Population-Based Stroke Survey in Mumbai, India: Incidence and 28-Day Case Fatality

Objectives: The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having ‘first-ever stroke’ (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006. B...

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Published inNeuroepidemiology Vol. 31; no. 4; pp. 254 - 261
Main Authors Dalal, P.M., Malik, S., Bhattacharjee, M., Trivedi, N.D., Vairale, J., Bhat, P., Deshmukh, S., Khandelwal, K., Mathur, V.D.
Format Journal Article
LanguageEnglish
Published Basel, Switzerland S. Karger AG 01.01.2008
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Online AccessGet full text
ISSN0251-5350
1423-0208
1423-0208
DOI10.1159/000165364

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Abstract Objectives: The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having ‘first-ever stroke’ (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006. Background: An estimated 5.8 million people died from stroke (cerebrovascular disease) in 2005, two thirds of them were from low-/middle-income countries but reliable population-based studies are scarce. Methods: The manual on WHO STEPwise approach to stroke surveillance (STEPS Stroke; http://www.who.int/chp/steps/Manual pdf) was the operational protocol. We selected a well-defined community (H-district) having verifiable census data and being representative of the population structure of Mumbai (Bombay). Of 337,391 permanent residents, 156,861 persons between the age of 25 and 94+ years who were eligible for survey were screened. The responses to a predefined questionnaire (version 2.0) were entered in coded data sheets for analysis. Results: During the 2-year study period (January 2005 to December 2006), 456 (238 males and 218 females) had FES, indicating an annual incidence in subjects of 25 years and above of 145/100,000 persons (CI 95%: 120–170); for males it is 149/100,000 persons (CI 95%: 120–170) and for females it is 141/100,000 persons (CI 95%: 120–160). The age-standardized rate for study population (both sexes) by the direct method using Segi’s 1996 world population is 152/100,000/year (CI 95%: 132–172). Stroke diagnosis was supported by computed tomography in 407 (89.2%) of 456 FES cases: 366 (80.2%) had ischemic stroke, 81 (17.7%) had hemorrhagic stroke and 9 (1.9%) were in the unspecified category. The mean age was 66 ± (SD) 13.60 years, women were older as compared to men (mean age 68.9 ± 13.12 years vs. 63.4 ± 13.53 years). Case fatality: at 28 days, 320 (70%) of 456 FES cases were still alive and 136 (29.8%) had died. Of the 320 surviving patients 38.5% had moderate to severe disability by the modified Rankin scale. Conclusions: The results of Mumbai stroke study, using uniform definitions and methodologies, show that the annual standardized incidence rates, stroke subtypes and case fatality rate are very similar to those reported from developed nations. To plan effective intervention and prevention strategies, standardized data in representative samples of regional populations are urgently needed.
AbstractList The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having 'first-ever stroke' (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006. An estimated 5.8 million people died from stroke (cerebrovascular disease) in 2005, two thirds of them were from low-/middle-income countries but reliable population-based studies are scarce. The manual on WHO STEPwise approach to stroke surveillance (STEPS Stroke; http://www.who.int/chp/steps/Manual pdf) was the operational protocol. We selected a well-defined community (H-district) having verifiable census data and being representative of the population structure of Mumbai (Bombay). Of 337,391 permanent residents, 156,861 persons between the age of 25 and 94+ years who were eligible for survey were screened. The responses to a predefined questionnaire (version 2.0) were entered in coded data sheets for analysis. During the 2-year study period (January 2005 to December 2006), 456 (238 males and 218 females) had FES, indicating an annual incidence in subjects of 25 years and above of 145/100,000 persons (CI 95%: 120-170); for males it is 149/100,000 persons (CI 95%: 120-170) and for females it is 141/100,000 persons (CI 95%: 120-160). The age-standardized rate for study population (both sexes) by the direct method using Segi's 1996 world population is 152/100,000/year (CI 95%: 132-172). Stroke diagnosis was supported by computed tomography in 407 (89.2%) of 456 FES cases: 366 (80.2%) had ischemic stroke, 81 (17.7%) had hemorrhagic stroke and 9 (1.9%) were in the unspecified category. The mean age was 66 +/- (SD) 13.60 years, women were older as compared to men (mean age 68.9 +/- 13.12 years vs. 63.4 +/- 13.53 years). Case fatality: at 28 days, 320 (70%) of 456 FES cases were still alive and 136 (29.8%) had died. Of the 320 surviving patients 38.5% had moderate to severe disability by the modified Rankin scale. The results of Mumbai stroke study, using uniform definitions and methodologies, show that the annual standardized incidence rates, stroke subtypes and case fatality rate are very similar to those reported from developed nations. To plan effective intervention and prevention strategies, standardized data in representative samples of regional populations are urgently needed.
