7 results for Anderson, CS

  • Trends in ethnic disparities in stroke incidence in Auckland, New Zealand, during 1981 to 2003.

    Carter, Kristie; Anderson, CS; Hackett, Maree; Feigin, Valery; Barber, Peter; Broad, Joanna; Bonita, R (2006)

    Journal article
    The University of Auckland Library

    • Abstract Background and Purpose - Although geographical variations in stroke rates are well documented, limited data exist on temporal trends in ethnic-specific stroke incidence.Methods - We assessed trends in ethnic-specific stroke rates using standard diagnostic criteria and community-wide surveillance procedures in Auckland, New Zealand (NZ) in 1981 to 1982, 1991 to 1992, and 2002 to 2003. Indirect and direct methods were used to adjust first-ever (incident) and total (attack) rates for changes in the structure of the population and reported with 95% CIs. Ethnicity was self-defined and categorized as "NZ/ European," "Maori," " Pacific peoples," and " Asian and other."Results - Stroke attack (19%; 95% CI, 11% to 26%) and incidence rates (19%; 95% CI, 12% to 24%) declined significantly in NZ/Europeans from 1981 to 1982 to 2002 to 2003. These rates remained high or increased in other ethnic groups, particularly for Pacific peoples in whom stroke attack rates increased by 66% (95% CI; 11% to 225%) over the periods. Some favorable downward trends in vascular risk factors, such as cigarette smoking, were counterbalanced by increasing age, body mass index, and diabetes in certain ethnic groups.Conclusions - Divergent trends in ethnic-specific stroke incidence and attack rates, and of associated risk factors, have occurred in Auckland over recent decades. The findings provide mixed views as to the future burden of stroke in populations undergoing similar lifestyle and structural changes.

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  • The Impact of Stroke on Unpaid Caregivers: Results from the Auckland Regional Community Stroke Study, 2002-2003

    Parag, Varsha; Hackett, Maree; Yapa, Chaturangi; Kerse, Ngaire; McNaughton, Harry; Feigin, VL; Anderson, CS (2008)

    Journal article
    The University of Auckland Library

    ackground: Few studies have assessed the longitudinal impact of providing unpaid care for stroke survivors. We aimed to describe the positive and negative impact of providing unpaid care and to identify independent predictors of poor carer outcome. Methods: The Auckland Regional Community Stroke study was a prospective population-based stroke incidence study conducted in Auckland, New Zealand, over a 12-month period in 2002–2003. Stroke survivors and their unpaid carers were assessed at 6 and 18 months after stroke onset using the Short Form 36 questionnaire and the Bakas Caregiving Outcomes Scale. Results: Data were available from 167 stroke survivor–carer pairs at 6 months and 62 pairs at 18 months. Unpaid carers reported lower health-related quality of life at 6 months after stroke than their age- and sex-matched counterparts in the New Zealand population. The impact of providing care was predominantly negative; however, approximately one third of the carers had improved relationships with the stroke survivor. No reliable predictors of carer burden were identified. Conclusions: This study re-emphasises the heavy burden of stroke on unpaid carers but was unable to identify factors that predicted carers at the greatest risk of experiencing a poor outcome. Effective strategies are needed to reduce the burden of providing unpaid care.

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  • Improved survival after stroke: is admission to hospital the major explanation? Trends analyses of the Auckland Regional Community Stroke Studies

    Carter, K; Anderson, CS; Hackett, Maree; Barber, Peter; Bonita, R (2007)

    Journal article
    The University of Auckland Library

    Background: There is uncertainty regarding the impact of changes in stroke care and natural history of stroke in the community. We examined factors responsible for trends in survival after stroke in a series of population-based studies. Methods: We used statistical models to assess temporal trends in 28-day and 1-year case fatality after first-ever stroke cases registered in 3 stroke incidence studies undertaken in Auckland, New Zealand, over uniform 12-month calendar periods in 1981–1982 (n = 1,030), 1991–1992 (1,305) and 2001–2002 (1,423). Cox proportional hazards regression was used to evaluate the significance of pre-defined ‘patient’, ‘disease’ and ‘service/care’ factors on these trends. Results: Overall, there was a 40% decline in 28-day case fatality after stroke over the study periods, from 32% (95% confidence interval, 29–35%) in 1981–1982 to 23% (21–25%) in 1991–1992 and then 19% (17–21%) in 2002–2003. Similar relative declines were seen in 1-year case fatality. In regression models, the trends were still significant after adjusting for patient and disease factors. However, further adjustment for care factors (higher hospital admission and neuroimaging) explained most of the improvement in survival. Conclusions: These data show significant downwards trends in case fatality after stroke in Auckland over 20 years, which can largely be attributed to improved stroke care associated with increases in hospital admission and brain imaging during the acute phase of the illness.

