Supplementary Material for: Trends in the Incidence and Mortality of Stroke in Matão, Brazil: The Matão Preventing Stroke (MAPS) Study

Background: Stroke population-based studies in the same setting comparing time trends of rates are a gold standard method to determine the primary prevention status of stroke. Twelve years ago, we measured the stroke incidence and mortality in Matão city, Southeast of Brazil. Objective: This second Matão stroke registry study aimed to determine the time trends in the incidence, mortality, case fatality, and functional status of patients with stroke. Methods: This was a prospective, population-based study known as the Matão Preventing Stroke (MAPS). We determined all incident stroke events that occurred between August 1, 2015, and July 31, 2016. Between the periods of November 1, 2003, to October 31, 2004, and August 1, 2015, to July 31, 2016, the rates were age adjusted to the Brazilian and world population. Functional status was measured by Barthel scale 1 year after the index event. Results: We registered 81 cases of incident stroke. Demographic and cardiovascular risk factors were similar in both periods. The mean age increased by 9%, from 65.2 (95% CI 62.6–67.8) to 71.0 (95% CI 68.1–73.8) years. Between 2003–2004 and 2015–2016, the age-adjusted incidence decreased by 39% (incidence rate ratio [IRR] 0.61; 95% CI 0.46–0.79) and mortality by 50% (IRR 0.50; 95% CI 0.31–0.94). The 1-year case fatality was 26%; approximately 56% of the patients were functionally independent, while 7% had a recurrent stroke. Compared with the results of our first registry study, these outcomes did not differ significantly. Conclusion: Our findings agree with those of previous studies, showing a decline in the incidence and mortality of stroke in Brazil. Improvements in local public health care might explain these declines.

背景：在同一地区开展的脑卒中时间趋势比较研究，是评估脑卒中一级预防现状的金标准方法。十二年前，我们曾在巴西东南部马唐（Matão）市开展过脑卒中发病率与死亡率相关研究。
目的：本项为马唐市第二项脑卒中登记研究——马唐脑卒中预防登记研究（Matão Preventing Stroke, MAPS），旨在明确脑卒中患者的发病率、死亡率、病例病死率及功能状态的时间变化趋势。
方法：本研究为基于人群的前瞻性研究。我们纳入了2015年8月1日至2016年7月31日期间发生的所有新发脑卒中事件。针对2003年11月1日至2004年10月31日、以及2015年8月1日至2016年7月31日两个时间段的数据，相关率均按照巴西人群与世界标准人口进行了年龄标化。于患者首次发病后1年，采用巴氏指数（Barthel scale）评估其功能状态。
结果：本研究共登记81例新发脑卒中病例。两个时间段的人口学特征与心血管危险因素均无显著差异。患者平均年龄升高9%，从65.2岁（95%置信区间[confidence interval, CI] 62.6–67.8）升至71.0岁（95%CI 68.1–73.8）。与2003–2004年相比，2015–2016年的年龄标化发病率下降39%（发病率比[incidence rate ratio, IRR] 0.61；95%CI 0.46–0.79），死亡率下降50%（IRR 0.50；95%CI 0.31–0.94）。1年病例病死率为26%；约56%的患者在随访1年后功能独立，7%的患者出现脑卒中复发。与本团队首次脑卒中登记研究的结果相比，本次研究的结局指标无显著差异。
结论：本研究结果与既往同类研究一致，均显示巴西地区脑卒中的发病率与死亡率呈下降趋势。当地公共卫生保健体系的优化完善或可解释这一下降趋势。