Incidence and Post-Stroke Survival in the Normandy Stroke Population-Based Study (2017-2022): Impact of Time-Based Versus Tissue-Based Definitions.

Authors

Ahmad Nehme, Romain Schneckenburger, Marguerite Watrin, Jean Bouchart, Marion Boulanger, Julien Cogez, Sophie Guettier, Estelle La Porte, Lucie Laroche, Gwendoline Le Du, Olivier Martinaud, Rémy Morello, Denis Vivien, Emmanuel Touzé

Published in

Neurology. Volume 107. Issue 9. Pages e218457. Nov 10, 2026. Epub Oct 16, 2026.

Abstract

The 11th edition of the International Classification of Diseases (ICD-11) incorporates a tissue-based definition of stroke and may alter estimates of incidence and outcomes. We assessed whether transitioning from a time-based to a tissue-based definition introduces age-dependent changes in stroke incidence and post-stroke survival.
The Normandy Stroke Study is a population-based study using multiple overlapping sources to identify stroke cases in Caen-Normandy-Metropole, France. Events occurring between May 15, 2017, and December 31, 2022, were classified using time-based (symptoms ≥24 hours) and tissue-based definitions (symptoms ≥24 hours or <24 hours with neuroimaging evidence of ischemic injury).
Among 3,826 first-ever strokes meeting the tissue-based definition, median (IQR) age was 76 (64-85) years, and 1,932 (50.5%) were female. The age-standardized incidence rate of stroke (95% CI) was 161 (156-166) per 100,000 person-years (ESP2013), including 132 (128-137) for ischemic or undetermined stroke, 22 (20-24) for intracerebral hemorrhage, and 7 (6-8) for subarachnoid hemorrhage. Three-year mortality was 36.4% (95% CI 34.9-38.0). Compared with the time-based definition, the tissue-based definition increased stroke incidence by 6.5% and reduced 3-year mortality by 3.9%. The impact of the tissue-based definition on stroke incidence was greater at younger ages (all strokes: younger than 55 years = +8.5%; 55 years or older = +6.0%; ischemic stroke: younger than 55 years = +12.5%; 55 years or older = +7.3%).
Adoption of a tissue-based definition modestly increased stroke incidence and post-stroke survival, with greater impacts at younger ages. Implementation of ICD-11 may introduce age-related differences in temporal trends, highlighting the importance of consistent definitions in stroke surveillance.

PMID:
42886872
Bibliographic data and abstract were imported from PubMed on 17 Oct 2026.

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