Background: Studying stroke rates in a whole community is a rational way to assess the quality of patient care and primary prevention. However, there are few studies of trends in stroke rates worldwide and none in Brazil. Objective: Established study methods were used to define the rates for first ever stroke in a defined population in Brazil compared with similar data obtained and published in 1995. Methods: All stroke cases occurring in the city of Joinville during 2005-2006 were prospectively ascertained. Crude incidence and mortality rates were determined, and age adjusted rates and 30 day case fatality were calculated and compared with the 1995 data. Results: Of the 1323 stroke cases registered, 759 were first ever strokes. The incidence rate per 100 000 was 105.4 (95% CI 98.0 to 113.2), mortality rate was 23.9 (95% CI 20.4 to 27.8) and the 30 day case fatality was 19.1%. Compared with the 1995 data, we found that the incidence had decreased by 27%, mortality decreased by 37% and the 30 day case fatality decreased by 28%. Conclusions: Using defined criteria we showed that in an industrial southern Brazilian city, stroke rates are similar to those from developed countries. A significant decrease in stroke rates over the past decade was also found, suggesting an improvement in primary prevention and inpatient care of stroke patients in Joinville.It is currently not clear if stroke rates are changing in different parts of the world. The incidence of total stroke in Latin American and Caribbean countries other than Brazil has been found to be between 135 and 151 per 100 000 population in well designed community based studies.1 Only three population based epidemiological studies have been carried out in Brazilian communities where the rates have ranged from 137 to 168 per 100 000 population.2-4 However, those studies were conducted in different decades and in distinct regions, which complicates the interpretation of trends in rates. There have been no comparative studies in which the same population base was analysed at two different time points.A recent study demonstrated a decrease in stroke mortality rates over the past two decades for all Brazilian regions, 5 but it is not clear if this is the result of a decreasing incidence or better health care and management of these patients.Our aim was to determine the incidence, mortality rates and case fatality of stroke in the city of Joinville and compare our results with a prospective, population based study on first ever stroke carried out in 1995 in the same city using similar methods. 3 METHODS Study populationIn the year 2000 census, the population of the city of Joinville was 429 604 inhabitants, and the projection for the year 2005 was 487 047 inhabitants. 6 The city has four general hospitals and one public institutional care facility, totalling 840 beds. All of the hospitals, with the exception of the public institutional care facility, have CT services available on a 24 h basis.

Case fatality rate, prognosis and incidence adjusted for stroke subtypes were similar to those found in other population based studies. The prevalence rates of ischaemic heart disease, dyslipidaemia, arterial hypertension and diabetes suggest that Joinville presents a mixed pattern of cardiovascular risk, a pattern seen in developed and developing countries alike.

Background: Temporal trends on the incidence of stroke and its subtypes could help assess on-going public health policies and point to further targets for action among middle- and low-income countries, where the stroke burden is very high. This study aimed at evaluating longitudinal trends of stroke incidence in Joinville, Brazil. Methods: We ascertained the incidence of all first-ever strokes occurred in 1995, 2005-2006 and 2012-2013, which were extracted from Joinville Stroke Registry, a prospective epidemiological data bank, launched in 1995. Results: From 1995 to 2013, the age-adjusted incidence of all strokes decreased 37% (95% CI 32-42). From 2005 to 2013, the haemorrhagic stroke (HS) incidence decreased 60% (95% CI 13-86), ischemic stroke (IS) incidence decreased 15% (95% CI 1-28), and subarachnoid haemorrhage incidence remained stable. The proportion of IS and HS patients with regularly treated hypertension increased by 60% (p = 0.01) and 33% (p = 0.01), respectively. The proportion of IS and HS patients that quit smoking increased 8% (p = 0.03) and 17% (p = 0.03), respectively. Conclusions: Stroke incidence has been decreasing in Joinville over the last 18 years, more so for HS than IS. Better control of hypertension and tobacco use might explain these findings.