J Korean Neurosurg Soc.  2020 Jan;63(1):69-79. 10.3340/jkns.2018.0182.

Trends in the Incidence and Treatment of Cerebrovascular Diseases in Korea : Part II. Cerebral Infarction, Cerebral Arterial Stenosis, and Moyamoya Disease

• Lee SU
• Kim T
• Kwon OK
• Bang JS
• Ban SP
• Byoun HS
• Oh CW

• KMID: 2501694
• DOI: http://doi.org/10.3340/jkns.2018.0182

Abstract

Objective
: To analyze trends in the incidence and treatment of diseases associated with ischemic stroke, namely, cerebral infarction (CI), cerebral arterial stenosis (CASTN), and moyamoya disease (MMD), based on Korean National Health Insurance Service (NHIS) data from 2008 to 2016.
Methods
: Data was extracted from the national health-claim database provided by the NHIS for 2008–2016 using International Classification of Diseases codes. The crude and age-standardized incidences of each disease (CI, CASTN without a history of CI, and MMD) were calculated; additional analyses were conducted according to age and sex. Trends in the number of patients undergoing treatment according to treatment method were analyzed for each disease using the Korean Classification of Diseases procedure codes.
Results
: In 2016, the total number of adults with newly diagnosed CI was 83939, reflecting a 9.4% decrease from that in 2008. The agestandardized incidence of CI in adults was 153.2 per 100000 person-years in 2016, reflecting a 37.2% decrease from that in 2008, while that of CASTN was 167.3 per 100000 person-years in 2016, reflecting a 73.3% increase from that in 2008. Among treated cases, the number of patients who underwent intra-arterial (IA) treatment, including IA fibrinolysis and mechanical thrombectomy, showed the most prominent increase, increasing at an annual rate of 25.8%. For CASTN, the number of cases treated with carotid artery stenting or balloon angioplasty (CAS) showed the most prominent increase, increasing at a rate of 69.8% over the 9-year period. For MMD, the total number of patients with newly diagnosed MMD and that with adult MMD demonstrated significantly increasing trends, while the number of pediatric patients with newly diagnosed MMD declined by 18.0% over the 9-year period. The age-standardized incidences of pediatric and adult MMD in 2016 were 2.4 and 3.4 per 100000 person-years, respectively.
Conclusion
: Although the incidence of CI showed a declining trend over a 9-year period, the number and proportion of patients treated for CI increased. Meanwhile, the incidence of CASTN and the number of patients treated for CASTN have demonstrated increasing trends since 2008. On the other hand, the number of patients diagnosed with pediatric MMD decreased, despite no significant change in the incidence. In contrast, the number of patients and the incidence of adult MMD increased. These trends reflect changes in the population structure, gains in the accessibility of imaging examinations, and the development of endovascular techniques.

Keyword

Incidence; National health service; Cerebral infarction; Caritid stenosis; Moyamoya disease

Figure

• 

  Fig. 1. Incidence of cerebral infarction (CI). A : Total number of patients diagnosed with CI, the crude incidence, and age-standardized incidence show decreasing trends over the 9-year observation period. B and C : The age-specific incidences show decreasing trends over the 9-year observation period for all age groups. The crude incidence was significantly higher in men than in women.

• 

  Fig. 2. Treatments for CI. Total number of adult patients treated for acute or subacute CI increased annually, at an annual rate of 15.5%. The number of patients who underwent DB increased steadily until 2014 and then showed a decreasing trend. The number of patients who underwent CEA increased steadily until 2011 and then plateaued. The number of ICAS cases has decreased since 2013. The number of CAS cases increased 2.4-fold over a period of 5 years (until 2013) and then plateaued. The number of patients who underwent IA treatment, including IA fibrinolysis and mechanical thrombectomy, has increased at an annual rate of 25.8% over 9 years. CEA : carotid endarterectomy, ICAS : intracranial arterial stenting and balloon angioplasty, CAS : carotid artery stenting and balloon angioplasty, IA : intra-arterial, CI : cerebral infarction, DB : direct bypass.

• 

  Fig. 3. Incidence of cerebral arterial stenosis (CASTN). A : Total number of patients diagnosed with CASTN, the crude incidence, and age-standardized incidence show significantly increasing trends over a 9-year period. B and C : The age-specific incidence of CASTN increased annually for all age groups, and was the highest for patients in their 70s. The crude incidence of CASTN in men exceeded that in women among patients in their 30s or older, and was 1.5 times more than that in women among patients in their 80s.

• 

  Fig. 4. Treatments for CASTN. Total number of adult patients treated for CASTN increased annually, at an annual rate of 5.2%. The number of patients who underwent DB increased steadily until 2013 and then showed a decreasing trend. The number of patients who underwent CEA increased steadily until 2012 and then plateaued. The number of ICAS cases has decreased since 2012, while the number of CAS cases has increased by 1.7-fold over a 9-year period. CAS : carotid artery stenting and balloon angioplasty, ICAS : intracranial arterial stenting and balloon angioplasty, CAS : carotid artery stenting and balloon angioplasty, CASTN : cerebral artery stenosis, DB : direct bypass.

• 

  Fig. 5. Incidence of moyamoya disease (MMD). A : The total number of patients with newly diagnosed MMD and that with adult MMD demonstrated increasing trends, while the number of pediatric patients with newly diagnosed MMD declined by 18.0% over a 9-year period. B and C : While the agespecific incidences in pediatric patients with MMD decreased, that in adult patients increased over a 9-year period. A bimodal shape is observed, peaking in the teens and 50s, but this pattern is more pronounced in women than in men.

Reference

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