Neuroepidemiology最新文献

{"title":"Dementia and Cancer: Unravelling Methodological Biases in a Population-Based Cohort.","authors":"Amber P Selie, Kimberly D van der Willik, M Arfan Ikram, Jeremy A Labrecque, Sanne B Schagen","doi":"10.1159/000548633","DOIUrl":"https://doi.org/10.1159/000548633","url":null,"abstract":"<p><strong>Background: </strong>An inverse association between dementia and cancer has been consistently reported and often attributed to opposing biological mechanisms. However, methodological biases such as collider stratification and surveillance bias may underlie this finding.</p><p><strong>Methods: </strong>We examined the association between dementia and subsequent cancer diagnoses among 4,532 participants of the population-based Rotterdam Study. Individuals with incident dementia were matched to up to two participants without dementia by age and sex; importantly, we also aligned the start of follow-up between these groups to reduce immortal time bias and ensure comparable observation windows. Cancer outcomes included both pathology-confirmed (PC) and non-pathology-confirmed (NPC) diagnoses to address potential surveillance bias. We applied cause-specific Cox proportional hazards models and Fine and Gray subdistribution hazard models to estimate cancer risk, accounting for the competing risk of death.</p><p><strong>Results: </strong>An initial analysis of the full cohort, assessing the association between ever having dementia and ever having cancer, replicated the previously reported inverse association (hazard ratio [HR] 0.58; 95% CI 0.50-0.68). However, after matching and aligning follow-up periods, Kaplan-Meier curves indicated a lower probability of remaining cancer-free among individuals with dementia compared to those without dementia-particularly when including NPC diagnoses, which were more frequent among participants with dementia. In these analyses, the direction of the association reversed (HR 5.23; 95% CI 3.65-7.48), suggesting a higher cancer risk among individuals with dementia. This elevated risk persisted in competing risks analysis (subdistribution HR 2.54; 95% CI 1.80-3.58), suggesting that the elevated cancer risk was not solely attributable to differential mortality.</p><p><strong>Conclusions: </strong>The frequently reported inverse association between dementia and cancer may reflect methodological artefacts rather than biological antagonism. Accounting for collider stratification and surveillance bias revealed a potential positive association, underscoring the importance of bias-aware epidemiological methods in research on comorbidities of ageing.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-19"},"PeriodicalIF":4.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing Routinely Collected Health Data for Global Monitoring of Stroke: Roadmap and Vision for INSPIRE-STROKE.","authors":"Lachlan L Dalli, Muideen T Olaiya, Amy Y X Yu, Mathew J Reeves, Dominique A Cadilhac, Lee Nedkoff, Valery Feigin, Bo Norrving, Moira K Kapral, William Whiteley, Anne-Marie Schott, Julia Ferrari, Hanne Christensen, Brian Mac Grory, Eric E Smith, Yannick Béjot, Manav Vyas, Nishant K Mishra, Jong-Moo Park, Michael D Hill, Christine Benne-Christensent, Seana L Gall, Monique F Kilkenny","doi":"10.1159/000548781","DOIUrl":"https://doi.org/10.1159/000548781","url":null,"abstract":"<p><strong>Introduction: </strong>Sustainable and low-cost data systems for national and global surveillance of stroke are urgently needed to address the growing burden of stroke. Routinely collected health data (including registries and administrative data) are proliferating at a rapid pace, offering promise for systematic and enduring global stroke surveillance. However, several challenges exist in utilising these routinely collected data from across the globe for global stroke surveillance, such as non-standardised definitions and coding, missingness of data, and lack of transparent or reproducible methods. We aim to describe the vision and methods for a new global collaboration to leverage and harmonise population-level health data for global stroke surveillance.</p><p><strong>Methods: </strong>The International Network for Standardised Population Insights and Real-world Evidence for STROKE (INSPIRE-STROKE) was established in October 2023 and currently includes 39 collaborators from 16 countries. The vision of INSPIRE-STROKE is to develop new methods that will harmonise and combine health databases across the world to facilitate reliable and robust multi-country stroke surveillance. Through this scientific community, we are initially collaborating to 1) summarise existing methods for calculating and reporting measures of post-stroke outcomes using routinely collected health data; 2) develop consensus-based standards for analysing routinely collected health data on post-stroke outcomes; and 3) conduct proof-of-concept studies to align variables/definitions in routinely collected health data and create standardised statistical code to measure post-stroke outcomes (e.g., medication adherence, readmissions, and mortality) according to consensus-based definitions.