The sex gap in stroke incidence did not change with time except for subarachnoid hemorrhage. Despite lower rates, more women than men experience an incident stroke each year because of a longer life expectancy.

The incidence of cerebral haemorrhage was studied from a population-based stroke registry. The incidence was 12-3 per 100 000 per year in women and 13-9 per 100 000 per year in men, with a peak in the eighth decade and a male preponderance. Haemorrhages were deep seated and mostly due to hypertension. Recognised clinical characteristics of haemorrhage are acute onset, convulsion, vomiting, and disturbed consciousness. This study showed that cerebral haemorrhage may present with pure motor deficit or transient deficit preceding the stroke. The mortality was 51% in the first month, and 61% by two years.

Since 1985 there has been a Stroke Registry in Dijon to record every stroke occurring in the population of a city of 140,000 inhabitants. The survey has been exhaustive and included the numerous sources of information as well as CT scanning. The annual incidence is 145/100,000 with an annual specific incidence of 170/100,000 in men, 126/100,000 in women. The annual specific incidence shows a female preponderance until 30 years of age, after which the males lead from the age of 30 to 80, when the rates become equal. Sixty-eight percent of strokes produced by infarct, 12% by lacunae, 5% by subarachnoid hemorrhage and 15% by cerebral hemorrhage. Differences exist in this distribution, with the preponderance of young people in subarachnoid hemorrhage, and cerebral hemorrhage is commoner in the 5th decade while infarct increases with age in both sexes. Infarct appears commoner during winter, transient ischemic attacks during summer, while cerebral hemorrhage has a constant incidence during the year. Mortality is high mainly during the 1st month with 12.5% during the 1st week, 21.5% the 1st month and 30% the 1st year. Our results are in the mean similar to white occidental countries, but opposite to those observed in Japan; they emphasize the importance of the lacunar syndrome, and the seasonal variations in different types of stroke.

Background and Purpose-The incidence of stroke in France is estimated at between 120 000 and 150 000 cases per year.This modeling study assessed the clinical and economic benefits of establishing specialized stroke units compared with conventional care. Methods-Data from the Dijon stroke registry were used to determine healthcare trajectories according to the degree of autonomy and organization of patient care. The relative risks of death or institutionalization or death or dependence after passage through a stroke unit were compared with conventional care. These risks were then inserted with the costing data into a Markov model to estimate the cost-effectiveness of stroke units. Results-Patients cared for in a stroke unit survive more trimesters without sequelae in the 5 years after hospitalization than those cared for conventionally (11.6 versus 8.28 trimesters). The mean cost per patient at 5 years was estimated at 30 983 € for conventional care and 34 638 € in a stroke unit. An incremental cost-effectiveness ratio for stroke units of 1359 € per year of life gained without disability was estimated. Conclusions-The cost-effectiveness ratio for stroke units is much lower than the threshold (53 400 €) of acceptability recognized by the international scientific community. This finding justifies organizational changes in the management of stroke patients and the establishment of stroke units in France.