Objectives: The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having ‘first-ever stroke’ (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006. Background: An estimated 5.8 million people died from stroke (cerebrovascular disease) in 2005, two thirds of them were from low-/middle-income countries but reliable population-based studies are scarce. Methods: The manual on WHO STEPwise approach to stroke surveillance (STEPS Stroke; http://www.who.int/chp/steps/Manual pdf) was the operational protocol. We selected a well-defined community (H-district) having verifiable census data and being representative of the population structure of Mumbai (Bombay). Of 337,391 permanent residents, 156,861 persons between the age of 25 and 94+ years who were eligible for survey were screened. The responses to a predefined questionnaire (version 2.0) were entered in coded data sheets for analysis. Results: During the 2-year study period (January 2005 to December 2006), 456 (238 males and 218 females) had FES, indicating an annual incidence in subjects of 25 years and above of 145/100,000 persons (CI 95%: 120–170); for males it is 149/100,000 persons (CI 95%: 120–170) and for females it is 141/100,000 persons (CI 95%: 120–160). The age-standardized rate for study population (both sexes) by the direct method using Segi’s 1996 world population is 152/100,000/year (CI 95%: 132–172). Stroke diagnosis was supported by computed tomography in 407 (89.2%) of 456 FES cases: 366 (80.2%) had ischemic stroke, 81 (17.7%) had hemorrhagic stroke and 9 (1.9%) were in the unspecified category. The mean age was 66 ± (SD) 13.60 years, women were older as compared to men (mean age 68.9 ± 13.12 years vs. 63.4 ± 13.53 years). Case fatality: at 28 days, 320 (70%) of 456 FES cases were still alive and 136 (29.8%) had died. Of the 320 surviving patients 38.5% had moderate to severe disability by the modified Rankin scale. Conclusions: The results of Mumbai stroke study, using uniform definitions and methodologies, show that the annual standardized incidence rates, stroke subtypes and case fatality rate are very similar to those reported from developed nations. To plan effective intervention and prevention strategies, standardized data in representative samples of regional populations are urgently needed.
The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having 'first-ever stroke' (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006.OBJECTIVESThe aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having 'first-ever stroke' (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006.An estimated 5.8 million people died from stroke (cerebrovascular disease) in 2005, two thirds of them were from low-/middle-income countries but reliable population-based studies are scarce.BACKGROUNDAn estimated 5.8 million people died from stroke (cerebrovascular disease) in 2005, two thirds of them were from low-/middle-income countries but reliable population-based studies are scarce.The manual on WHO STEPwise approach to stroke surveillance (STEPS Stroke; http://www.who.int/chp/steps/Manual pdf) was the operational protocol. We selected a well-defined community (H-district) having verifiable census data and being representative of the population structure of Mumbai (Bombay). Of 337,391 permanent residents, 156,861 persons between the age of 25 and 94+ years who were eligible for survey were screened. The responses to a predefined questionnaire (version 2.0) were entered in coded data sheets for analysis.METHODSThe manual on WHO STEPwise approach to stroke surveillance (STEPS Stroke; http://www.who.int/chp/steps/Manual pdf) was the operational protocol. We selected a well-defined community (H-district) having verifiable census data and being representative of the population structure of Mumbai (Bombay). Of 337,391 permanent residents, 156,861 persons between the age of 25 and 94+ years who were eligible for survey were screened. The responses to a predefined questionnaire (version 2.0) were entered in coded data sheets for analysis.During the 2-year study period (January 2005 to December 2006), 456 (238 males and 218 females) had FES, indicating an annual incidence in subjects of 25 years and above of 145/100,000 persons (CI 95%: 120-170); for males it is 149/100,000 persons (CI 95%: 120-170) and for females it is 141/100,000 persons (CI 95%: 120-160). The age-standardized rate for study population (both sexes) by the direct method using Segi's 1996 world population is 152/100,000/year (CI 95%: 132-172). Stroke diagnosis was supported by computed tomography in 407 (89.2%) of 456 FES cases: 366 (80.2%) had ischemic stroke, 81 (17.7%) had hemorrhagic stroke and 9 (1.9%) were in the unspecified category. The mean age was 66 +/- (SD) 13.60 years, women were older as compared to men (mean age 68.9 +/- 13.12 years vs. 63.4 +/- 13.53 years). Case fatality: at 28 days, 320 (70%) of 456 FES cases were still alive and 136 (29.8%) had died. Of the 320 surviving patients 38.5% had moderate to severe disability by the modified Rankin scale.RESULTSDuring the 2-year study period (January 2005 to December 2006), 456 (238 males and 218 females) had FES, indicating an annual incidence in subjects of 25 years and above of 145/100,000 persons (CI 95%: 120-170); for males it is 149/100,000 persons (CI 95%: 120-170) and for females it is 141/100,000 persons (CI 95%: 120-160). The age-standardized rate for study population (both sexes) by the direct method using Segi's 1996 world population is 152/100,000/year (CI 95%: 132-172). Stroke diagnosis was supported by computed tomography in 407 (89.2%) of 456 FES cases: 366 (80.2%) had ischemic stroke, 81 (17.7%) had hemorrhagic stroke and 9 (1.9%) were in the unspecified category. The mean age was 66 +/- (SD) 13.60 years, women