,000 population in black males, 3.6 in white males, 4.9 in black females and 2.3 in white females.

o Compared with Whites, young African Americans have 2-3 times the risk of ischemic stroke and African-Americans are twice as likely as Euro-Americans to experience lacunar strokes—thrombotic strokes in small blood vessels.


o African-American men and women are more likely also to die of stroke.

o In 2004, there was a reported increase in the incidence of stroke among Mexican Americans compared with non-Hispanic whites (Brain Attack Surveillance in Corpus Christi project).

o The crude cumulative incidence was 168/10,000 in Mexican Americans and 136/10,000 in non-Hispanic whites.

o Specifically, Mexican Americans had an increased incidence of intracerebral hemorrhage and subarachnoid hemorrhage compared with non-Hispanic whites, as well as an increased incidence of ischemic stroke and TIA at younger ages.


o For men age 20 and older, the age-adjusted prevalence of stroke is• 2.5% for non-Hispanic black men• 2.3% for Mexican-American men• 2.2% for non-Hispanic white men

o For women age 20 and older, the age-adjusted prevalence for stroke is o 3.2% for non-Hispanic blackso 1.5% for non-Hispanic whiteso 1.3% for Mexican-Americans

o The annual rates per 1,000 population of new and recurrent strokes for men ages 65-74 are o 15.2 for American Indianso 14.4 for non-blackso 11.9 for blacks


o The annual rates per 1,000 population for new and recurrent strokes for women ages 65-74 are o 16.1 for blacks o 7.9 for American Indianso 6.2 for non-blacks

o Annual rates per 1,000 population of new and recurrent strokes for men and women ages 75-84 are o 24.6 for non-black men and 22.7 for non-black

women o 17.5 for black males and 22.4 for black women


o Annual rates per 1,000 population of new and recurrent strokes for men and women ages 85 and older are o 27.9 for non-black men and 30.6 for non-black womeno 40.8 for black men and 0.0 for black women

o Annual rates per 1,000 population of stroke in Japanese-American men also increases with advancing age.

o At ages 45-49 years, the incidence is o 2.1 for total stokeo 1.5 for thromboembolic strokeo .04 for intracerebral hemorrhage

o At ages 65-68 years, the incidence is o 8.2 for total strokeo 6.6 for thromboembolic strokeo 1.0 for intracerebral hemorrhage.


o At ages 40–69 years, the percent who die one year following a first stroke is o 14% of white men o 20% of white womeno 19% of black men; and o 19% of black women.

o At ages 70 and older, the percent who die one year following a first stroke iso 24 % of white men o 27% of white women o 25%of black men; and o 22% of black women.


o The median survival time (in years) following a first stroke is:o 6.8 for men and 7.4 for women aged 60 -69 years.o 5.4 for men and 6.4 for women aged 70–79 years;

and o 1.8 for men and 3.1 for women aged 80 years and

oldero 8% of men and 11% of women will have a stroke

within 6 years after a myocardial infarction.o 51% of men and 53% of women under age 65 who

have a stroke after heart attack will die within 8 years.


o CVDs are among the top 10 causes of death in children, with rates highest in the first year of life.

o Compared to the stroke risk of white children, black children have a higher relative risk of 2.12, Hispanics have a lower relative risk of 0.76, and Asians have a similar risk.

o Boys have a 1.28-fold higher risk of stroke than girls.

o There are no ethnic differences in stroke severity or case fatality, but boys have a higher case-fatality rate for ischemic stroke. (Neurology. 2003;61:189–194.)

Transient Ischemic Attack (TIA)

o The prevalence of TIA in men is estimated to be 2.7% for ages 65–69 years and 3.6 % for ages 75–79 years.

o For women, TIA prevalence is estimated to be 1.6% for ages 65–69 years and 4.1% for ages 75–79 years.

o About 15% of strokes are preceded by a TIA. o About half of patients who experience a TIA fail to

report it to their healthcare providers.o 14% of persons who survive a first stroke or transient

ischemic attack (TIA) will experience a recurrence within 1 year

o After TIA, the 90-day risk of stroke is 3–17.3%, highest within the first 30 days.

o Within a year of TIA, up to a quarter of patients will die.

Morbidity

o Stroke is a leading cause of serious, long-term disability in the United States.

o The length of time to recover from a stroke depends on its severity.

o Four million Americans are living with the effects of stroke.

o More than 1.1 million American adults report having difficulty with functional limitations, activities of daily living, etc., as the result of a stroke.

o About one-third have mild impairments, another third are moderately impaired and the remainder are severely impaired.

o Institutional care is required by 20% at three months after onset.

