NEMESIS

1. NEMESIS North-East MElbourne Stroke Incidence Study A non-authorised summary by Fabrizio Carinci ..for the authorised version: http://www.strokeresearch.com.au/researchstudy.htm

2. NEMESIS.Aims • To obtain a measure of the incidence of stroke, and its subtypes, in an Australian community • To compare and contrast the costs associated with different subtypes of stroke and to determine whether the costs of stroke are greater for particular ethnic groups. In addition, to determine the costs associated with common patterns of stroke care • To determine the degree of risk of various stroke subtypes associated with hypertension and exposure to passive smoking • To determine outcome of stroke particularly in relation to dementia after stroke, recurrent stroke, and quality of life after stroke.

3. NEMESIS.Methods.Population • All suspected cases of cerebrovascular disease which meet the • World Health Organisation standard diagnostic criteria. • Stroke: • "rapidly developing clinical signs of focal or global disturbance lasting more than 24 hours or leading to death with no apparent cause other than vascular“ • Geographical area: • inner Northeast Melbourne (8 postcodes)

4. NEMESIS.Methods.DataCapturing • Overlapping sources: • Public and Private Hospital admission and Discharge lists • Contact with Stroke Registrars • Fortnightly phone call to nursing homes and hostels • Scrutiny of radiology lists • Scrutiny of death certificates and perusal of Coroner’s records • Bi-monthly contact with General Practitioners

5. NEMESIS.Methods.SurroundingAreas • Hospital “spillover”: • 12 public hospitals • 27 private hospitals • 5 public rehabilitation/specialist care • 6 private rehabilitation hospitals • GPs: • Surrounding rim of 5km

6. NEMESIS.Results.Incidence.Overall • Crude annual incidence rate: • 206/100,000 (105 males, 217 females) • IR doubles with each decade of life • Standardised IR: 100 (113 males, 89 females) • (average, different from Perth study) • 37% die within one year (low) • 19% within 28 days (not too high) • 27% deaths outside the hospital

7. NEMESIS.Results.Incidence.Subtypes • Standardised IR: • 71 cerebral infarction • 16 intracerebral hemorrage • 6 subarachnoid hemorrage • 18 undetermined • Similar to other community-based studies in mainly white populations • Cerebral infarction among women, intracerebral • hemorrage in men greater than Perth study

8. NEMESIS.Results.Costs • Estimated 1997 value: • $A1.3billion (25% lower NHMRC estimate) • First-year costs: • 28% acute • 27% inpatient rehabilitation • 11% nursing home • 8% readmissions • 6% indirect • 4% carer time • ….. • .6% GPs

9. NEMESIS.Results.InformalCare • Caregiver time costs: • between 4% and 7% of total stroke-related costs in the first year • between 14% and 23% of lifetime costs after first stroke • 68% primary caregivers not employed in paid work

10. NEMESIS.Results.Handicap

11. NEMESIS.Design.Limitations • Bias: • “ it is acknowledged that the refusal rate together with the rate of late notification to our study may have introduced bias” • Survivors assessed were: • more likely to have been born in Australia • less likely to have been admitted to a private hospital • English as preferred language • Lifestyle, ethnic mix and socioeconomic class not representative of Melbourne and Australian population

12. NEMESIS.Design.Perspectives

13. NEMESIS.Design.Others • South London Stroke Register • http://www.kcl-phs.org.uk/stroke/research/SLSR.htm • J Neurol Neurosurg Psychiatry 2002;72:211-216 • Norway Stroke Register • Stroke. 1999;30:56-60 • European Stroke Database • http://www.ncl.ac.uk/stroke-research-unit/posters/bsrcsmx.htm • Hunter Region, NSW • http://www.hmr.net.au/resc-hhsr.htm

14. NEMESIS.Design.Others.London NEMESIS.InformalCare “this region of Melbourne is located in the inner suburbs of a major city and contains people who, on average, have a higher socio-economic status than Victoria and Australia…not all stroke patients were interviewed, and the interviewed group was not completely representative of the stroke population”