title: Trends in incidence and early outcomes in a Black Afro-Caribbean population from 1999 to 2012: Etude Réalisée en Martinique et Centrée sur l'Incidence des Accidents Vasculaires Cérébraux II Study.
abstract: OBJECTIVE
  Seldom studies are available on trends in stroke incidence in blacks. We aimed to evaluate whether stroke risk prevention policies modified first-ever stroke incidence and outcomes in the black Afro-Caribbean population of Martinique.
  
  
  METHODS
  Etude Réalisée en Martinique et Centrée sur l'Incidence des Accidents Vasculaires Cérébraux (ERMANCIA) I and II are 2 sequential prospective population-based epidemiological studies. There have assessed temporal trends in first-ever stroke incidence, risk factors, pathological types, and early outcomes in the black Afro-Caribbean population of Martinique comparing two 12-month periods (1998-1999 and 2011-2012). Crude and age-standardized incidence and 30-day outcomes for stroke in the 2 study periods were compared using Poisson regression.
  
  
  RESULTS
  We identified 580 and 544 first-ever strokes in the 2 studies. World age-standardized incidence rates decreased by 30.6% in overall (111 [95% confidence interval, 102-120] versus 77 [95% confidence interval, 70-84]). Rate decline was greater in women than in men (34% versus 26%) particularly in women aged 65 to 74 years (-69%) and 75 to 84 years (-43%). Frequencies of hypertension and diabetes mellitus were unchanged, whereas dyslipidemia, smoking, and atrial fibrillation significantly increased. Only ischemic stroke types showed significant rate reduction in overall and in women, incidence rate ratio (95% confidence intervals) of 0.69 (0.50-0.97) and 0.61 (0.42-0.88), respectively. The overall 30-day case-fatality ratio remained stable (19.3%/17.6%), whereas a better 30-day outcome was found (modified Rankin Score, ≤2 in 47%/37.6%; P=0.03).
  
  
  CONCLUSIONS
  Over 13 years, there has been a significant decrease (30.6%) in the age-specific first-ever stroke incidence in our Afro-Carribean population. Although prevention policies seem effective, we need to focus on new risk factors limitation and on male population adherence to prevention program.
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.). stephane.olindo@chu-fortdefrance.fr.
authors.forename: Stephane
authors.initials: S
authors.lastname: Olindo
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.).
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chausson
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.).
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mejdoubi
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.).
authors.forename: Severine
authors.initials: S
authors.lastname: Jeannin
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.).
authors.forename: Karine
authors.initials: K
authors.lastname: Rosillette
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.).
authors.forename: Martine
authors.initials: M
authors.lastname: Saint-Vil
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.).
authors.forename: Aissatou
authors.initials: A
authors.lastname: Signate
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.).
authors.forename: Mireille
authors.initials: M
authors.lastname: Edimonana-Kaptue
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.).
authors.forename: Veronique
authors.initials: V
authors.lastname: Larraillet
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.).
authors.forename: Philippe
authors.initials: P
authors.lastname: Cabre
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.).
authors.forename: Didier
authors.initials: D
authors.lastname: Smadja
authors.affiliation: From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.).
authors.forename: Julien
authors.initials: J
authors.lastname: Joux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology*; D017691:Caribbean Region / Q000208:ethnology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008395:Martinique / Q000208:ethnology; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000208:ethnology*; D016896:Treatment Outcome
keywords: blacks; epidemiology; incidence; outcomes assessment; stroke; trends