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  • Falls after stroke: results from the Auckland Regional Community Stroke (ARCOS) study 2002-2003

    Kerse, Ngaire; Parag, Varsha; Feigin, VL; McNaughton, Harry; Hackett, Maree; Bennett, Derrick; Anderson, CS (2008)

    Journal article
    The University of Auckland Library

    Background and Purpose— Falls are an important issue in older people. We aimed to determine the incidence, circumstances, and predictors of falls in patients with recent acute stroke. Methods— The Auckland Regional Community Stroke (ARCOS) study was a prospective population-based stroke incidence study conducted in Auckland, New Zealand (NZ) during 2002 to 2003. Among 6-month survivors, the location and consequences of any falls were ascertained by self-report as part of a structured interview. Multivariable logistic regression was used to establish associations between risk factors and “any” and “injurious” falls. Results— Of 1104 stroke survivors who completed an interview, 407 (37%) reported at least 1 fall, 151 (37% of fallers, 14% of stroke survivors) sustained an injury that required medical treatment, and 31 (8% of fallers, 3% of stroke survivors) sustained a fracture. The majority of falls occurred indoors at home. Independent factors associated with falls were depressive symptoms, disability, previous falls, and older age. For injurious falls, the positively associated factors were female sex and NZ/European ethnicity and dependence before the stroke, whereas higher levels of activity and normal cognition were negatively associated factors. Conclusions— Falls are common after stroke, and their predictive factors are similar to those for older people in general. Falls prevention programs require implementation in stroke services.

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  • Changes in long-term survival after stroke in Auckland, New Zealand between 1981 and 1991, amongst those alive at 3 months

    Broad, Joanna; Feigin, Valery; Bonita, R; Anderson, CS (2000)

    Journal article
    The University of Auckland Library

    Background. The Auckland Stroke Studies have previously demonstrated that differences in 3-month survival after stroke between 1981 and 1991 were explained by reduced severity at stroke onset. Long-term differences in stroke survival have not been adequately described. Method. Two large population-based studies of stroke in Auckland were conducted, with follow-up to 6 years. Long-term survival in those alive at 3 months was analysed using proportional hazards analysis, adjusted for demographics, severity, pre-stroke conditions and other factors, to explore the association of post-stroke survival with post-stroke care. Comparison with population-based data is also made. Results. Median survival time after stroke improved from 1.4 years in the 1981 cohort to 3.1 years in 1991. This is evident in a 43% reduced hazard (HR50.57, 95%CI 0.51 to 0.64) in 1991 even after adjustment for stroke severity and other factors. In those alive at 3 months, non-haemorrhagic stroke, demographic factors (increasing age, female sex, Maori or pacific ethnicity) and pre-stroke conditions (diabetes, and dependence in self-care) are the main non-modifiable predictors of death. Cigarette smoking is associated with 23% increased hazard (HR51.23, 95%CI 1.07 to 1.41). Referral to a neurologist is associated with 31% improved long-term survival (HR50.69, 95%CI 0.56 to 0.86). Discussion. Predictors of death early after stroke are different from those associated with later death. Reduced severity and changes in early care do not adequately account for the remaining improvement. Increased mean population life expectancy of 1.1 years over the same 10-year interval explains only part of the observed improvement in survival.

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  • Stroke incidence and case fatality in Australasia: A comparison of the Auckland and Perth population-based stroke registers

    Bonita, R; Broad, Joanna; Anderson, CS; Jamrozik, KD; Stewart-Wynne, EG; Anderson, NE (1994-03)

    Journal article
    The University of Auckland Library

    Background and Purpose: Population-based studies are crucial for identifying explanations for the decline in mortality from stroke and for generating strategies for public health policy. However, they present particular methodological difficulties, and comparability between them is generally poor. In this article we compare the incidence and case fatality of stroke as assessed by two independent well-designed incidence studies. Methods: Two registers of acute cerebrovascular events were compiled in the geographically defined metropolitan areas of Auckland, New Zealand (population 945 369), during 1991-1992 for 12 months and Perth, Australia (population 138 708), during 1989-1990 for 18 months. The protocols for each register included prospective ascertainment of cases using multiple overlapping sources and the application of standardized definitions and criteria for stroke and case fatality. Results: In Auckland, 1803 events occurred in 1761 residents, 73% of which were first-ever strokes. The corresponding figures for Perth were 536 events in 492 residents, 69% of which were first-ever strokes. Both studies identified a substantial proportion of nonfatal strokes managed solely outside the hospital system: 28% in Auckland and 22% in Perth of all patients registered. The age- standardized annual incidence of stroke (all events) was 27% higher among men in Perth compared with Auckland (odds ratio, 1.27; P=.016): women tended to have higher rates in Auckland, although these differences were not statistically significant. In both centers approximately a quarter of all patients died within the first month after a stroke. There were significant differences in the prevalence of hypertension among first-ever strokes. Conclusions: These two studies emphasize the importance of identifying all patients with stroke, both hospitalized and nonhospitalized, in order to measure the incidence of stroke accurately. The incidence and case fatality of stroke were remarkably similar in Auckland and Perth in the early 1990s. However, there are differences in the sex-specific rates that correspond to differences in the pattern of risk factors.

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  • Management of hypertension in the oldest old: a study in primary care in New Zealand

    Senior, Hugh; Anderson, CS; Chen, Mei-hua; Haydon, R; Lillis, Steven; Gommans, J; Walker, D; Fourie, D (2006)

    Journal article
    The University of Auckland Library

    Background: the benefits of blood pressure (BP) lowering are well established except in the oldest old, and suboptimal control of hypertension has been found in many different populations. Objective: to assess the frequency of hypertension and its adequacy of management in the oldest old in primary care. Design: a cross-sectional study. Setting: sixty-seven general practitioners (GPs) in three urban centres in New Zealand. Methods: we conducted structured reviews of medical records for all ambulatory people aged ≥80 years who were registered with a participating GP. Hypertensive status and BP control were classified according to standard criteria. Logistic regression analyses were used to identify independent factors for BP control.

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