The aim of the current study was to evaluate the outcome at 1 year following a first-ever stroke based on a population-based registry from 2001 to 2003 in Tartu, Estonia. The outcome of first-ever stroke was assessed in 433 patients by stroke risk factors, demographic data and stroke severity at onset using the Barthel Index (BI) score and the modified Rankin Score (mRS) at seventh day, 6 months and 1 year. Female sex, older age, blood glucose value >10 mmol/l on admission and more severe stroke on admission were the best predictors of dependency 1 year following the first-ever stroke. At 1 year, the percentage of functionally dependent patients was 20% and the survival rate was 56%. The use of antihypertensive/antithrombotic medication prior to stroke did not significantly affect the outcome. The survival rate of stroke patients in Tartu is lower compared with other studied populations. The outcome of stroke was mainly determined by the initial severity of stroke and by elevated blood glucose value on admission. Patients with untreated hypertension had more severe stroke and trend for unfavourable outcome compared with those who were on treatment.

Background and Purpose-The purpose of the present study was to estimate the time trends of stroke during the last 10 years in an Estonian population by comparison of the results from the 2 previous stroke registries from Tartu. Methods-The Third Stroke Registry in Tartu was conducted from January 12, 2001, to November 30, 2003. The previous registry was composed from January 1, 1991, to December 31, 1993. The design of both studies is similar, using the same study criteria and classification schemes. Results-A total of 1280 patients with first-ever stroke were registered during the 5-year study period. The overall incidence rate of 230 per 100 000 declined between the studies to 188 per 100 000 age-standardized to the European standard population. The age-adjusted incidence rate for women decreased from 204 to 164 per 100 000 between the 2 periods. In most of the age groups, the overall case-fatality rates declined during the second period; the trend in the age group 75 to 84 years was statistically significant. Conclusions-The incidence of first-ever stroke in Tartu has declined significantly during the past decade and reached the level of the first registry. The 28-day case-fatality rate has declined from 30% to 26%. The prevalence of cardiovascular risk factors, incidence of stroke, and ischemic heart disease has been high in Eastern European countries. Our data show that the situation has improved. (Stroke. 2005;36:2544-2548.)

SUMMARY This study was undertaken to establish the incidence and mortality for various types of cerebrovascular disease in the population of Tartu. All medical records for this population were reviewed for the period 1970 through 1973, and those with a diagnosis of brain infarction, transient ischemic attacks, cerebral hemorrhage or subarachnoid hemorrhage were identified. Only the first stroke was considered when determining incidence. A total of 786 cases were included in the study. Without cases of transient ischemic attacks, the number was 667 (e.g., cases of stroke). Cerebral infarction accounted for 80% of all strokes, cerebral hemorrhage for 13.5% and subarachnoid hemorrhage for 6.5%. The incidence rate for stroke was higher for men than for women and significantly increased in each older age group. The rate for all persons was 184 per 100,000 population per year. The incidence of transient ischemic attacks was 33 per 100,000 population per year. The mortality rate for stroke for this population was 98/100,000 per year. The data on incidence of stroke and its types, its dependence on age and sex, and mortality rate are close to the corresponding data reported from other countries.

A remarkable increase in the incidence and decline in the case-fatality rate of first-ever stroke was observed in Tartu, Estonia. The increase of incidence for those younger than 70 years could be due to the increased prevalence of risk factors. The decline in case fatality could theoretically be related to better management of secondary complications.

The total stroke incidence in Tartu is comparable with other European studies, but the rates for younger patients are higher. This may be associated with lower quality of life, less attention to public health, high prevalence and/or poor control of stroke risk factors. The 28-day case-fatality is somewhat higher than in other European centres.

Physically inactive patients are at a higher risk for late polio-related symptoms. An active lifestyle should be recommended for patients with polio sequels.

To measure the incidence and outcome of stroke in Estonia a community-based study of first-ever stroke was carried out in Tartu from 1991 through 1993. A total of 829 first-ever stroke cases were registered during the 3-year period. Most stroke patients were prospectively identified from the Department of Neurology and Neurosurgery of the University Hospital, other sources where death certificates, autopsy protocols, outpatient and hospital records. The hemorrhagic stroke subtype constituted 15% of all cases. Although pathological verification was available in 32% of cases (autopsy or CT/MRI), the incidence and 30 days'' case fatality rates for the hemorrhagic subtype were similar to those of other studies, while the rates for the ischemic subtype were higher than those reported by many authors. The total incidence rate (2.50 per 1,000), the age-specific rates for the patients < 65 and the overall case fatality rate at 30 days were higher than those found by most study centers. Possibly, a study of stroke risk factors would explain the high burden of stroke in Estonia.

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