</p><p><strong>Conclusion: </strong>INSPIRE-STROKE will support more reliable investigations into country-level trends in stroke incidence and outcomes, by leveraging routinely collected health data at a global scale. The large and diverse data compiled for INSPIRE-STROKE could facilitate exploration of rare stroke outcomes, particularly among under-represented groups (e.g., pregnant women, children). INSPIRE-STROKE will strengthen health policy and resource planning by providing high-quality evidence to improve access to stroke care and maximise patient outcomes.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-14"},"PeriodicalIF":4.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Strategy and Prognosis in Ruptured Multiple Intracranial Aneurysms: Insights from a Multicenter Cohort Study.","authors":"Xiuhu An, Long Zhao, Han Yu, Chenguang Jia, Bangyue Wang, Yan Zhao, Zhenbo Liu, Xinbo Ge, Xinyu Yang, Xiaosong Shan, Xiaoping Tang","doi":"10.1159/000548678","DOIUrl":"https://doi.org/10.1159/000548678","url":null,"abstract":"<p><strong>Objective: </strong>There is currently no clear consensus on the optimal treatment strategy for multiple intracranial aneurysms (MIAs). This study aims to systematically compare the clinical outcomes of one-stage treatment of all aneurysms versus treatment of only the responsible aneurysm in patients with ruptured MIAs.</p><p><strong>Methods: </strong>We included patients with ruptured MIAs who underwent surgical treatment in the Chinese Multicenter Cerebral Aneurysm Database (CMAD). 1:1 Propensity score matching (PSM) was applied to balance baseline differences between groups and to compare outcomes and complications between one-stage treatment of all aneurysms and treatment of the responsible aneurysm only. The association between treatment modality and in-hospital complications was assessed using a generalized estimating equation (GEE) model. Survival was analyzed using Kaplan-Meier curves, and Cox proportional hazards models were used to identify risk factors for mortality in patients with ruptured MIAs.</p><p><strong>Results: </strong>A total of 811 patients with ruptured MIAs were initially enrolled in this study. After PSM, 316 patients who underwent one-stage treatment were matched with 316 patients who received treatment for the responsible aneurysm only, resulting in 632 patients included in the final analysis. Although no statistically significant difference in mortality was observed between the groups, the survival curve trend favored one-stage treatment, with a lower 2-year mortality rate (11.2% vs. 16.2%; HR 1.368, 95% CI 0.920-2.032, P = 0.121). No significant differences were found between the groups in terms of functional outcomes or in-hospital complications. Multivariable Cox proportional hazards analysis identified age, previous stroke, and Hunt-Hess (HH) grade IV-V as independent risk factors for mortality. Endovascular treatment (EVT) was found to be a protective factor.</p><p><strong>Conclusion: </strong>In this cohort, one-stage treatment of ruptured MIAs appeared feasible and showed no evident excess risk compared with treating only the responsible aneurysm. Patient selection remains critical, and the identified mortality risk factors may provide useful guidance for clinical risk assessment and preventive strategies.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-21"},"PeriodicalIF":4.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Lifestyle Activity Engagement on Incident Disability: A Stratified Analysis by Cardiovascular Disease Risk.","authors":"Fumio Sakimoto, Takehiko Doi, Sho Nakakubo, Soichiro Matsuda, Keitaro Makino, Hiroyuki Shimada","doi":"10.1159/000548635","DOIUrl":"https://doi.org/10.1159/000548635","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular disease (CVD) is associated with disability, highlighting the need for prevention strategies that assess and mitigate CVD risk. This study aimed to examine the relationship between participation in lifestyle activities and incident disability among older individuals at high risk of CVD.</p><p><strong>Methods: </strong>This prospective cohort study included 3,217 older adults (mean age 70.7 years, standard deviation ± 6.8; 1,843 women [57.3%]). Absolute CVD risk was estimated using the revised World Health Organization charts, categorizing individuals' risk levels as either low (< 10%) or high (≥ 10%). The incidence of disability was monitored for 60 months. Baseline assessments included the frequency of participation in 36 lifestyle activities spanning physical, cognitive, and social domains, measured by annual participation frequency. A total score was calculated and categorized into three tertiles based on the frequency of participation (low, moderate, and high groups). An adjusted Cox proportional hazard analysis assessed disability risk based on baseline participation in lifestyle activities stratified by CVD risk level.