%0 Journal Article
%T Five-Year Case Fatality Following First-Ever Stroke in the Mashhad Stroke Incidence Study: A Population-Based Study of Stroke in the Middle East.
%A Farzadfard MT
%A Thrift AG
%A Amiri A
%A Kapral MK
%A Hashemi P
%A Sposato LA
%A Salehi M
%A Shoeibi A
%A Hoseini A
%A Mokhber N
%A Azarpazhooh MR
%J J Stroke Cerebrovasc Dis
%V 27
%N 4
%D Apr 2018
%M 29433933
%F 2.677
%R 10.1016/j.jstrokecerebrovasdis.2017.11.018
%X <B>OBJECTIVE: </B>Despite recent declines in stroke mortality in high-income countries, the incidence and mortality of stroke have increased in many low- and middle-income countries. Population-based information on stroke in such countries is a research priority to address this rising trend. This study was designed to evaluate 5-year stroke mortality and its associated factors.<BR><B>METHODS: </B>During a 12-month period beginning from November 2006, 624 patients with first-ever stroke (FES) living in Mashhad, Iran, were recruited and followed longitudinally. Kaplan-Meier analyses were used to determine the cumulative risk of death. Prognostic variables associated with death were assessed using a Cox proportional hazard, backward logistic regression model.<BR><B>RESULTS: </B>The 5-year cumulative risk of death was 53.8% for women and 60.5% for men (log rank = .1). The most frequent causes of death were stroke (41.2%), myocardial infarction/vascular diseases (16.4%), and pneumonia (14.2%). In multivariable Cox proportional hazard analysis, male gender (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.01-1.64), age (HR: 1.04, 95% CI: 1.03-1.05, per 1-year increase), National Institute of Health Stroke Scale score at admission (HR: 1.11, 95% CI: 1.09-1.12, per 1-point increase), atrial fibrillation (HR: 1.78, CI: 1.24-2.54), and education < 12 years (HR: 1.61, 95% CI: 1.08-2.4) were associated with greater 5-year case fatality.<BR><B>CONCLUSIONS: </B>Long-term case fatality following stroke in Iran is greater than that observed in many high-income countries. Targeting strategies to reduce the poor outcome following stroke, such as treating AF, is likely to reduce this disparate outcome.