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Team: Padma Chutoo, Elena Kulinskaya, Nicholas Steel and Ilyas Bakbergenuly

Project: Stroke Mortality and Morbidity in the United Kingdom

Working paper 1: Review of Stroke Mortality and Morbidity in United Kingdom by Padma Chutoo

Stroke is a severe disease that occurs 152,000 times a year (that is, one every 3 minutes 27 seconds) in the UK accounting for 53,004 deaths [1]. Stroke can be classified in terms of ischaemic stroke, IS (clot) and haemorrhagic stroke, HS (bleed). About 85 % of all strokes are ischaemic (clot) and 15 % haemorrhagic (bleed). Transient Ischaemic attack (TIA), often referred as “mini-stroke” is regarded as a warning sign for future strokes. For the purpose of the current study, TIA and IS stroke types are considered.

A stroke can be life-threatening condition and may also cause long-term problems and disability which can necessitate rehabilitation and further care. Many of these stroke survivors experience significant and long-term physical and psychological impacts, repeat strokes, transient ischaemic attacks (TIAs) and/or death within a year of stroke. Stroke is the third leading causes of disability-adjusted life years lost, DALYS. It is no longer regarded as the “disease of the old age” due to the worrying trend of younger people being affected by it. The trend is expected to double by 2030 unless proper strategies are devised. The economic burden of stroke in UK is estimated to be around £9 billion a year. The annual NHS costs of stoke are estimated to hit £10.2 billion in 2035.

The risk of premature death and disability is quite high among stroke survivors. It is of utmost importance to gain insight on risk factors, trends in incidence and diagnosis after stroke in an effort to reduce the risk of mortality and morbidity and consequently, improve the outcome.

The main aim of the research is to study the impact of stroke on the survival of the stroke patients in the UK. Hazards will be estimated of all-cause mortality on risk factors influencing the risk of stroke (demographical data, treatments, comorbidities and lifestyle interventions). The residual impairment and functional outcome after stroke among stroke survivors will be also investigated. The treatments effects of different medical therapies on survival will also be explored. To achieve the following objectives, medical records was extracted from the Health Improvement Network (THIN) database pertaining to adult patients born as from the year 1960.THIN data currently contains the electronic medical records of 11.1 million patients (3.7 million active patients) equivalent to 75.6 million patient years of data collected from 562 general practices in the UK, covering 6.2% of the UK population. Despite significant progress in prevention, treatment and rehabilitation, there is still great capacity for further improvements, which in turn could reduce these large economic burdens and to achieve the following research is warranted.

[1] PM Rothwell, AJ Coull, MF Giles, SC Howard, LE Silver, LM Bull, SA Gutnikov, P Edwards, D Mant, CM Sackley, et al. Change in stroke incidence, mortality, case-fatality, severity, and risk factors in oxfordshire, uk from 1981 to 2004 (oxford vascular study). The Lancet, 363(9425):1925–1933, 2004.