Remarkable Decline in Ischemic Stroke Mortality is Not Matched by Changes in Incidence

Abstract

To determine 30-day case fatality and 1-year mortality after hospital admission, a cohort of incident hospitalized IS patients for the period 1997-2005 was constructed. This period was selected because good quality data were available for these years and include surrounding Background and Purpose-In Western Europe, mortality from ischemic stroke (IS) has declined over several decades. Agesex-specific IS mortality, IS incidence, 30-day case fatality, and 1-year mortality after hospital admission are essential for explaining recent trends in IS mortality in the new millennium. Methods-Data for all IS deaths in the Netherlands were grouped by year, sex, and age. A joinpoint regression was fitted to detect points in time at which significant changes in the trends occur. By linking nationwide registers, a cohort of patients first admitted for IS between 1997 and 2005 was constructed and age-sex-specific 30-day case fatality and 1-year mortality were computed. IS incidence (admitted IS patients and out-of-hospital IS deaths) was computed by age and sex. Mann-Kendall tests were used for trend evaluation. Results-IS mortality declined continuously between1980 and 2000 with an attenuation of decline in the 1990s in some of the age-sex groups. A remarkable decline in IS mortality after 2000 was observed in all age-sex groups, except for young men. An improved decline in 30-day case fatality and in 1-year mortality was also observed in almost all age-sex groups.In contrast, IS incidence remained stable between 1997 and 2005 or even increased slightly. Conclusions-The recent remarkable decline in IS mortality was not matched by a decline in the number of incident nonfatal IS events. This is worrying, because IS is already a leading cause of adult disability, claiming a heavy human and economic burden. Prevention of IS is therefore now of the greatest importance. IS IncidenceThe incidence of IS was defined as the sum of patients with first hospitalization for IS and patients who died from first IS before hospitalization.The number of patients with an incident hospitalization for IS between 1997 and 2007 was determined by constructing a cohort as was described above. The risk of IS does not depend on whether a unique combination of linking variables is present or not. Therefore we increased the observed number of IS in the constructed cohort using the age-sex-specific uniquity percentage (% of uniqueness ranges from 79.3% in age group 35-44 years to 99.8% in age group >95 years) allowing us to calculate an absolute number of first IS events in the Netherlands.To construct a cohort of patients who died from an incident IS before hospitalization, information from the cause of death register, the population registry, and hospital discharge registry were linked. All out-of-hospital deaths attributable to IS (ICD-10 code I63 and I64) between January 1, 1997 and December 31, 2005 were selected from the cause of death register. Information was subsequently collected on hospital admissions that may have occurred previously for the ...

Declining Mortality in Cerebral Venous Thrombosis

“…Similar trends in declining mortality have been found in other diseases, such as ischemic stroke 7 and pulmonary embolism. 8 However, the decline in mortality in CVT is too large to be solely explained by this factor.…”

Twenty years trends in mortality rates from stroke in Klaipeda

“…Vaartjes et al. (2013) used a joinpoint regression analysis to show slowly decreasing ischemic stroke death rates up until 2000 and a remarkable decline in stroke mortality after 2000 in all age–sex groups, except for young men, similarly as in our study. U.S. authors (study period of 1969–2013) undertook joinpoint analysis of U.S. National Vital Statistics data which revealed the decreasing trend in stroke mortality corresponding to the last segment of our study: a decrease from 5.5% during 2001–2007 to 3.0% during 2007–2013 (Ma et al.…”

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

“…Case fatality rates due to stroke vary around the world (Feigin, Lawes, Bennett, Barker‐Collo, & Parag, 2009) and depend on the severity of stroke, the subtype of stroke and other factor (Coull et al., 2004; Eliasziw et al., 2004; Eriksson & Olsson, 2001; Evans, Harraf, Donaldson, & Kalra, 2002; Evans, Perez, Yu, & Kalra, 2000; Feigin et al., 2009; Jackson & Sudlow, 2005; de Jong, Lodder, Kessels, & van Raak, 2004; Norrving, 2003; Vaartjes, O'Flaherty, Capewell, Kappelle, & Bots, 2013; Yokota, Minematsu, Hasegawa, & Yamaguchi, 2004). Stroke mortality has decreased in many countries, but the incidence has not (Feigin et al., 2009; Vaartjes et al., 2013).…”

“…Stroke mortality has decreased in many countries, but the incidence has not (Feigin et al., 2009; Vaartjes et al., 2013). Ten treatable risk factors have been associated with 90% of the risk of ischemic or hemorrhagic stroke (O'Donnell et al., 2010).…”