Long-Term Effect

o Stroke costs the United States $30 billion annually.o Direct costs, such as hospitals, physicians and

rehabilitation add up to $17 billion; o Indirect costs, such as lost productivity, total $13

billion. o The average cost per patient for the first 90 days

post-stroke is $15,000, although 10 percent of the cases exceed $35,000.

o 12 contiguous states and the District of Columbia have stroke death rates that are consistently more than 10 percent higher than the rest of the country.

Long-Term Effect

o These states, referred to as the “stroke belt,” include Virginia, North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, Arkansas, Tennessee, Kentucky and Indiana, and Washington, D.C.

o Higher incidence and mortality may be linked to a number of factors, including a higher than average population of African-Americans; a higher than average population of older adults; and dietary factors

Risk Factors/Prevention

o There are several risk factors which can make a person more likely to experience a stroke.

o Controllable risk factors include hypertension, atrial fibrillation, smoking, high cholesterol and excess weight.

o Some risk factors that you cannot change are age, gender, race, family history, and diabetes.

o High blood pressure increases one’s stroke risk two to six times.

o Blood pressure that is consistently higher than 140/90 damages artery walls and can increase blood-clotting action, which can lead to formation of stroke-causing clots.

Controllable Risk Factors/Prevention

o Smoking, in addition to harming the lungs, also injures blood vessel walls, speeds up hardening of the arteries, increases how hard your heart has to work, and raises blood pressure.

o Smoking can double your stroke risk, but once you quit, within two to five years your stroke risk will be the same as someone who never smoked.

o Atrial fibrillation, a particular type of irregular heart beat, affects more than 1 million Americans.

o If left untreated, stroke risk increases from four to six times.

Controllable Risk Factors/Prevention

o Excess cholesterol settles on artery walls and leads to eventual blockage of these vessels by thrombosis.

o Being overweight strains the entire circulatory system and predisposes you to other stroke risk factors, such as high blood pressure.

Unpreventable Risk Factors

o Stroke risk doubles in most ethnic groups with each decade past age 55.

o Males have a slightly higher stroke risk than females.

o African Americans have double the stroke risk of most other racial groups.

o A family history of stroke can mean that you are at a higher risk.

o Circulation problems associated with diabetes may increase stroke risk even if blood sugar and insulin levels are closely managed

Traumatic Brain Injury

o There are 5500 TBIs a day and 137 resulting deaths.

o That means that every 15 seconds someone in the U.S. receives a head injury.

o Every five minutes one of these individual will die, and another will become permanently disabled.

o Conservative estimates claim over 2 million individual experience a TBI each year.

o About 500,000 to 750,000 head injuries each year are severe enough to require hospitalization.

o About 75,000 to 100,000 result in death.

Age, Race, Sex, Ethnicity

o The populations most likely to be affected by TBI are young children, young adults, and the elderly, who fall and suffer elder abuse.

o Head injury is the leading cause of death and disability in children and young adults in the U.S.

o It represents an estimated 13% of all injuries nationwide.

o Throughout the world, the median age of TBI is 18.o Males are twice as likely as females to experience

head injuries.o The most frequently injured group of individuals is

males between the ages of 15 and 24, constituting 50% of all head injury cases.

Age, Race, Sex, Ethnicity

o Deaths due to head injuries represent 2% of all deaths, and 26% of all injury deaths.

o There is little information regarding the relationship between race and head injury.

o Generally, nonwhites are 49% more likely to have a head injury than whites.

o Incidence rates are as follows:o 209 per 100,000 whiteso 278 per 100,000 blacks o 262 per 100,000 Hispanics

Long-Term Effects

o Among survivors, 80% of all head injuries are considered minor with moderate and severe head injuries accounting for 10% each.

o Long-term disabilities are experienced by 70-90% of all individuals experiencing mild head injuries almost all of whom report verbal problems and another 59% of whom report impaired memory.

o About 10% of all mild head injury survivors have permanent neurological deficits, and one-third are unemployed 6 months after injury.

o Almost 15% of persons employed full time before a head injury will not have returned to work four years later.

Long-Term Effects

o About 5,000 new cases of epilepsy are attributed to HI each year.

o About 10% of severe head injury survivors go into a prolonged coma (2 or more weeks), while only 3% of all comatose patients remain in this state.

o Prolonged coma patients have a 30-40% chance of ending up in a persistent vegetative state.

o Approximately 2000 survivors will exist in a persistent vegetative state.

