NEMESIS North-East MElbourne Stroke Incidence Study A non-authorised summary by Fabrizio Carinci..for the authorised version:

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.

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)

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

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

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

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

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

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

NEMESIS.Results.Handicap

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

NEMESIS.Design.Perspectives

NEMESIS.Design.Others South London Stroke Register J Neurol Neurosurg Psychiatry 2002;72: Norway Stroke Register Stroke. 1999;30:56-60 European Stroke Database Hunter Region, NSW

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”