Page last updated: 24-NOV-2009

Stroke

ONS kitemarkStatistical Publication Notice

24 November 2009

Stroke Statistics Update.

INTRODUCTION

This release offers an overview of the latest publication of statistical information from ISD's Coronary Heart Disease (CHD) & Stroke Programme. There are separate summaries for each of CHD and stroke. This page relates to the annual update of Stroke statistics including information at NHS Board, Local Council and Community Health Partnership level.  Hospital activity, operations, incidence, and prescribing data to 31 March 2009 and mortality data to 31 December 2008 are included in this release.
 
Cerebrovascular Disease, commonly know as stroke, is a preventable disease which kills more than 5,000 people in Scotland every year. A stroke is a brain attack. A stroke is what happens when the blood supply to part of the brain is cut off. This occurs because of a blocked or a burst blood vessel. Stroke mainly affects people over the age of 65 but can affect anyone.
 
Stroke is a priority in Scotland where prevalence of the associated risk factors, such as smoking, diet and physical activity, is high and around 2.5% of men and 2.8% of women are living with stroke (Scottish Health Survey 2008, section 8.3).
 
The Scottish Government published their strategy document Better Heart Disease and Stroke Care Action Plan in June 2009 which confirmed that Stroke would continue to be a national clinical priority for NHSScotland.

KEY POINTS

Age-standardised mortality rates for CVD (for those under 75) rose slightly between 2007 and 2008, from 18.8 per 100,000 population in 2007 to 19.6 per 100,000 in 2008 (a 4% rise), but have fallen by almost 48% over the period 1995-2008, approaching the Scottish Government’s target of a 50% reduction in premature stroke mortality over the period 1995-2010.
 
0911Stroke1
 
Between 1999/00 and 2008/09 the incidence rate for CVD (total number of people diagnosed with CVD per 100,000 population, standardised by age and sex) decreased by 21.2%. (from 214.7 cases per 100,000 population in 1999/00 to 169.1 cases per 100,000 population in 2008/09).
 
The number of prescriptions for cardiovascular disease (both coronary heart disease and cerebrovascular disease) increased by 73%  in the last decade (from 14 million in 1999/00 to 24 million in 2008/09). The associated costs over the same period rose by a third, from £140 million to £187 million, and reached a peak of £230 million in 2004/05 before reducing to £187 million in 2008/09.
 
There is a positive relationship between deprivation and mortality rates for Cerebrovascular Disease. The relationship is stronger in the under 65s - the Standardised Mortality Ratio (SMR) is 4 times higher for the most deprived 10% of the population compared to the least deprived 10%.
 
The number of carotid endarterectomy operations performed decreased between 2007/08 and 2008/09, from 529 to 467. The age-sex standardised rates for Scotland have remained fairly consistent over the last 5 years at around 7-8 per 100,000 population.

INTERPRETATION

Data for year ending 31 Mar 2009 based on hospital discharges is provisional but we estimate that we have approximately 99% of all acute hospital discharge records.

DETAILED FINDINGS

MORTALITY

Age-standardised mortality rates for CVD (for those under 75) rose slightly between 2007 and 2008, from 18.8 per 100,000 population in 2007 to 19.6 per 100,000 in 2008 (a 4% rise), but have fallen by almost 48% over the period 1995-2008, approaching the Scottish Government’s target of a 50% reduction in premature stroke mortality over the period 1995-2010 (see Table MS2). 

The long term decline in death rates for all ages from CVD in Scotland has continued with an overall fall (standardised by age and sex) of 31% (from 86.5 deaths per 100,000 population for year ending 31 December 1999 to 59.7 deaths per 100,000 population for year ending 31 December 2008) (see Table MS1).  

0911Stroke2

The number of all ages stroke deaths has decreased by 28.1% between 1999 (4,239) and 2008 (3,048) (see Table MS1).  

DEPRIVATION

There is a positive relationship between deprivation and mortality rates for Cerebrovascular Disease. The relationship is stronger in the under 65s - the Standardised Mortality Ratio (SMR) is 4 times higher for the most deprived 10% of the population compared to the least deprived 10% (see Table DS1).

INCIDENCE

Between 1999/00 and 2008/09 the incidence rate for CVD (total number of people diagnosed with CVD per 100,000 population, standardised by age and sex) decreased by 21.2%. (from 214.7 cases per 100,000 population in 1999/00 to 169.1 cases per 100,000 population in 2008/09) (see Table IS1 and Table IS3).

