22. European Stroke Conference 4 Epidemiology of stroke 15:00 - 15:10 Trends in stroke, coronary heart disease, and cardiovascular risk factors during the past half century in a Japanese community: the Hisayama Study, 1961-2009 J. Hata1, T. Ninomiya2, Y. Hirakawa3, M. Nagata4, N. Mukai5, S. Gotoh6, M. Fukuhara7, F. Ikeda8, K. Shikata9, D. Yoshida10, M. Kamouchi11, T. Kitazono12, Y. Kiyohara13 Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN1,Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN2, Graduate School of Medi-cal Sciences, Kyushu University, Fukuoka, JAPAN3, Graduate School of Medical Sciences, Ky-ushu University, Fukuoka, JAPAN4, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN5, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JA-PAN6, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN7, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN8, Graduate School of Medi-cal Sciences, Kyushu University, Fukuoka, JAPAN9, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN10, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN11, Graduate School of Medical Sci-ences, Kyushu University, Fukuoka, JAPAN12, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN13 Background: Changes in lifestyle and advances in medical technology during the past half cen-tury are likely to have affected the incidence and mortality of cardiovascular disease and the prevalence of risk factors in Japan. Methods: In the town of Hisayama located in a suburb of the Fukuoka metropolitan area in Ja-pan, five cohorts consisting of the residents aged >/=40 years were established in 1961, 1974, 1983, 1993, and 2002, and were followed up for 7 years, respectively. Results: The age-adjusted incidence of stroke decreased greatly, by 51% in men and by 43% in women, from the 1960s to the 1970s, but this decreasing trend slowed down thereafter. Among stroke subtypes, the incidences of brain infarction in both sexes and brain haemorrhage in men showed a similar decreasing pattern, while those of brain haemorrhage in women and subarach-noid haemorrhage in both sexes did not show clear secular changes. The age-adjusted mortality of stroke decreased as a result of the decline in the incidence and a significant improvement in survival rate. The incidence and mortality of coronary heart disease (acute myocardial in-farction, cardiac sudden death, or coronary intervention) did not show clear changes. Although the prevalence of hypertension in both sexes did not show dramatic changes, the proportion of participants receiving antihypertensive treatment increased, and blood pressure among hy-pertensive participants decreased over the study period. The smoking rate in men and women decreased from 1961 to 1993. In contrast, the prevalence of metabolic risk factors (i.e., glucose intolerance, hypercholesterolaemia, and obesity) increased with time in both sexes. Conclusions: In the Japanese community, the decreasing trends in the stroke incidence have recently slowed down, and there has been no clear change in the incidence of coronary heart disease, probably because the benefits of hypertension control and smoking cessation have been negated by increasing metabolic risk factors. 3 Epidemiology of stroke 14:50 -15:00 Inverse association between neighborhood socioeconomic status and post stroke mortality, an analysis of the Dijon stroke registry taking account of place of care O. GRIMAUD1, E. LERAY2, B. Lalloue3, J. Durier4, M. Giroud5, Y. Béjot6 EHESP, RENNES, FRANCE1,EHESP, Rennes, FRANCE2, EHESP, Rennes, FRANCE3, Uni-versity of Burgundy, Dijon, FRANCE4, University Hospital and Faculty of Medicine of Dijon, Dijon, FRANCE5, University Hospital and Faculty of Medicine of Dijon, Dijon, FRANCE6 Background Evidence of an inverse association between neighborhood socioeconomic status (NSES) and post stroke mortality is accumulating. We explored whether this disadvantage originates while patients are in acute care. Methods The study population includes all incident stroke cases identified by the Dijon stroke registry between 1998 and 2010. We used the Townsend deprivation score to determine NSES for 46 neighborhoods whose socioeconomic status remained stable during the study period. Follow up was up to 90 days after stroke. Using Cox proportional hazards models we examine asso-ciations between NSES and death taking into account the whole observation time, then distin-guishing time spent in and outside acute care. Results Our sample included 1327 incident stroke cases (mean age 75, 49% male, 86% ischemic). Cas-es did not differ across tertiles of NSES in terms of risk factors prevalence, stroke type and se-verity. Increasing level of deprivation was associated with younger age (p for trend<10-3), and longer length of stay (p for trend 0.01). 207 cases (15.6%) died during follow up, most of them (163 or 79%) whilst in acute care. Overall, there was a gradient of increasing risk of death with increasing tertile of deprivation: 2nd versus 1st tertile, age and gender adjusted hazards ratio (HR)=1.35 (95% CI :0.96-1.88); 3rd versus 1st tertile HR=1.48 (1.03-2.12)(p for trend 0.03). No significant trend was identified when analyzing risk of death whilst in acute care, whereas a strong gradient existed whilst outside acute care : 2nd versus 1rst tertile HR=1.43 (0.64-3.18), 3rd versus 1st HR=2.75 (1.28-5.93) (p for trend 0.008). This gradient persisted when adjusting for stroke type and severity. Conclusion In this sample, the positive association between residential deprivation and post stroke mortal-ity is mainly driven by death occurring outside acute care. Differences in the process of acute care are therefore unlikely to explain this disadvantage. 140 © 2013 S. Karger AG, Basel Scientific Programme
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