Stroke Incidence and Survival in the Beginning of the 21st Century in Southern Sweden

Abstract

Background and Purpose— We report trends of stroke incidence and survival up to year 2001/2002 in Lund-Orup, Sweden, and projections of future stroke incidence in Sweden. Methods— Lund Stroke Register, a prospective population-based study, included all first-ever stroke patients, between March 1, 2001 and February 28, 2002, in the Lund-Orup health care district. Institution-based studies for 1983 to 1985 and 1993 to 1995 were used for comparison. We calculated age-standardized incidence and Cox proportional hazards analysis of survival (stroke subtype, sex, age group, and study period in the analysis). Minimum follow-up was 46 months. Based on our register’s stroke incidence and the official Swedish population projection, a projection for future stroke incidence on a national basis was calculated. Results— We included 456 patients with first-ever stroke in 2001/2002. The age-standardized incidence (to the European population) was 144 per 100 000 person-years (95%CI 130 to 158) in 2001/2002, 158 (95%CI 149 to 168) in 1993 to 1995, and 134 (95%CI 126 to 143) in 1983 to 1985. Cox proportional hazard analysis indicated decreased risk of death after stroke in 2001/2002 (hazard ratio 0.80; 95%CI 0.67 to 0.94) compared with 1993 to 1995. Up to year 2050, the annual number of new stroke patients in Sweden may increase by 59% based solely on demographic changes. Conclusions— Despite possible underestimation of stroke incidence during the previous institution-based studies, the increased stroke incidence between 1983 to 1985 and 1993 to 1995 did not continue in 2001/2002. The long-term survival after stroke continues to improve. As the elderly population is growing in Sweden, stable incidence and increasing survival will result in a rapidly increasing prevalence of stroke patients in Sweden.

Complex health problems among the oldest old in Sweden: increased prevalence rates between 1992 and 2002 and stable rates thereafter

“…Rates may also change due to change in reporting, better diagnoses, as well as improvements of assistive devices. For example, the increased prevalence of mild stroke between 1992 and 2002 could be due to the combined effect of stable incidence rates and increased survival after stroke reported in other Swedish studies (Hallstrom et al 2008;Stegmayr and Asplund 2003). In addition, as a consequence of increased knowledge among patients and physicians mild strokes may have been increasingly detected and diagnosed (Stegmayr and Asplund 2003).…”

Time trends in outcome of subarachnoid hemorrhage

“…Exclusion of 2 studies 12,14 which did not report 1-month outcomes, and 1 study with an exceptionally low case-fatality rate of 8%, 39 did not substantially alter the results. Eighteen studies including our own 11,13,[21][22][23][24][25][27][28][29][31][32][33]35,37,38 reported the mean age of cases with SAH and proportion of women. After adjustment for age and sex, there was a similar but nonsignificant reduction in case-fatality of 0.9% per annum (Ϫ0.2 to 2.0%, p ϭ 0.10).…”

Correlates of short- and long-term case fatality within an incident stroke population in Tanzania

“…The resulting co-morbidity probably contributes to higher case fatality rates and we hypothesise that death could be reduced by improved active rehabilitation following stroke. 3 Indeed, studies of stroke survivors in the UK, Japan and Hungary have noted the link between survival and active poststroke medical management. 21,22 While other authors have noted most of these variables as predictive of post-stroke outcome, it is those factors which were not associated with case fatality which are perhaps the most interesting.…”

“…[3][4][5][6] In low-and middle-income regions, the situation is more complex. With limited provision of primary healthcare in many regions, poststroke mortality rates remain high, and demographic changes mean that as populations age, rates of stroke-attributable mortality are likely to continue to rise.…”