Long-Term Effects

o For an individual, the lifetime cost for care of a head injury survivor are estimated to between $4.1 and $9 million.

o The average acute care hospital stay for a patient with a severe head injury is 56 to 60 days, with a cost of $324, 000 per person.

o The total annual cost of hospitalization for all head injuries exceeds $37,800 million.

o Post-hospital rehabilitation services cost $125,000 per year, and may be required for several years.


o Car crashes account for 50% of all TBIs.o Alcohol plays a significant role in head injury

accidents.o About 56% of head injury survivors have a

documentable blood alcohol level at the time of their accident.

o For children under 1 year of age, the most common etiology of head injury is abuse.

o With young children, it is not the surface with which the head contacts, but the force of the impact.

o For infants under 6 months of age, the abuser is usually mom, and the injury comes from a softer abuse, such as smothering.


o Over 6 months, the abuser is usually a significant other male, and resulting injury is more severe and focal.

o Between the ages of 1 and 4 years, falls from 2' or more (windows, steps, trees, playground equipment) are most common.

o Babies who are not walking should not use walkers as they don't have the perceptual skills to use the walker and can tip off or into hard surfaces.

o Ages 5-9 years experience the most car-pedestrian injuries.


o Ages 9-14 years experience the most sports-related injuries.

o For boys, the most dangerous sports are football and soccer.

o For girls, field hockey, basketball, and volleyball are the most dangerous.

o Ages 15-19 years experience the most motor vehicle crashes (MVCs) due to poor judgment, alcohol, and/or drug use.

o One-fourth of all head injuries could be prevented if all cars were equipped with airbags.

o Motorcycle riders not wearing helmets are 40% more likely to incur a fatal injury and 15% more likely to sustain a head injury than helmeted riders.


o It is estimated that $61 million per year could be saved if all motorcyclists wore helmets.

o Bicyclists could reduce their risk of head injury by 88% by wearing protective head gear.

o In the USA only, violence from assaults and recreational beatings account for the highest statistics of head injury in the 10 largest cities in the US.

Dementia

o Approximately 5% to 10% of the adult population age 65 years and older is affected by a dementing disorder with the prevalence doubling every five years after the age of 65.

o The largest group affected by dementia is over 85 years of age with prevalence in this group reaching 50%.

o Alzheimer’s disease is the most common disorder causing cognitive decline in the elderly and accounting for 50-60% of all dementias.

Dementia

o Dementia is also a component in 30% of person's with Parkinson's disease.

o Vascular or multi-infarct dementia accounts for 15-20% of dementia patients.

o Primary risk factors for Alzheimer’s Disease are age and family history.

o Susceptibility genes, previous head injury with loss of consciousness, female sex and lower education level have also been implicated.

Dementia

o Approximately 4 million Americans have Alzheimer’s disease.

o Approximately 19 million Americans say they have a family member with Alzheimer’s, and 37 million know someone with the disease.

o 14 million Americans will have Alzheimer’s by the middle of the next century unless a cure or prevention is found.

o It is estimated that more than 22 million individuals worldwide will have Alzheimer’s by 2025.

Dementia

o One in 10 persons over 65 and nearly half of those over 85 have Alzheimer’s disease.

o A small percentage of people in their 30s and 40s develop the disease.

o A person with Alzheimer’s lives an average of 8 years and as many as 20 years or more from the onset of symptoms.

o After diagnosis and treatment, greater than 50% of individuals diagnosed with dementia function at a higher level.

Dementia

o Alzheimer’s disease costs the U.S. at least $100 billion a year.

o Neither Medicare nor private health insurance covers the type of long-term care most patients need.

o Alzheimer’s disease costs American businesses more than $33 billion annually — $26 billion to lost productivity of caregivers plus $7 billion related to costs for health and long-term care.

o More than 7 out of 10 people with Alzheimer’s disease live at home.

o Almost 75 percent of home care is provided by family and friends.

Dementia

o The remainder is “paid” care costing an average of $12, 500 per year, most of which is covered by families.

o Half of all nursing home patients have Alzheimer’s disease or a related disorder.

o The average per patient cost for nursing home care is $42,000 per year but can exceed $70,000 per year in some areas of the country.

o The average lifetime cost per patient is estimated to be $174,000.

SUPPLEMENTAL SLIDES Epidemiology. General Information o Declines in death rates from cardiovascular...

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