</p><p><strong>Results: </strong>Over 60 months, 326 participants (10.2%) experienced disability. Older adults who were highly active in cognitive and social activities had a lower risk of disability than those who were less active. Stratified analysis based on CVD risk level showed that engagement in lifestyle activities was linked to disability risk among older adults at high risk of CVD, whereas no such association was observed in those at low risk.</p><p><strong>Conclusion: </strong>Among older adults at high CVD risk, greater engagement in lifestyle activities was associated with a reduced risk of disability after 60 months.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-19"},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global inequalities in the burden of traumatic spinal cord injury from 1990 to 2021: findings from the global burden of disease study 2021.","authors":"Siqiao Wang, Shun Chen, Wenyong Fan, Tao Chen, Xiao Hu, Chen Li, Zhourui Wu, Wei Xu, Zhihui Xiao, Bei Ma, Liming Cheng","doi":"10.1159/000548481","DOIUrl":"https://doi.org/10.1159/000548481","url":null,"abstract":"<p><strong>Instruction: </strong>Traumatic spinal cord injury (TSCI) can cause severe health loss because of premature mortality and long-term disabilities. This study estimated the global, regional, and national incidence, prevalence and years lived with disability (YLDs) of TSCI using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021.</p><p><strong>Methods: </strong>DisMod-MR2.1 was utilized to derive case number and age-standardized rate (ASR) with 95% uncertainty intervals (95% UIs) for the incidence (ASIR), prevalence (ASPR), and YLDs (ASYR) for SCI from 1990 to 2021 for the whole world, 21 GBD regions, and 204 countries. Estimated annual percentage change (EAPC) was determined using a linear regression mode. Spearman rank order correlation was performed to identify the correlations between sociodemographic index (SDI) and the burden of TSCI.</p><p><strong>Results: </strong>Globally, there were 574,502 (95% UI 440,219 to 757,445) incident cases, 15,400,682 (95% UI, 17,075,106-14,009,114) prevalent cases and 1,305,142 (95% UI, 1,726,419-917,167) YLDs of total TSCI in 2021. From 1990, the number of incidences, prevalence, and YLDs cases showed an upward trend, while the ASIR, ASPR, and ASYR showed a downward trend. Males had higher ASIR, ASPR, and ASYR, and the ASIR, ASPR, and ASYR increased with age. Cervical SCI had higher ASIR and ASYR than SCI below neck level. It showed positive correlations between SDI and ASIR (rho = 0.4670, p < 0.01), ASPR (rho = 0.4035, p < 0.01), and ASYR (rho = 0.2727, p = 0.003) in 2021.</p><p><strong>Conclusion: </strong>The absolute counts of incidence, prevalence, and burden of TSCI substantially increased from 1990 to 2021, despite the decrease in corresponding ASRs. TSCI happened in the most active periods of individuals globally, which were shifting towards older age groups over time. TSCI had larger effects on the elderly and males than younger populations and females.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-26"},"PeriodicalIF":4.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the frequency of individual outdoor activity and risk of incident dementia in an elderly population in China: a national cohort study.","authors":"Yizhu Song, Zihan Yu, Shiyu Lou, Dechen Liu","doi":"10.1159/000548330","DOIUrl":"https://doi.org/10.1159/000548330","url":null,"abstract":"<p><strong>Introduction: </strong>This study explored the association between the frequency of individual outdoor activity and the risk of incident dementia in an elderly population in China. We aimed to provide scientific evidence to support non-pharmaceutical strategies for preventing or delaying the onset of dementia.</p><p><strong>Methods: </strong>A total of 8,758 participants (median age: 85 years) from the Chinese Longitudinal Healthy Longevity Survey were included in the analyses. We assessed the association between the frequency of individual outdoor activity and the risk of incident dementia using the Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses were performed, stratified by age, sex, and residence. Additionally, a sensitivity analysis was conducted to evaluate the robustness of the findings after excluding participants who, at baseline, had a Mini-Mental State Examination (MMSE) score <18 or had been diagnosed with stroke, other cerebrovascular diseases, diabetes mellitus, cancer, or Parkinson's disease.</p><p><strong>Results: </strong>Over a median follow-up period of 4.33 years, 637 participants (7.27%) developed dementia. Compared with those who almost never engaged in outdoor activities, participants who engaged almost daily had a reduced risk of incident dementia by approximately 25% (HR: 0.75, 95% CI: 0.62-0.92). Subgroup analyses showed significant associations in females and participants living in cities and towns, whereas no significant differences were observed between age groups. The sensitivity analysis yielded results consistent with the primary analysis.