Modeling the future burden of stroke in The Netherlands: impact of aging, smoking, and hypertension.
ABSTRACT In the near future, the number of stroke patients and their related healthcare costs are expected to rise. The purpose of this study was to estimate this expected increase in stroke patients in the Netherlands. We sought to determine what the future developments in the number of stroke patients due to demographic changes and trends in the prevalence of smoking and hypertension in terms of the prevalence, incidence, and potential years of life lost might be.
A dynamic, multistate life table was used, which combined demographic projections and existing stroke morbidity and mortality data. It projected future changes in the number of stroke patients in several scenarios for the Dutch population for the period 2000 to 2020. The model calculated the annual number of new patients by age and sex by using incidence rates, defined by age, sex, and major risk factors. The change in the annual number of stroke patients is the result of incident cases minus mortality numbers.
Demographic changes in the population suggest an increase of 27% in number of stroke patients per 1000 in 2020 compared with 2000. Extrapolating past trends in the prevalence of smoking behavior, hypertension, and stroke incidence resulted in an increase of 4%.
The number of stroke patients in the Netherlands will rise continuously until the year 2020. Our study demonstrates that a large part of this increase in the number of patients is an inevitable consequence of the aging of the population.
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ABSTRACT: Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention. With a simulation model, lifetime health-care costs were estimated for a cohort of obese people aged 20 y at baseline. To assess the impact of obesity, comparisons were made with similar cohorts of smokers and "healthy-living" persons (defined as nonsmokers with a body mass index between 18.5 and 25). Except for relative risk values, all input parameters of the simulation model were based on data from The Netherlands. In sensitivity analyses the effects of epidemiologic parameters and cost definitions were assessed. Until age 56 y, annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions. Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.PLoS Medicine 03/2008; 5(2):e29. · 16.27 Impact Factor
Article: A Brazilian experience to describe functioning and disability profiles provided by combined use of ICD and ICF in chronic stroke patients at home-care.[show abstract] [hide abstract]
ABSTRACT: To present experience of combined use of the International Classifications to determine functioning and disability profiles of chronic stroke patients at home-care. It was a design observational study with 13 subjects sampled from 39 patients with stroke pre-selected from 115 patients attended by a public home-care service. Their socio-demographic and others independent variables were assessed and frequencies of codified events from International Classification of Diseases (ICD) and International Classification of Functioning, Disability and Health (ICF) were recorded. Endocrine, nutritional and metabolic diseases; diseases of the nervous and circulatory system; diseases of skin and subcutaneous tissue and diseases of the musculoskeletal system and connective tissue were recorded by ICD being complemented by ICF mainly describing impairments in neuromusculoskeletal and movement-related function and structure; limitations in activities and participation for domestic life and barriers for natural environment and human-made changes to environment. Moreover, it was observed functioning profile describing sensory function and structures related to movements preserved; good interpersonal interactions and facilities provided by services and policies. Preserved functions and structures related to movement and advantages in interpersonal interactions, public services and healthy policies could be used to guide therapy and to prevent rehospitalisation commonly observed in chronic stroke survivals.Disability and Rehabilitation 03/2011; 33(21-22):2064-74. · 1.50 Impact Factor
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ABSTRACT: To investigate the long-term effects on children of parental stroke, with respect to care-giving tasks, children's behavioural problems and stress, and to study the relationship between stress and child, patient and partner characteristics. A total of 44 children (age range 10-21 years) were assessed 3 years after parental stroke. Behavioural problems were assessed with the Child Behaviour Check List and the Youth Self-Report. Stress was measured using the Dutch Stress Questionnaire for Children. Most children (66%) assisted their parent in self-care or mobility. Some of the children (31%) experienced behavioural problems. The results showed that 37.5% of younger children show externalizing problems on the Child Behaviour Check List. Stress was significantly related to female gender of the child, and to depression, limitations in extended activities of daily living and life satisfaction of the patient. Most children do well 3 years after parental stroke. However, some children of patients after stroke have behavioural problems and need attention in clinical practice.Journal of Rehabilitation Medicine 12/2007; 39(9):703-7. · 2.05 Impact Factor