Abstract MP080: Trends in Nine-year Survival of Stroke Patients between 1980 and 2000 The Minnesota Stroke Survey
Authors: Schissel Candace , Berger Alan K , Luepker Russell V , Steffen Lyn M , Sillah Arthur , Jacobs David R , Anderson David C , Lakshminarayan Kamakshi 
Published: July 2021

Background:
There have been numerous advances in stroke care over the past 30 years. We examined early and long-term stroke survival over this period to learn if these advances were associated with improved outcomes.

Methods:
Data for years 1980, 1985, 1990, 1995, and 2000 were obtained from the Minnesota Stroke Survey, a population-based surveillance of hospitalized acute stroke patients aged 30-74 years in the Minneapolis-St. Paul metropolitan area. Cases with an acute stroke hospital discharge code (ICD-9-CM 431, 432, 434, 436, 437) and a new neurological deficit of vascular origin lasting at least 24 hours or until death were selected (n= 3,737). Non-stroke etiologies were excluded. Cases were sub-typed as ischemic (IS) (n=1,638) or hemorrhagic strokes (HS) (n=485) for years 1990, 1995, and 2000 by neuroimaging. Mortality was obtained by linkage to the Department of Health vital statistics. We report 30 day, 1 year, and 9 year age-adjusted post-stroke survival.

Results:
All stroke: Survival improved from 1980 to 2000 (Table). Early (30 day) survival improved (men 78% to 86%, p=0.003; women 79% to 88%, p=0.001) as did long-term (9 year) survival (men 33% to 49%, p=<0.001; women 35% to 53%, p<0.001). Long-term survival gains were not simply due to early survival improvements as shown by increased post 30-day and post-1-year survival (Table). Stroke Subtypes: Early (30 day) IS survival did not improve significantly from 1990 to 2000 (men 88% to 90%, p=0.56; women 87% to 92%, p=0.08) and neither did 30 day HS survival (men 61% to 69%, p=0.39; women 63% to 69%, p=0.38). For IS, 9-year survival improved (men 39% to 53%, p<0.001; women 43% to 59%, p<0.001). For HS, 9 year survival improved in men (men 29% to 48%, p=0.03; women 44% to 51%, p=0.34).

Conclusion:
Early and long-term stroke survival improved between 1980 and 2000. Improved long-term survival was not merely due to improved early survival. Long-term survival improved for IS in both sexes. Small samples sizes may explain the lack of significant improvements in HS survival in women.

Table.

Age Adjusted Stroke Survival Between 1980 and 2000 Among Men and Women Aged 30-74 Years in the Minneapolis-St. Paul, Minnesota Metropolitan Area. Data shown is for all stroke.

Age Adjusted Survival, %

1980
1985
1990
1995
2000
P-trend

Men, n

318

325

368

361

637

30-day
77.9
82.9
87.9
84.6
85.7
0.003

1-year
67.5
70.8
77.7
77
78.7
<0.001

5-years
51.4
47.7
55.5
60.4
62.3
<0.001

9-years
32.9
33.8
39.5
43.9
49
<0.001

1-year survival among 30-day survivors
86.5
85.3
88.5
91
91.9
0.002

9-year survival among 1 year survivors
48.2
47.3
51.1
57.5
62.3
<0.001

Women, n

249

277

327

299

576

30-day
79.1
85.1
84.4
86.8
88.1
0.001

1-year
64.3
74.6
72.2
75.5
79.6
<0.001

5-years
47.8
58.8
53.2
57.8
64.6
<0.001

9-years
35.4
47.2
41.5
43.6
53.3
<0.001

1-year survival among 30-day survivors
81.2
87.6
85.5
87
90.4
0.005

9-years survival among 1 year survivors
54.5
63.1
57.7
57.4
67.3
0.040