</p><p><strong>Conclusion: </strong>Frequent participation in individual outdoor activity may be associated with a reduced risk of dementia among the elderly in China. These findings support outdoor activity as a potential non-pharmaceutical strategy to delay cognitive decline and prevent dementia.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-19"},"PeriodicalIF":4.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145152079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Neglected Adolescent and Young adults Neurological Diseases: A systematic analysis from the GBD study 2021.","authors":"Jiayi Tian, Lili Lu, Yingxue Wang, Yihan Wang, Susu Tian, Xinyi Hu, Yuxuan Liu, Shengli Li, Shiguang Zhu, Wei Wang","doi":"10.1159/000548366","DOIUrl":"https://doi.org/10.1159/000548366","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Adolescent neurological disorders remain a leading cause of the global disease burden. This study aims to provide an updated assessment and insights into the burden trends from 1990 to 2021.</p><p><strong>Methods: </strong>We calculated the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for common 10 prevalent neurological diseases in adolescents and young adults globally from 1990 to 2021. Data were presented by total numbers, sex, age, year, location, risk factors, Socio-Demographic Index (SDI), and expressed in counts and rates.</p><p><strong>Results: </strong>In 2021, migraine (592.8 million, 95% UI 47.6-1445.1), idiopathic epilepsy (204.8 million, 95% UI 152.8-279.5), and stroke (116.1 million, 95% UI 104.2-126.9) ranked as the top three neurological disorders globally in terms of DALYs. From 1990 to 2021, the absolute number of DALYs and deaths due to common neurological disorders significantly increased, although the age-standardized mortality rate slightly declined. Most diseases burden increased with age, with a higher prevalence in females than in males. Furthermore, significant variations were observed between different diseases and regions, and the age-standardized DALY rates for most neurological disorders showed a significant positive correlation with the country's SDI value.</p><p><strong>Conclusion: </strong>Neurological disorders ranked second in global adolescent and young adults' DALYs and remained a key mortality driver. Persistent absolute burden despite declining age-standardized rates urges prioritized prevention policies and care strategies amid population growth.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-21"},"PeriodicalIF":4.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Activity and Stroke Incidence Among Post-Menopausal Women: Insights from the Women's Health Initiative.","authors":"Ganesh Asaithambi, Brian Silver, Anne-Marie Meyer, Kelly R Evenson, Connor R Miller, Tracy E Madsen, Sylvia Wassertheil-Smoller, Monik C Botero, Marcia L Stefanick, Michael J LaMonte","doi":"10.1159/000548425","DOIUrl":"https://doi.org/10.1159/000548425","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of morbidity and mortality, particularly in older adults. Identifying lifestyle factors, such as physical activity (PA), that mitigate stroke risk is critical for stroke prevention, especially in postmenopausal women. We sought to determine the association between levels and types of recreational PA and risk of total, ischemic, and hemorrhagic stroke in postmenopausal women.</p><p><strong>Methods: </strong>We performed a prospective cohort study conducted within the Women's Health Initiative from 1993 to 1998 with a mean follow up of 8.5 years. We studied a total of 139,871 postmenopausal women aged 50-79 years without prior cardiovascular disease or stroke at enrollment. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Recreational PA assessed via questionnaire, including total, light, moderate, and vigorous activities and walking. Incident total, ischemic, and hemorrhagic stroke. HRs and 95% CIs were adjusted for sociodemographic, lifestyle, and clinical factors.</p><p><strong>Results: </strong>During follow up, 4,642 stroke occurred (3,496 ischemic and 728 hemorrhagic). Higher levels of total PA (per 1-SD MET-hr/wk: HR=0.90, 95% CI: 0.87-0.93), walking (HR=0.93, 95% CI: 0.90-0.96), and moderate PA (HR=0.91, 95% CI: 0.88-0.94) were associated with reduced total stroke risk. Similar inverse associations were found for ischemic stroke. Vigorous PA demonstrated a J-shaped association with ischemic stroke, while light PA was not significantly associated with stroke risk. Total (HR=0.90, 95% CI: 0.83-0.97) and vigorous PA (HR=0.88, 95% CI: 0.81-0.96) were inversely associated with hemorrhagic stroke. Associations were consistent across subgroups defined by age, race/ethnicity, blood pressure, hormone therapy use, BMI, and dietary intake.</p><p><strong>Conclusion: </strong>Increased recreational PA, particularly moderate, with cautious interpretation of vigorous activity due to its J-shaped association and potential risks, is associated with reduced risks of total and ischemic stroke in postmenopausal women. Our findings support promoting PA as a key strategy for stroke prevention in this population.