were older as compared to men (mean age 68.9 +/- 13.12 years vs. 63.4 +/- 13.53 years). Case fatality: at 28 days, 320 (70%) of 456 FES cases were still alive and 136 (29.8%) had died. Of the 320 surviving patients 38.5% had moderate to severe disability by the modified Rankin scale.The results of Mumbai stroke study, using uniform definitions and methodologies, show that the annual standardized incidence rates, stroke subtypes and case fatality rate are very similar to those reported from developed nations. To plan effective intervention and prevention strategies, standardized data in representative samples of regional populations are urgently needed.CONCLUSIONSThe results of Mumbai stroke study, using uniform definitions and methodologies, show that the annual standardized incidence rates, stroke subtypes and case fatality rate are very similar to those reported from developed nations. To plan effective intervention and prevention strategies, standardized data in representative samples of regional populations are urgently needed.
Objectives: The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having 'first-ever stroke' (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006. Background: An estimated 5.8 million people died from stroke (cerebrovascular disease) in 2005, two thirds of them were from low-/middle-income countries but reliable population-based studies are scarce. Methods: The manual on WHO STEPwise approach to stroke surveillance (STEPS Stroke; http://www.who.int/chp/steps/Manual pdf) was the operational protocol. We selected a well-defined community (H-district) having verifiable census data and being representative of the population structure of Mumbai (Bombay). Of 337,391 permanent residents, 156,861 persons between the age of 25 and 94+ years who were eligible for survey were screened. The responses to a predefined questionnaire (version 2.0) were entered in coded data sheets for analysis. Results: During the 2-year study period (January 2005 to December 2006), 456 (238 males and 218 females) had FES, indicating an annual incidence in subjects of 25 years and above of 145/100,000 persons (CI 95%: 120-170); for males it is 149/100,000 persons (CI 95%: 120-170) and for females it is 141/100,000 persons (CI 95%: 120-160). The age-standardized rate for study population (both sexes) by the direct method using Segi's 1996 world population is 152/100,000/year (CI 95%: 132-172). Stroke diagnosis was supported by computed tomography in 407 (89.2%) of 456 FES cases: 366 (80.2%) had ischemic stroke, 81 (17.7%) had hemorrhagic stroke and 9 (1.9%) were in the unspecified category. The mean age was 66 plus or minus (SD) 13.60 years, women were older as compared to men (mean age 68.9 plus or minus 13.12 years vs. 63.4 plus or minus 13.53 years). Case fatality: at 28 days, 320 (70%) of 456 FES cases were still alive and 136 (29.8%) had died. Of the 320 surviving patients 38.5% had moderate to severe disability by the modified Rankin scale. Conclusions: The results of Mumbai stroke study, using uniform definitions and methodologies, show that the annual standardized incidence rates, stroke subtypes and case fatality rate are very similar to those reported from developed nations. To plan effective intervention and prevention strategies, standardized data in representative samples of regional populations are urgently needed. Copyright [copy 2008 S. Karger AG, Basel
Objectives: The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having 'first-ever stroke' (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006. Background: An estimated 5.8 million people died from stroke (cerebrovascular disease) in 2005, two thirds of them were from low-/middle-income countries but reliable population-based studies are scarce. Methods: The manual on WHO STEPwise approach to stroke surveillance (STEPS Stroke; http://www.who.int/chp/steps/Manual pdf) was the operational protocol. We selected a well-defined community (H-district) having verifiable census data and being representative of the population structure of Mumbai (Bombay). Of 337,391 permanent residents, 156,861 persons between the age of 25 and 94+ years who were eligible for survey were screened. The responses to a predefined questionnaire (version 2.0) were entered in coded data sheets for analysis. Results: During the 2-year study period (January 2005 to December 2006), 456 (238 males and 218 females) had FES, indicating an annual incidence in subjects of 25 years and above of 145/100,000 persons (CI 95%: 120-170); for males it is 149/100,000 persons (CI 95%: 120-170) and for females it is 141/100,000 persons (CI 95%: 120-160). The age-standardized rate for study population (both sexes) by the direct method using Segi's 1996 world population is 152/100,000/year (CI 95%: 132-172). Stroke diagnosis was supported by computed tomography in 407 (89.2%) of 456 FES cases: 366 (80.2%) had ischemic stroke, 81 (17.7%) had hemorrhagic stroke and 9 (1.9%) were in the unspecified category. The mean age was 66 ± (SD) 13.60 years, women were older as compared to men (mean age 68.9 ± 13.12 years vs. 63.4 ± 13.53 years). Case fatality: at 28 days, 320 (70%) of 456 FES cases were still alive and 136 (29.8%) had died. Of the 320 surviving patients 38.5% had moderate to severe disability by the modified Rankin scale. Conclusions: The results of Mumbai stroke study, using uniform definitions and methodologies, show that the annual standardized incidence rates, stroke subtypes and case fatality rate are very similar to those reported from developed nations. To plan effective intervention and prevention strategies, standardized data in representative samples of regional populations are urgently needed. Copyright © 2008 S. Karger AG, Basel [PUBLICATION ABSTRACT]
Author Mathur, V.D.
