R. Bonita et al., APPROACHES TO THE PROBLEMS OF MEASURING THE INCIDENCE OF STROKE - THEAUCKLAND STROKE STUDY, 1991-1992, International journal of epidemiology, 24(3), 1995, pp. 535-542
Background. Stroke registers are the preferred choice for determining
incidence, case-fatality and severity of acute stroke in defined popul
ations. This paper highlights some of the problems likely to be encoun
tered in this endeavour by describing the experience of measuring acut
e stroke prospectively. Methods. The Auckland Stroke Study is a commun
ity-based study among 945 000 residents of the Auckland region, New Ze
aland. Standard definitions and overlapping case-finding methods were
used to identify all new acute stroke events occurring during the 12-m
onth period ending 1 March 1992. Particular attention was directed at
including nonfatal strokes managed outside hospital. The latter were i
dentified by use of a cluster sample, a technique suitable for populat
ions where residents have a personal primary health care physician. Re
sults. The comprehensive sources of referral to the study involved the
review of 5736 records, less than one-third of which met the criteria
for inclusion. The majority of included acute stroke events (n = 1803
) were found through routinely available sources such as hospital admi
ssion records (63%) and death registrations (10%). The remainder (27%)
were identified through intensive efforts at case-finding of stroke e
vents managed outside hospital. The 1803 events were registered in 176
1 people, 817 men and 944 women; for 587 (72%) men and 718 (76%) women
, the stroke was the first ever experienced. Conclusions. While time-c
onsuming, costly and,demanding, there appears to be no easier alternat
ive to a register to estimate incidence. This study demonstrates the i
mportance of the use of comprehensive case-finding sources and suggest
s approaches to overcoming the difficulties in monitoring stroke incid
ence in large populations.