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-23"},"PeriodicalIF":4.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in incidence of intracerebral hemorrhage and its bleeding sites from 1985 to 2017 in Japanese rural communities.","authors":"Kenichi Ariyada, Kazumasa Yamagishi, Eiko Honda, Tomomi Kihara, Tomoko Sankai, Isao Muraki, Yuji Shimizu, Tetsuya Ohira, Takeshi Tanigawa, Hironori Imano, Hiroyasu Iso","doi":"10.1159/000548448","DOIUrl":"https://doi.org/10.1159/000548448","url":null,"abstract":"<p><strong>Introduction: </strong>Evaluating long-term trends for the incidence of intracerebral hemorrhage is a priority for primary prevention. It is also important to assess the trends in the proportions of bleeding sites because the pathogenesis, prognosis, and operative procedures differ among them.</p><p><strong>Methods: </strong>A prospective community-wide stroke registry in two rural Japanese communities (Ikawa Town and Kyowa Town, with populations of approximately 5000 and 15,000, respectively) was conducted. The age-adjusted incidence of intracerebral hemorrhage from 1985 to 2017 was calculated by the direct method using the World Standard Population. The proportions of intracerebral hemorrhage by bleeding sites (putamen, thalamus, lobes, cerebellum, and brainstem) based on neuroimaging were calculated in each of the following three periods: 1985-1995, 1996-2006, and 2007-2017.</p><p><strong>Results: </strong>During the study period, 383 intracerebral hemorrhage events as first-ever strokes were registered. The age-adjusted incidence declined over time by 33%, with a large reduction between 1985-1989 and 1990-1994, but the magnitude of the decline has diminished since the 1990s. The proportions of bleeding sites were 37%, 29%, and 31% for putamen in 1985-1995, 1996-2006, and 2007-2017, respectively; the corresponding proportions were 24%, 35%, and 18% for thalamus; 10%, 10%, and 21% for lobes; 2%, 8%, and 12% for cerebellum; and 8%, 6%, and 5% for brain stem.</p><p><strong>Conclusion: </strong>The age-adjusted incidence declined by 33% from the 1990s with a large reduction in the early 1990s in Japanese rural communities. Among intracerebral hemorrhages, the proportion of bleeding sites decreased for the putamen, thalamus, and brain stem, and increased for lobes and the cerebellum.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-17"},"PeriodicalIF":4.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic Variation in Moyamoya Angiopathy in a Diverse New Zealand Population: A Population-Based Cohort Study.","authors":"Karim M Mahawish","doi":"10.1159/000548482","DOIUrl":"https://doi.org/10.1159/000548482","url":null,"abstract":"<p><strong>Introduction: </strong>Moyamoya angiopathy (MMA) has been reported in the ethnically diverse Auckland region of New Zealand, but the sociodemographic burden and clinical outcomes remain poorly characterised. This study aims to determine age, sex, and prevalence of MMA stratified by ethnicity, and to assess clinical outcomes in adults residing in Auckland (population 1.9 million).</p><p><strong>Methods: </strong>A retrospective review of patient records and radiology reports from 2008 to 2025 was conducted using ICD codes and keyword searches. Prevalence was estimated using national census data. Primary outcomes were functional independence (modified Rankin Score 0-2) and the composite of stroke or transient ischaemic attack (TIA). Associations were assessed using univariate and multivariate Cox regression. A pooled analysis of published cohorts was also performed for context.</p><p><strong>Results: </strong>A total of 100 patients were identified (73% female; mean age 38.5 years, SD 17). Period prevalence was highest among Pacific peoples (11/100,000), followed by Māori (6/100,000), Asians (4/100,000), and Europeans (2/100,000). Overall prevalence increased from 0.8 to 4.5 per 100,000 between 2001 and 2025 (p<0.0001). During a median follow-up of 4.2 years, 39% experienced a cerebrovascular event, at a median of 647 days from diagnosis. Two-thirds remained functionally independent. Bilateral internal carotid artery involvement (HR 0.52, 95% CI 0.30-0.91) and recurrent cerebrovascular events (HR 0.54, 95% CI 0.31-0.94) were associated with poorer outcomes, while antithrombotic use was protective (HR 2.1, 95% CI 1.11-3.9). Outcomes were consistent with other international cohorts.</p><p><strong>Conclusion: </strong>This population-based study highlights marked ethnic variation in MMA prevalence, with the highest rates in Pacific peoples, and an elevated risk of early cerebrovascular events. These findings have implications for timely diagnosis and targeted management in diverse populations.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-20"},"PeriodicalIF":4.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}