Increasing Stroke Incidence and Decreasing Case Fatality, 1989–1998

Abstract

Background and Purpose-Although the incidence of and mortality from myocardial infarction (MI) have declined in most industrialized countries, incidence studies of stroke have shown less consistent trends. This study examines time trends in the incidence of stroke and case fatality rates in relation to socioeconomic circumstances and history of MI. Methods-Stroke incidence in the city of Malmö, Sweden (250 000 citizens), has been continuously monitored since 1989.All patients 50 to 79 years of age who experienced a first-ever stroke between 1989 and 1998 were included. Results-We included 3621 patients (1969 men, 1652 women). The age-standardized incidence was 647 per 100 000 persons-years for men and 400 per 100 000 persons-years for women. The annual increase-3.1% in men (PϽ0.05) and 2.9% in women (PϽ0.05)-was more pronounced in the younger age groups and was lowest in areas with poor socioeconomic circumstances. We found that 13% of the men and 6% of the women had a history of MI; this proportion was stable over the study period. The average case fatality rates in 1989 to 1998 were 10% for men and 9.3% for women. Rates remained stable for men but declined significantly in women (odds ratio per year, 0.895; 95% confidence interval, 0.84 to 0.95). Conclusions-In this urban population, stroke incidence increased between 1989 and 1998. The rate of increase tended to be lower in residential areas with least favorable socioeconomic circumstances. The proportion with a history of MI remained unchanged during the study period. There has been significant improvement in the case fatality rate in women but not in men.

Socioeconomic Differences in Stroke Incidence and Prognosis Under a Universal Healthcare System

“…7,24 Less obvious is the similar socioeconomic gradient we saw in both genders for ischemic stroke, because socioeconomic inequalities are usually stronger in men than in women. 25 Out-of-hospital mortality in women contributes more to total incidence than male out-of-hospital mortality.…”

Blood Pressure Control and Risk of Stroke

“…This may be one reason why the incidence of stroke in Sweden has remained unaltered or tended to increase. 4,15 Poor hypertension control is a long-standing and problematic clinical issue. There is more than one explanation, such as the attitude of the patient toward treatment, the clinician's notion and behavior, patient-doctor relations, drug intolerance, resistant hypertension, etc.…”

“…The annual incidence of stroke increased from 1989 to 1998 in men and women. 4 Because hypertension is regarded as the most important risk factor for stroke, its increasing incidence may be attributed to inadequate hypertension control. Few population-based studies have studied the incidence of stroke in relation to the quality of hypertension treatment.…”

Sex Differences in Incidence, Mortality, and Survival in Individuals With Stroke in Scotland, 1986 to 2005

“…3 Furthermore, hospital discharge data will only identify patients admitted to the hospital with stroke. Several registry-based studies report that Ͼ90% of patients with stroke are managed in the hospital, 8,26 a figure that is similar in Scotland. 27 Several registry-based studies have reported a reduction in stroke severity over time 23,28 and hospitalization of milder strokes may distort trends in case-fatality.…”

“…1,2 Although overall mortality from stroke is falling in western Europe and America, [3][4][5] trends in incidence are less clear and there are conflicting reports of stable, 6 increasing, 7,8 and decreasing rates. 5,9,10 Stroke is a disease of the elderly.…”