Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults-A Worldwide Meta-analysis The GOAL Initiative

被引：45

作者：

Jacob, Mina A. ^{[1
]}

Ekker, Merel S. ^{[1
]}

Allach, Youssra ^{[1
]}

Cai, Mengfei ^{[1
]}

Aarnio, Karoliina ^{[2
,3
]}

Arauz, Antonio ^{[4
]}

Arnold, Marcel ^{[5
]}

Bae, Hee-Joon ^{[6
]}

Bandeo, Lucrecia ^{[7
]}

Barboza, Miguel A. ^{[8
]}

Bolognese, Manuel ^{[9
]}

Bonardo, Pablo ^{[7
]}

Brouns, Raf ^{[10
,11
]}

Chuluun, Batnairamdal ^{[12
]}

Chuluunbatar, Enkhzaya ^{[14
]}

Cordonnier, Charlotte ^{[15
]}

Dagvajantsan, Byambasuren ^{[13
]}

Debette, Stephanie ^{[16
]}

Don, Adi ^{[17
]}

Enzinger, Chris ^{[19
,20
]}

Ekizoglu, Esme ^{[21
]}

Fandler-Hofler, Simon ^{[19
]}

Fazekas, Franz ^{[19
]}

Fromm, Annette ^{[22
]}

Gattringer, Thomas ^{[19
,20
]}

Hora, Thiago F. ^{[23
]}

Jern, Christina ^{[24
,26
]}

Jood, Katarina ^{[25
,27
]}

Kim, Young Seo ^{[28
]}

Kittner, Steven ^{[29
]}

Kleinig, Timothy ^{[30
]}

Klijn, Catharina J. M. ^{[1
]}

Korv, Janika ^{[31
]}

Kumar, Vinod ^{[32
]}

Lee, Keon-Joo ^{[6
]}

Lee, Tsong-Hai ^{[33
,34
]}

Maaijwee, Noortje A. M. ^{[9
]}

Martinez-Majander, Nicolas ^{[2
,3
]}

Marto, Joao P. ^{[35
,36
]}

Mehndiratta, Man M. ^{[37
]}

Mifsud, Victoria ^{[32
]}

Montanaro, Vinicius ^{[23
]}

Pacio, Gisele ^{[7
]}

Patel, Vinod B. ^{[38
]}

Phillips, Matthew C. ^{[39
]}

Piechowski-Jozwiak, Bartlomiej ^{[32
]}

Pikula, Aleksandra ^{[40
]}

Ruiz-Sandoval, Jose ^{[42
]}

von Sarnowski, Bettina ^{[43
]}

Swartz, Richard H. ^{[41
]}

机构：

[1] Radboud Univ Nijmegen, Med Ctr, Dept Neurol, Donders Inst Brain Cognit & Behav, Nijmegen, Netherlands

[2] Helsinki Univ Hosp, Neurol, Helsinki, Finland

[3] Univ Helsinki, Helsinki, Finland

[4] Natl Inst Neurol & Neurosurg Mexico, Mexico City, DF, Mexico

[5] Univ Bern, Inselspital, Univ Hosp, Dept Neurol, Bern, Switzerland

[6] Seoul Natl Univ, Coll Med, Bundang Hosp, Cerebrovasc Dis Ctr, Seoul, South Korea

[7] Hosp Britan Buenos Aires, Neurol Dept, Buenos Aires, DF, Argentina

[8] Hosp Dr Rafael Calderon Guardia, CCSS, Neurosci Dept, San Jose, Costa Rica

[9] Lucerne Cantonal Hosp, Dept Neurol & Neurorehabil, Neuroctr, Luzern, Switzerland

[10] Vrije Univ Brussel, Fac Med & Pharm, Jette, Belgium

[11] ZorgSaam Hosp, Dept Neurol, Terneuzen, Netherlands

[12] Mongolian Natl Univ Med Sci, Int Sch Tradit Med, Ulaanbaatar, Mongolia

[13] Mongolian Natl Univ Med Sci, Dept Neurol, Sch Med, Ulaanbaatar, Mongolia

[14] Taipei Med Univ, Dept Global Hlth, Sch Publ Hlth, Taipei, Taiwan

[15] Univ Lille, CHU Lille, INSERM, LilNCogLille Neurosci & Cognit,U1172, Lille, France

[16] Univ Bordeaux, INSERM, Bordeaux Populat Hlth Res Ctr, Team VINTAGE, Bordeaux, France

[17] Tel Aviv Univ, Sackler Fac Med, Sch Med, Tel Aviv, Israel

[18] Tel Aviv Univ, Sackler Fac Med, Dept Epidemiol & Prevent Med, Sch Publ Hlth, Tel Aviv, Israel