The incidence rate for CVD (standardised by age and sex) increased by 2.1% from 165.6 per 100,000 population in 2007/08 to 169.1 per 100,000 population in 2008/09 (see Table IS1 and Table IS3). This may only be a “blip” in the longer term downward trend.

Incidence is closely related to age - the rate for under 75s in 2008/09 was 102.8 per 100,000 population and for over 75s for the same period was 1761.2 per 100,000 population (see Table IS1 and Table IS3).

Incidence rates are consistently higher for males than females across all age groups (see Table IS1 and Table IS3).

OPERATIONS

The number of carotid endarterectomy operations performed decreased between 2007/08 and 2008/09, from 529 to 467. The age-sex standardised rates for Scotland have remained fairly consistent over the last 5 years at around 7-8 per 100,000 population (see Table OS1).

HOSPITAL ACTIVITY

The number of cerebrovascular disease discharges has risen by 5.6% to 24,914 in 2008/09. Although there are more discharges for women than men, the standardised discharge rates for men are higher - this is because the female patients are older (see Table AS1).

Cerebrovascular disease age-sex standardised discharge rate for females under 45 has decreased by 5.8% between 2007/08 and 2008/09, but for males has increased by 6% (see Tables AS1, AS2 and AS4).

The female age-sex standardised discharge rate for subarachnoid haemorrhage continues to be higher than that for males (see Tables AS1, AS2 and AS4).

The Age-Sex Standardised discharge rate for TIAs and related syndromes continues to follow the upward trend since 2004/05. The rate has increased by 7.2% from 2007/08 to 42.4 per 100,000 in 2008/09 (see Tables AS1, AS2 and AS4).

GP PRESCRIBING

Over the decade 1999/00 - 2008/09 the numbers of prescriptions dispensed for cardiovascular related drugs continued to rise although the overall costs fell following a peak in the middle of the decade. Costs often reduce as medicines become available in generic form once drug patents expire (see Table G1).

0911Stroke3

The number of prescriptions for cardiovascular disease (both coronary heart disease and cerebrovascular disease) increased by 73%  in the last decade (from 14 million in 1999/00 to 24 million in 2008/09). The associated costs over the same period rose by a third, from £140 million to £187 million, and reached a peak of £230 million in 2004/05 before reducing to £187 million in 2008/09 (see Table G1).

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MAIN CONTACTS:

Adam Redpath
Programme Principal
CHD/Stroke Programme
0131 275 6704
adam.redpath@nhs.net

David Clark
Principal Information Analyst
0131 275 6144
dclark5@nhs.net  

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GLOSSARY:

Carotid Endarterectomy - an operation to either remove a blockage in the carotid artery in the neck , or to help keep the artery open by the insertion of a stent (a short stainless steel mesh tube)

CVD – Cerebrovascular Disease.  Includes subarachnoid haemorrhage, stroke (non-traumatic intracerebral haemorrhage and cerebral infarction) and transient ischaemic attacks (TIAs)

Stroke – occurs when an area of the brain is deprived of its blood supply - usually because of a blockage or burst blood vessel. 'Stroke' is commonly used to describe all cerebrovascular diseases and includes non-traumatic intracerebral haemorrhage and cerebral infarction

TIA - transient ischaemic attack

Cerebrovascular disease - class of diseases of the blood vessels in the brain, including strokes.

Cardiovascular disease includes diseases which affect the heart and the blood vessels, including coronary heart disease, stroke and other cerebrovascular diseases.

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PRE-RELEASE ACCESS:

Under terms of the "Pre-Release Access to Official Statistics (Scotland) Order 2008", ISD are obliged to publish information on those receiving Pre-Release Access ("Pre-Release Access" refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre-Release Access and, separately, those receiving extended Pre-Release Access.
 
Standard (five day) Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
NHS Board Chief Executives
NHS Board Communication leads
 
Extended Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
This extended Pre-Release Access is given to a small number of named individuals in the Scottish Government Health Department (Analytical Services Division). This Pre-Release Access is for the sole purpose of enabling that department to gain an understanding of the statistics prior to briefing others in Scottish Government (during the period of standard Pre-Release Access).
 
 
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HISTORY OF THIS PUBLICATION:

Last Published: 25 November 2008
Next Due: 23 November 2010
Data Available Since: Most data is included within a time series for the previous decade.

 


Main contact: Email Adam Redpath