Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland (E.S., N.A.M., A.H., N.P., K.B.).
Social Research Division, Economic and Social Research Institute, Dublin, Ireland (N.A.D., M.A.W.).
Stroke. 2021 Dec;52(12):3961-3969. doi: 10.1161/STROKEAHA.121.034005. Epub 2021 Sep 9.
Cognitive impairment no dementia (CIND) and dementia are common stroke outcomes, with significant health and societal implications for aging populations. These outcomes are not included in current epidemiological models. We aimed to develop an epidemiological model to project incidence and prevalence of stroke, poststroke CIND and dementia, and life expectancy, in Ireland to 2035, informing policy and service planning.
We developed a probabilistic Markov model (the StrokeCog model) applied to the Irish population aged 40 to 89 years to 2035. Data sources included official population and hospital-episode statistics, longitudinal cohort studies, and published estimates. Key assumptions were varied in sensitivity analysis. Results were externally validated against independent sources. The model tracks poststroke progression into health states characterized by no cognitive impairment, CIND, dementia, disability, stroke recurrence, and death.
We projected 69 051 people with prevalent stroke in Ireland in 2035 (22.0 per 1000 population [95% CI, 20.8-23.1]), with 25 274 (8.0 per 1000 population [95% CI, 7.1-9.0]) of those projected to have poststroke CIND, and 12 442 having poststroke dementia (4.0 per 1000 population [95% CI, 3.2-4.8]). We projected 8725 annual incident strokes in 2035 (2.8 per 1000 population [95% CI, 2.7-2.9]), with 3832 of these having CIND (1.2 per 1000 population [95% CI, 1.1-1.3]), and 1715 with dementia (0.5 per 1000 population [95% CI, 0.5-0.6]). Life expectancy for stroke survivors at age 50 was 23.4 years (95% CI, 22.3-24.5) for women and 20.7 (95% CI, 19.5-21.9) for men.
This novel epidemiological model of stroke, poststroke CIND, and dementia draws on the best available evidence. Sensitivity analysis indicated that findings were robust to assumptions, and where there was uncertainty a conservative approach was taken. The StrokeCog model is a useful tool for service planning and cost-effectiveness analysis and is available for adaptation to other national contexts.
认知障碍但非痴呆（CIND）和痴呆是常见的中风结局，对老龄化人口的健康和社会有重大影响。这些结果并未包含在当前的流行病学模型中。我们旨在开发一个流行病学模型，以预测 2035 年爱尔兰中风、中风后 CIND 和痴呆的发病率和患病率，以及预期寿命，为政策和服务规划提供信息。
我们开发了一个概率马尔可夫模型（StrokeCog 模型），适用于 2035 年年龄在 40 至 89 岁的爱尔兰人口。数据来源包括官方人口和住院统计数据、纵向队列研究和已发表的估计。在敏感性分析中对关键假设进行了不同的分析。结果经过外部验证，与独立来源一致。该模型追踪中风后患者的健康状况进展，包括无认知障碍、CIND、痴呆、残疾、中风复发和死亡。
我们预计 2035 年爱尔兰将有 69051 名中风患者（22.0/1000 人[95%置信区间，20.8-23.1]），其中 25274 名（8.0/1000 人[95%置信区间，7.1-9.0]）预计会出现中风后 CIND，12442 名出现中风后痴呆（4.0/1000 人[95%置信区间，3.2-4.8]）。我们预计 2035 年将有 8725 例中风新发病例（2.8/1000 人[95%置信区间，2.7-2.9]），其中 3832 例为 CIND（1.2/1000 人[95%置信区间，1.1-1.3]），1715 例为痴呆（0.5/1000 人[95%置信区间，0.5-0.6]）。50 岁中风幸存者的预期寿命为女性 23.4 年（95%置信区间，22.3-24.5），男性 20.7 年（95%置信区间，19.5-21.9）。
本研究采用了最佳现有证据，建立了一种新型的中风、中风后 CIND 和痴呆的流行病学模型。敏感性分析表明，这些发现对假设具有稳健性，并且在存在不确定性的情况下采取了保守的方法。StrokeCog 模型是服务规划和成本效益分析的有用工具，可用于适应其他国家的情况。