Khandelwal, K.
Malik, S.
Vairale, J.
Bhattacharjee, M.
Bhat, P.
Deshmukh, S.
Trivedi, N.D.
Dalal, P.M.
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/18931521$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright 2008 S. Karger AG, Basel
Copyright 2008 S. Karger AG, Basel.
Copyright (c) 2008 S. Karger AG, Basel
Copyright 2008 S. Karger AG, Basel.
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– notice: Copyright 2008 S. Karger AG, Basel.
– notice: Copyright (c) 2008 S. Karger AG, Basel
– notice: Copyright 2008 S. Karger AG, Basel.
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Keywords Stroke
WHO STEPS
Public health
Stroke, epidemiology
Stroke, registry
Language English
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Sudlow CLM, Warlow CP: Comparing stroke incidence worldwide - what makes studies comparable? Stroke1996;27:550-558.8610328
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Goldstein LB, Samsa GP: Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial. Stroke1997;28:307-310.9040680
Dalal PM, Dalal KP, Vyas AC: Strokes in the young population in west-central India - some observations on changing trends in morbidity and mortality. Neuroepidemiology 1989;8:160-164.272580710.1159%2F000110178
Truelsen T, Heuschmann PU, Bonita R, Arjundas G, Dalal P, et al: Standard method for developing stroke registers in low-income and middle-income countries: experiences from a feasibility study of a stepwise approach to stroke surveillance (STEPS Stroke). Lancet Neurol 2007;6:134-139.1723980010.1016%2FS1474-4422%2806%2970686-X
Strong K, Mathers C, Bonita R: Preventing stroke: saving lives around the world. Lancet Neurol 2007;6:182-187.1723980510.1016%2FS1474-4422%2807%2970031-5
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Feigin VL, Lawes CMM, Bennet DA, Anderson CS: Stroke epidemiology: a review of population based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003;2:43-53.1284930010.1016%2FS1474-4422%2803%2900266-7
Sridharan R: Risk factors for ischaemic stroke: a case control analysis. Neuroepidemiology 1992;11:24-30.160849110.1159%2F000110903
Ahmed OB, Pinto CB, Lopez AD, Murray CJL, Lozano R, Inoue M: Age Standardization of Rates: a New WHO Standard; GPE Discussion Paper Series, No. 31. EIP/GPE/EVD. Geneva, World Health Organization, 2000.
Anand K, Chowdhury D, Singh KB, Pandav CS, Kapoor SK: Estimation of mortality and morbidity due to strokes in India. Neuroepidemiology 2001;20:208-211.1149016810.1159%2F000054789
Feigin VL: Stroke in developing countries: can the epidemic be stopped and outcomes improved? Lancet Neurol 2007;6:94-97.1723978910.1016%2FS1474-4422%2807%2970007-8
Sulter G, Steen C, Keyser JD: Use of the Barthel Index and Modified Rankin Scale in acute stroke trials. Stroke 1999;30:1538-1541.1043609710.1161%2F01.STR.30.8.1538
Dalal PM, Bhattacharjee M: Stroke epidemic in India: hypertension-stroke control programme is urgently needed. J Assoc Physicians India 2007;55:689-691.18173020
Election Commission of India, electoral rolls 2004 Maharashtra Assembly constituency 036, updated up to August 18, 2004.
