Abstract
AIM: To examine secular change in functional outcomes and associated factors of stroke in a rapidly aging region. METHODS: We retrospectively analyzed cerebral infarction and intracerebral hemorrhage incidence registered cases in the Akita Stroke Registry from 1985 to 2014, divided into three of 10 years each. Functional outcome was defined as good with a modified Rankin scale score of 0-1 and poor with a score of 3-6 at discharge. Mixed effects logistic regression analysis with the location of medical facility as a random effects variable by disease type was used to examine the results. RESULTS: There were 81 254 eligible patients (cerebral infarction: 58 217, intracerebral hemorrhage: 23 037). Age at onset increased over time in both diseases (cerebral infarction: median [interquartile range] age, 70 [63-77] years in 1985-1994 to 77 [69-83] years in 2005-2014; intracerebral hemorrhage: 64 [56-72] years in 1985-1994 to 72 [61-80] years in 2005-2014). Multivariate analysis showed that the odds ratio associated with good outcomes increased over time for cerebral infarction, and cerebral hemorrhage increased in periods 2 and 3 compared with period 1, but decreased from period 2 to period 3. For cerebral infarction, the odds ratios of prior diabetes associated with poor outcomes decreased over time. CONCLUSION: The age at onset increased over time. In cerebral infarction, functional outcomes improved over time, and the association between diabetes and poor outcome declined over time. It was speculated that these results were related to advances in the healthcare system and improved management of vascular risk factors during the study period. Intracerebral hemorrhage improved during the first 20 years, with no apparent improvement thereafter. Geriatr Gerontol Int 2023; 23: 486-492.