F. Chin

Time Trends in Hospital-Referred Stroke and Transient Ischemic Attack: Results of a 7-Year Nationwide Survey in France

Background: Nationwide evaluations of the burden of stroke are scarce. We aimed to evaluate trends in stroke and transient ischemic attack (TIA) hospitalization, in-hospital case fatality rates (CFRs) and mortality rates in France during 2000–2006. Methods: Hospitalizations for stroke and TIA were determined from National Hospital Discharge Diagnosis Records that used the International Classification of Disease, 10th revision, codes I60, I61, I63, I64, G45, G46. CFRs and mortality rates were estimated from the national death certificates database. Results: The total number of stays for stroke increased between 2000 and 2006 (88,371 vs. 92,118) contrasting with a decrease in that for TIA. The age-standardized (European population) hospitalization rates for TIA decreased in men (52.2 vs. 44.5/100,000/year, p = 0.002), whereas they remained stable in women (32.4 vs. 31.0/ 100,000/year). Concerning stroke, a decrease in hospitalization rates was observed in both men (from 135.3 to 123.4/ 100,000/year, p < 0.001) and women (from 85.1 to 80.7, p < 0.001). Whatever the age group and the sex, a sharp decrease in in-hospital stroke CFRs was noted. In addition, a 23% decrease in mortality rates was observed. This decrease was greater in patients >65 years. Conclusion: Our results demonstrate a decline in hospitalization rates for stroke, and in both stroke CFRs and mortality rates between 2000 and 2006. Improvements in stroke prevention and acute stroke care may have contributed to these results, and may have been initiated by recent advances in health policy with regard to this disease in France.

Time trends in pulmonary embolism mortality in France, 2000-2010

BACKGROUND Pulmonary Embolism (PE) is a potentially fatal complication of venous thrombosis. Recent and comprehensive estimates of PE incidence and mortality are scarce. Moreover, while contemporary mortality trends of PE would enable the evaluation of prevention and quality of care, such data are lacking. The aim of this study was to provide nationwide estimations of PE mortality and time trends in France between 2000 and 2010. METHODS Mortality data were obtained from the French Epidemiology Center on medical causes of death. Mortality rates were calculated with PE as an underlying or one of multiple causes of death. The annual percentage changes were assessed using a Poisson regression model. Age-standardized PE mortality rates were also assessed. RESULTS In 2010, the overall age-adjusted PE mortality rate was 21.0 per 100000. This rate was 30% higher in men than in women and decreased by 3% per year between 2000 and 2010. Over this period, PE mortality declined in men and women over 55 years but only slightly decreased in patients younger than 55. Cancer, obesity, osteopathies and complications of surgery were often coded as the underlying causes of death when PE was an associated cause of death recorded on certificate. DISCUSSION This study is the first to provide a contemporary and exhaustive nationwide estimation of PE mortality and time trends in France. The observed decrease in PE mortality between 2000 and 2010 is encouraging, but further efforts in prevention are needed to ensure that this reduction is widespread in all age groups.