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18931522 - Neuroepidemiology. 2008;31(4):262-3
References_xml – reference: Goldstein LB, Samsa GP: Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial. Stroke1997;28:307-310.9040680
– reference: Election Commission of India, electoral rolls 2004 Maharashtra Assembly constituency 036, updated up to August 18, 2004.
– reference: Ahmed OB, Pinto CB, Lopez AD, Murray CJL, Lozano R, Inoue M: Age Standardization of Rates: a New WHO Standard; GPE Discussion Paper Series, No. 31. EIP/GPE/EVD. Geneva, World Health Organization, 2000.
– reference: Lavados PM, Sacks C, Prina L, Escobar A, et al: Incidence, 30-day case fatality rate, and prognosis of stroke in Iquique, Chile: a 2 year community-based prospective study (PISCIS project). Lancet 2005;365:2206-2015.1597892910.1016%2FS0140-6736%2805%2966779-7
– reference: Strong K, Mathers C, Bonita R: Preventing stroke: saving lives around the world. Lancet Neurol 2007;6:182-187.1723980510.1016%2FS1474-4422%2807%2970031-5
– reference: Truelsen T, Heuschmann PU, Bonita R, Arjundas G, Dalal P, et al: Standard method for developing stroke registers in low-income and middle-income countries: experiences from a feasibility study of a stepwise approach to stroke surveillance (STEPS Stroke). Lancet Neurol 2007;6:134-139.1723980010.1016%2FS1474-4422%2806%2970686-X
– reference: Feigin VL: Stroke epidemiology in the developing world. Lancet 2005;365:2160-2161.1597891010.1016%2FS0140-6736%2805%2966755-4
– reference: Sudlow CLM, Warlow CP: Comparing stroke incidence worldwide - what makes studies comparable? Stroke1996;27:550-558.8610328
– reference: Feigin VL: Stroke in developing countries: can the epidemic be stopped and outcomes improved? Lancet Neurol 2007;6:94-97.1723978910.1016%2FS1474-4422%2807%2970007-8
– reference: Ming L, Bo W, Wen-Zhi W, Li-Ming L, et al: Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol 2007;6:456-464.1743410010.1016%2FS1474-4422%2807%2970004-2
– reference: Aho K, Harmsen P, Hatano S, Marquardsen J, et al: Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ 1980;58:113-130.6966542
– reference: Dalal PM: Burden of stroke: Indian perspective. Int J Stroke 2006;1:164-166.10.1111%2Fj.1747-4949.2006.00051.x
– reference: Bonita R, Mendis S, Truelsen T, Bogousslavsky J, Toole J, Yatsu F: The global stroke initiative. Lancet Neurol 2004;3:391-393.1520779110.1016%2FS1474-4422%2804%2900800-2
– reference: Sridharan R: Risk factors for ischaemic stroke: a case control analysis. Neuroepidemiology 1992;11:24-30.160849110.1159%2F000110903
– reference: Dalal PM, Bhattacharjee M: Stroke epidemic in India: hypertension-stroke control programme is urgently needed. J Assoc Physicians India 2007;55:689-691.18173020
– reference: Feigin VL, Lawes CMM, Bennet DA, Anderson CS: Stroke epidemiology: a review of population based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003;2:43-53.1284930010.1016%2FS1474-4422%2803%2900266-7
– reference: Anand K, Chowdhury D, Singh KB, Pandav CS, Kapoor SK: Estimation of mortality and morbidity due to strokes in India. Neuroepidemiology 2001;20:208-211.1149016810.1159%2F000054789
– reference: Sulter G, Steen C, Keyser JD: Use of the Barthel Index and Modified Rankin Scale in acute stroke trials. Stroke 1999;30:1538-1541.1043609710.1161%2F01.STR.30.8.1538
– reference: Dalal PM, Dalal KP, Vyas AC: Strokes in the young population in west-central India - some observations on changing trends in morbidity and mortality. Neuroepidemiology 1989;8:160-164.272580710.1159%2F000110178
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Snippet Objectives: The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having ‘first-ever stroke’ (FES)...
The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having 'first-ever stroke' (FES) and (2) to...
Objectives: The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having 'first-ever stroke' (FES)...
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SubjectTerms Adult
Aged
Aged, 80 and over
Brain - physiopathology
Female
Health Surveys
Humans
Incidence
India - epidemiology
Male
Middle Aged
Original Paper
Population Density
Poverty
Registries
Stroke - epidemiology
Stroke - mortality
Surveys and Questionnaires
Urban Population - statistics & numerical data
World Health Organization
Title Population-Based Stroke Survey in Mumbai, India: Incidence and 28-Day Case Fatality
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