ARCOS: Auckland Regional Community Stroke Study

ARCOS: Auckland Regional Community Stroke Study

An epidemiological study of the determinants of stroke impact on individuals, families and communities, carried out in Auckland in 2002–2003.

Rationale

Stroke is the third leading cause of death in New Zealand, and a major cause of disability. It has an enormous impact on patients, carers and society. About 18,000 people are living with the effects of stroke in New Zealand. This number is projected to double by 2020. There is uncertainty about which key socioeconomic and health service factors in this country influence recovery from stroke. Moreover, there is little information about the access and quality of stroke services, in particular for Maori and Pacific people who are at high risk of stroke and who experience inequity in healthcare.

Aims

The overall aim of this study was to quantify the impact of stroke in Auckland, to refine methods for assessing this impact, and to identify whether factors such as socioeconomic circumstances, ethnicity, case mix, and quality of healthcare delivery, influence variations in impact.

Update

* This study is now complete but the data analysis still continues. The major findings of this study to date are:


* A trend towards declining stroke incidence rates in New Zealand Europeans over the last 20 years, while in the same period Maori and Pacific populations have shown a near doubling of stroke incidence.


* In Maori and Pacific people, strokes occur at a younger age – on average up to 10 and 15 years earlier than in New Zealand Europeans.


* New Zealand Europeans experience less severe strokes than other ethnic groups in NZ.


* Compared to New Zealand Europeans, Maori, Pacific Islanders and Asian people are at 1.5 to 3 times’ greater risk of ischaemic stroke and intracerebral haemorrhage.


* The increased risk of stroke in Maori, Pacific Islanders and Asian people is partly attributed to a higher prevalence of obesity, diabetes and high blood pressure in these ethnic groups.

Design

The study created a prospective population-based stroke register for the total population of Auckland in 2002–2003. Survivors of all new cases of stroke over a 12-month period were subsequently followed for the next six months. The methodology included similar criteria for diagnosis, case ascertainment, outcomes, and reporting to the criteria that were well established in previous studies of stroke in Auckland (initially 680 patients identified in 1981–82, and then 1761 patients identified in 1991–92). In addition, the study used both qualitative and quantitative measures to determine the impact of stroke. Data processing and analyses were undertaken within the CTRU.

Funding

The study is funded by the Health Research Council of New Zealand.

AUT Investigators

*    Valery Feigin, Co-Principal Investigator
*    Elizabeth Mitchelson, Named Investigator

Collaborators

*    Craig Anderson, Principal Investigator (The George Institute for International Health, Sydney, Australia)
*    Derrick Bennett, Named Investigator (University of Oxford, United Kingdom)
*    Alan Barber, Named Investigator (Department of Medicine, The University of Auckland)
*    Ruth Bonita, Named Investigator (Non-Communicable Disease Surveillance, World Health Organization, Geneva, Switzerland)
*    Paul M Brown, Named Investigator (Department of Community Health, The University of Auckland)
*    Lorna Dyall, Named Investigator (Department of Community Health, The University of Auckland)
*    Sitaleki Finau, Named Investigator (Maori and Pacific Health, The University of Auckland)
*    Ngaire Kerse, Named Investigator (Department of General Practice and Primary Health Care, The University of Auckland)
*    Harry McNaughton, Named Investigator (Wellington School of Medicine)
*    Malakai Ofanoa, Named Investigator (Maori and Pacific Health, The University of Auckland)
*    Joe Singh, Named Investigator (North Shore Hospital, Auckland)
*    Alistair Woodward, Chair of Steering Committee (School of Population Health, The University of Auckland)