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Abstract

Background:

Stroke mortality rates in Brazil are the highest in the Americas. Deaths from cerebrovascular disease surpass coronary heart disease.

Aim:

To verify stroke mortality rates and morbidity in an area of São Paulo, Brazil, using the World Health Organization Stepwise Approach to Stroke Surveillance.

Methods:

We used the World Health Organization Stepwise Approach to Stroke Surveillance structure of stroke surveillance. The hospital-based data comprised fatal and nonfatal stroke (Step 1). We gathered stroke-related mortality data in the community using World Health Organization questionnaires (Step 2). The questionnaire determining stroke prevalence was activated door to door in a family-health-programme neighbourhood (Step 3).

Results:

A total of 682 patients 18 years and above, including 472 incident cases, presented with cerebrovascular disease and were enrolled in Step 1 during April–May 2009. Cerebral infarction (84.3%) and first-ever stroke (85.2%) were the most frequent. In Step 2, 256 deaths from stroke were identified during 2006–2007. Forty-four per cent of deaths were classified as unspecified stroke, 1/3 as ischaemic stroke, and 1/4 due to haemorrhagic subtype. In Step 3, 577 subjects over 35 years old were evaluated at home, and 244 cases of stroke survival were diagnosed via a questionnaire, validated by a board-certified neurologist. The population demographic characteristics were similar in the three steps, except in terms of age and gender.

Conclusion:

By including data from all settings, World Health Organization stroke surveillance can provide data to help plan future resources that meet the needs of the public-health system.

Keywords

concepts design prevention stroke surveillance

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References

1 Lotufo

. Stroke in Brazil: a neglected disease. Sao Paulo Med J 2005; 123:3–4.

2 Johnston

Mendis

Mathers

. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol 2009; 8:345–54.

3 Lotufo

Bensenor

. Stroke mortality in Brazil: one example of delayed epidemiological cardiovascular transition. Int J Stroke 2009; 4:40–1.

4 Lotufo

Goulart

Bensenor

. Race, gender and stroke subtypes mortality in Sao Paulo, Brazil. Arq Neuropsiquiatr 2007; 65:752–7.

5 Christensen

Valiente

Sampaio Silva

. Acute Treatment Costs of Stroke in Brazil. Neuroepidemiology 2009; 32:142–9.

6 Truelsen

Bonita

Jamrozik

. Surveillance of stroke: a global perspective. Int J Epidemiol 2001; 30(Suppl. 1): S11–6.

7 Truelsen

Bonita

. Surveillance of stroke: The WHO STEPwise approach. Summary. Geneva: World Health Organization, 2002.

8 Lotufo

Bensenor

. Improving WHO STEPS Stroke in Brazil. Lancet Neurol 2007; 6:387–8.

9 Aikawa

Bambirra

Seoane

Bensenor

Lotufo

. Higher burden of hemorrhagic stroke among women. An autopsy-based study in São Paulo, Brazil. Neuropidemiology 2005; 24:209–13.

10.

10 Lotufo

Bensenor

. Stroke mortality in São Paulo (1997–2003): a description using the tenth revision of the International Classification of Diseases. Arq Neuropsiquiatr 2004; 62:1008–11.

11.

11 Lotufo

Bensenor

. Trends of stroke subtypes mortality in Sao Paulo, Brazil (1996–2003). Arq Neuropsiquiatr 2005; 63:951–5.

12.

12 André

Curioni

Braga da Cunha

Veras

. Progressive decline in stroke mortality in Brazil from 1980 to 1982, 1990 to 1992, and 2000 to 2002. Stroke 2006; 37:2784–9.

13.

13 Minelli

Fen

Minelli

. Stroke incidence, prognosis, 30-day, and 1-year case fatality rates in Matão, Brazil: a population-based prospective study. Stroke 2007; 38:2906–11.

14.

14 Cabral

Gonçalves

Longo

. Incidence of stroke subtypes, prognosis and prevalence of risk factors in Joinville, Brazil: a 2 year community based study. J Neurol Neurosurg Psychiatry 2009; 80:755–61.

15.

15 Cabral

Gonçalves

Longo

. Trends in stroke incidence, mortality and case fatality rates in Joinville, Brazil: 1995–2006. J Neurol Neurosurg Psychiatry 2009; 80:749–54.

16.

16 Cincura

Pontes-Neto

Neville

. Validation of the National Institutes of Health Stroke Scale, modified Rankin Scale and Barthel Index in Brazil: the role of cultural adaptation and structured interviewing. Cerebrovasc Dis 2009; 27:119–22.

17.

17 Laurenti

Souza

Prado

Gotlieb

. Epidemiologic study of sudden death in adults from 15 to 74 years of age in the city of Sao Paulo. Arq Bras Cardiol 1980; 35:5–14.

18.

18 Lawlor

Smith

Leon

Sterne

Ebrahim

. Secular trends in mortality by stroke subtype in the 20th century: a retrospective analysis. Lancet 2002; 360:1818–23.

19.

19 Berger

Hense

Rothdach

Weltermann

Keil

. A single question about prior stroke versus a stroke questionnaire to assess stroke prevalence in populations. Neuroepidemiology 2000; 19:245–57.

20.

20 Truelsen

Heuschmann

Bonita

. 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; 6:134–39.

21.

21 Dalal

Malik

Bhattacharjee

Vairale

Bhat

. Population-based stroke survey in Mumbai: incidence and 28-day case fatality. Neuroepidemiology 2008; 31:254–61.

22.

22 Sridharan

Unnikrishnan

Sukumaran

. Incidence, types, risk factors, and outcome of stroke in a developing country: the Trivandrum Stroke Registry. Stroke 2009; 40:1212–8.

23.

23 Lavados

Hennis

Fernandes

. Stroke epidemiology, prevention, and management strategies at a regional level: Latin America and the Caribbean. Lancet Neurol 2007; 6:362–72.

24.

24 Feigin

Lawes

CMM

Bennett

Anderson

. Stroke epidemiology: are view of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003; 2:45–53.

25.

25 Correia

Silva

Matos

. Prospective community-based study of stroke in Northern Portugal. Incidence and case fatality in rural and urban populations. Stroke 2004; 35:2048–53.

26.

26 Lavados

Sacks

Prina

. Incidence, 30-day case-fatality rate, and prognosis of stroke in Iquique, Chile: a 2-year community-based prospective study (PISCIS project). Lancet 2005; 365:2206–15.

27.

27 Zhao

Liu

Wang

. Epidemiological transition of stroke in China: twenty-one-year observational study from the Sino-MONICA-Beijing Project. Stroke 2008; 39:1668–74.

A Stepwise Approach to Stroke Surveillance in Brazil: the EMMA (Estudo de Mortalidade E Morbidade Do Acidente Vascular Cerebral) Study

Abstract

Background:

Aim:

Methods:

Results:

Conclusion:

Keywords

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References