22. European Stroke Conference 515 Epidemiology of stroke Severity of stroke in young adults in Estonia from 2008 to 2012 S. Schneider1, A. Kornejeva2, L. Busina3, R. Vibo4, J. Korv5 Department of Neurology, North Estonia Medical Centre; Department of Neurology and Neu-rosurgery, University of Tartu, Tallinn, ESTONIA1, Department of Neurology and Neurosurgery, University of Tartu, Tartu, ESTONIA2, Department of Neurology and Neurosurgery, University of Tartu, Tartu, ESTONIA3, Department of Neurology and Neurosurgery, University of Tartu, Tartu, ESTONIA4, Department of Neurology and Neurosurgery, University of Tartu, Tartu, ESTONIA5 Background: Baseline NIHSS score is a prognostic factor for recovery after stroke. The incidence of stroke in young adults in Estonia is high. However, the severity of stroke is unknown. The aim of this study was to determine the severity of acute ischemic stroke in the young in Estonia and to com-pare it with other studies. Methods: Medical documents of all consecutive patients aged 15-54 with first-ever ischemic stroke from the two hospitals of Estonia (Tartu University Clinics and North Estonia Medical Centre) from 2008 to 2012 were retrospectively analyzed. Stroke severity was categorized as mild (NIHSS 0-6), moderate (7-15) or severe (16-42). NIHSS score was assessed on admission and on day 7 or dis-charge. If NIHSS score was not available, it was assessed retrospectively on the basis of medical documentation using a validated algorithm. Stroke was subtyped according to the TOAST criteria. Results: Of the 411 patients, 274 (67%) were men. The mean age of patients was 46.2 years (SD 7.5), without significant gender differences. Two hundred twelve patients (52%) had stroke due to large-artery atherosclerosis, 112 (27%) had lacunar stroke, 62 (15%) had cardioembolism, 22 (5%) had stroke from other causes and 3 (1%) had stroke of undetermined cause. The median NIHSS score on admission and discharge was 4 (range 0-35) and 2 (range 0-23), respectively. Most of the strokes (67%) were mild, 24% had moderate and 9% had severe stroke on admission; the respective numbers at discharge were 81%, 17% and 3%. The in-hospital mortality rate was 1.2%. Men had significantly more severe strokes on admission (p=0.02) and a tendency to be more severe on dis-charge. 618 © 2013 S. Karger AG, Basel Scientific Programme Conclusions: There is a heavy male predominance in our study. We found that while stroke severity is generally mild, it is more severe in men. Further studies are needed to study the factors deter-mining prognosis after stroke. It is especially important among young patients as they represent the working-age population. 516 Epidemiology of stroke Does neighborhood unemployment have an impact on post-stroke survival? Results from a German cohort study. M. Unrath1, M. Kalic2, J. Minnerup3, P.U. Heuschmann4, K. Berger5 Institute of Epidemiology and Social Medicine, University of Münster, Münster, GERMANY1, Institute of Epidemiology and Social Medicine, University of Münster, Münster, GERMANY2, In-stitute of Epidemiology and Social Medicine, University of Münster, Münster, GERMANY3, Insti-tute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, GERMANY4, In-stitute of Epidemiology and Social Medicine, University of Münster, Münster, GERMANY5 Background: Little is known about the influence of neighborhood characteristics on survival after stroke. Aims of our study were to a) analyze the impact of neighborhood socio-economic status (SES-NH) on long-term survival after stroke in Dortmund, Germany, and b) to compare these results with survival analyses performed in a general population sample from the same city. Methods: Two prospective cohort studies formed the basis of our analyses. In the Dortmund Stroke Register (DOST), stroke patients (n = 1,883) were recruited from acute care hospitals serving the city. In the Dortmund health study (DHS), a random sample was drawn from the city’s general pop-ulation, with 2,291 individuals participating (response rate 66.9%). In both studies, vital status was ascertained in the city registration office. Information on neighborhood unemployment as indicator of SES-NH was obtained from the city’s statistical office. Multilevel survival analyses with different adjustment sets were performed to examine the association between SES-NH and survival. Results: In the DHS, higher SES-NH was associated with better survival after adjusting for individ-ual socio-demographic characteristics of the participants. The strength of this association decreased slightly when additional adjustment for education, lifestyle and morbidity was done. In the DOST, only stroke participants exposed to the lowest SES-NH (5th quintile) had lower survival rates as compared to the other categories. This association became stronger when the follow-up period was postponed to 12 and 24 months after discharge. Conclusion: The impact of SES-NH on survival was distinct for stroke patients and the general pop-ulation. Older age, relatively homogeneous lifestyle and similar morbidity profiles within the stroke cohort, as well as medical factors may help explain the observed differences in the association be-tween SES-NH and survival.
Karger_ESC London_2013
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