``EMMA Study: a Brazilian community-based cohort study of stroke mortality and morbidity{''}

Author(s)

Goulart, Alessandra Carvalho

• Document type: Review article
• Source: São Paulo Medical Journal; v. 134, n. 6, p. 543-554, NOV-DEC 2016.
• Web of Science Citations: 1

Abstract

CONTEXT AND OBJECTIVE: Stroke has a high burden of disability and mortality. The aim here was to evaluate epidemiology, risk factors and prognosis for stroke in the EMMA Study (Study of Stroke Mortality and Morbidity). DESIGN AND SETTINGS: Prospective community-based cohort carried out in Hospital Universitario, University of Sao Paulo, 2006-2014. METHODS: Stroke data based on fatal and non-fatal events were assessed, including sociodemographic data, mortality and predictors, which were evaluated by means of logistic regression and survival analyses. RESULTS: Stroke subtype was better defined in the hospital setting than in the local community. In the hospital phase, around 70% were first events and the ischemic subtype. Among cerebrovascular risk factors, the frequency of alcohol intake was higher in hemorrhagic stroke (HS) than in ischemic stroke (IS) cases (35.4% versus 12.3%, P < 0.001). Low education was associated with higher risk of death, particularly after six months among IS cases (odds ratio, OR, 4.31; 95% confidence interval, CI, 1.34-13.91). The risk of death due to hemorrhagic stroke was greater than for ischemic stroke and reached its maximum 10 days after the event (OR: 3.31; 95% CI: 1.55-7.05). Four-year survival analysis on 665 cases of first stroke (82.6% ischemic and 17.4% hemorrhagic) showed an overall survival rate of 48%. At four years, the highest risks of death were in relation to ischemic stroke and illiteracy (hazard ratio, HR: 1.83; 95% CI: 1.26-2.68) and diabetes (HR: 1.45; 95% CI: 1.07-1.97). Major depression presented worse one-year survival (HR: 4.60; 95% CI: 1.36-15.55). CONCLUSION: Over the long term, the EMMA database will provide additional information for planning resources destined for the public healthcare system. (AU)

• FAPESP's process: 10/20562-5 - Validation of the Portuguese version of the telephone interview for cognitive status among stroke patients
• Grantee: Alessandra Carvalho Goulart
• Support Opportunities: Regular Research Grants
• FAPESP's process: 15/17321-0 - PREDICTIVE VALUE OF BIOMARKERS AND NEUROIMAGING IN LONG-TERM EVOLUTION OF POST-STROKE DEPRESSION AND COGNITIVE IMPAIRMENT IN EMMA STUDY
• Grantee: Alessandra Carvalho Goulart
• Support Opportunities: Regular Research Grants
• FAPESP's process: 11/22872-4 - Treatment of major depressive disorder post stroke with transcranial direct corrent stimulation (TDCS): randomized, double-blind, clinical trial
• Grantee: Alessandra Carvalho Goulart
• Support Opportunities: Regular Research Grants
• FAPESP's process: 11/17568-4 - Epidemiological stroke surveillance: risk profile associated with early and long term case-fatality: study of stroke mortality and morbidity (EMMA study), São Paulo, Brazil
• Grantee: Alessandra Carvalho Goulart
• Support Opportunities: Regular Research Grants