BACKGROUND AND PURPOSE: Mortality from stroke has been declining over recent decades in most countries, except in Eastern Europe. In this analysis, based on the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (WHO MONICA) Project, we explored to what extent these trends are due to changes in stroke event rate and to changes in case fatality. METHODS: The WHO MONICA Project collected standardized data from 14 populations in 9 countries. All acute strokes occurring in men and women 35 to 64 years of age were included. Registration was carried out between 1982 and 1995, resulting in time spans from 7 to 13 years. Trends in event rates and case fatality were calculated as average annual percentage change. RESULTS: Up to 6-fold differences were observed in stroke mortality. Mortality declined in 8 of 14 populations in men and in 10 of 14 populations in women. An increase in mortality was observed in Eastern Europe. In the populations with a declining trend, about two thirds of the change could be attributed to a decline in case fatality. In populations with increasing mortality, the rise was explained by an increase in case fatality. CONCLUSIONS: In most populations, changes in stroke mortality, whether declining or increasing, were principally attributable to changes in case fatality rather than changes in event rates. Whether this was due to changes in the management of stroke or changes in disease severity cannot be established on the basis of these results.
BACKGROUND AND PURPOSE: Mortality from stroke has been declining over recent decades in most countries, except in Eastern Europe. In this analysis, based on the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (WHO MONICA) Project, we explored to what extent these trends are due to changes in stroke event rate and to changes in case fatality. METHODS: The WHO MONICA Project collected standardized data from 14 populations in 9 countries. All acute strokes occurring in men and women 35 to 64 years of age were included. Registration was carried out between 1982 and 1995, resulting in time spans from 7 to 13 years. Trends in event rates and case fatality were calculated as average annual percentage change. RESULTS: Up to 6-fold differences were observed in stroke mortality. Mortality declined in 8 of 14 populations in men and in 10 of 14 populations in women. An increase in mortality was observed in Eastern Europe. In the populations with a declining trend, about two thirds of the change could be attributed to a decline in case fatality. In populations with increasing mortality, the rise was explained by an increase in case fatality. CONCLUSIONS: In most populations, changes in stroke mortality, whether declining or increasing, were principally attributable to changes in case fatality rather than changes in event rates. Whether this was due to changes in the management of stroke or changes in disease severity cannot be established on the basis of these results.
Authors: Norrina B Allen; Theodore R Holford; Michael B Bracken; Larry B Goldstein; George Howard; Yun Wang; Judith H Lichtman Journal: Cerebrovasc Dis Date: 2010-09-28 Impact factor: 2.762
Authors: Darwin R Labarthe; George Howard; Monika M Safford; Virginia J Howard; Suzanne E Judd; Mary Cushman; Brett M Kissela Journal: Neuroepidemiology Date: 2016-09-15 Impact factor: 3.282
Authors: Anatoli Yashin; Igor Akushevich; Svetlana Ukraintseva; Lucy Akushevich; Konstantin Arbeev; Alexander Kulminski Journal: Stroke Date: 2010-01-21 Impact factor: 7.914
Authors: Norrina B Allen; Theodore R Holford; Michael B Bracken; Larry B Goldstein; George Howard; Yun Wang; Judith H Lichtman Journal: Neuroepidemiology Date: 2010-01-13 Impact factor: 3.282
Authors: Valery L Feigin; Mohammad H Forouzanfar; Rita Krishnamurthi; George A Mensah; Myles Connor; Derrick A Bennett; Andrew E Moran; Ralph L Sacco; Laurie Anderson; Thomas Truelsen; Martin O'Donnell; Narayanaswamy Venketasubramanian; Suzanne Barker-Collo; Carlene M M Lawes; Wenzhi Wang; Yukito Shinohara; Emma Witt; Majid Ezzati; Mohsen Naghavi; Christopher Murray Journal: Lancet Date: 2014-01-18 Impact factor: 79.321
Authors: Dominic P J Howard; Amitava Banerjee; Jack F Fairhead; Jeremy Perkins; Louise E Silver; Peter M Rothwell Journal: Circulation Date: 2013-04-18 Impact factor: 29.690