[19] Med Univ Graz, Dept Neurol, Graz, Austria

[20] Med Univ Graz, Div Neuroradiol, Dept Radiol, Graz, Austria

[21] Istanbul Univ, Istanbul Fac Med, Dept Neurol, Istanbul, Turkey

[22] Haukeland Hosp, Ctr Neurovasc Dis, Dept Neurol, Bergen, Norway

[23] SARAH Hosp Rehabil, Brasilia, DF, Brazil

[24] Univ Gothenburg, Sahlgrenska Acad, Dept Lab Med, Inst Biomed, Gothenburg, Sweden

[25] Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden

[26] Sahlgrens Univ Hosp, Dept Clin Genet & Genom, Gothenburg, Sweden

[27] Sahlgrens Univ Hosp, Dept Neurol, Gothenburg, Sweden

[28] Hanyang Univ, Coll Med, Dept Neurol, Seoul, South Korea

[29] Univ Maryland, Sch Med, Dept Neurol, Vet Affairs Maryland Hlth Care Syst, Baltimore, MD 21201 USA

[30] Royal Adelaide Hosp, Dept Neurol, Adelaide, SA, Australia

[31] Univ Tartu, Dept Neurol & Neurosurg, Tartu, Estonia

[32] Cleveland Clin Abu Dhabi, Neurol Inst, Abu Dhabi, U Arab Emirates

[33] Chang Gung Mem Hosp, Linkou Med Ctr, Dept Neurol, Taoyuan, Taiwan

[34] Chang Gung Univ, Coll Med, Taoyuan, Taiwan

[35] Univ Nova Lisboa, Hosp Egas Moniz, Ctr Hosp Lisboa Ocidental, Dept Neurol, Lisbon, Portugal

[36] Univ Nova Lisboa, NOVA Med Sch, CEDOC, Lisbon, Portugal

[37] GB Pant Inst Med Educ & Res GIPMER, Dept Neurol, New Delhi, India

[38] Inkosi Albert Luthuli Cent Hosp, Nelson R Mandela Sch Med, Dept Neurol, Mayville, South Africa

[39] Waikato Hosp, Dept Neurol, Hamilton, New Zealand

[40] Univ Hlth Network, Dept Med Neurol, Toronto, ON, Canada

[41] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med Neurol, Toronto, ON, Canada

[42] Hosp Civil Guadalajara Fray Antonio Alcalde, Dept Neurol, Guadalajara, Mexico

[43] Univ Med, Dept Neurol, Greifswald, Germany

[44] Univ Malaya, Dept Med, Kuala Lumpur, Malaysia

[45] Rambam Healthcare Campus, Haifa, Israel

[46] Univ Melbourne, Florey Inst Neurosci & Mental Hlth, Stroke Theme, Melbourne, Vic, Australia

[47] Austin Hlth, Dept Neurol, Melbourne, Vic, Australia

[48] Christchurch Hosp, Dept Neurol, Christchurch, New Zealand

[49] Univ Brescia, Neurol Clin, Dept Clin & Expt Sci, Brescia, Italy

来源：

NEUROLOGY | 2022年 / 98卷 / 06期

关键词：

CARDIOVASCULAR-DISEASE; COUNTRIES; TRENDS; EPIDEMIOLOGY; HYPERTENSION; COMMUNITIES; INTERSTROKE; PREVALENCE; MORTALITY; SUBTYPE;

D O I：

10.1212/WNL.0000000000013195

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Objectives There is a worldwide increase in the incidence of stroke in young adults, with major regional and ethnic differences. Advancing knowledge of ethnic and regional variation in causes and outcomes will be beneficial in implementation of regional health care services. We studied the global distribution of risk factors, causes, and 3-month mortality of young patients with ischemic stroke, by performing a patient data meta-analysis from different cohorts worldwide. Methods We performed a pooled analysis of individual patient data from cohort studies that included consecutive patients with ischemic stroke aged 18-50 years. We studied differences in prevalence of risk factors and causes of ischemic stroke between different ethnic and racial groups, geographic regions, and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression. Results We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Black (hypertension, 52.1%; diabetes, 20.7%) and Asian patients (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often the cause of stroke in high-income countries (HICs; both p < 0.001), whereas "other determined stroke" and "undetermined stroke" were higher in low and middle-income countries (LMICs; both p < 0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (odds ratio 2.49; 95% confidence interval 1.42-4.36). Discussion Ethnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial and regional differences in incidence of ischemic stroke. Our results also highlight the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve health care facilities in LMICs.

引用

页码：E573 / E588

页数：16

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