Variations in Stroke Incidence and Survival in 3 Areas of Europe

Abstract

Background and Purpose-Comparison of incidence and case-fatality rates for stroke in different countries may increase our understanding of the etiology of the disease, its natural history, and management. Within the context of an aging population and the trend for governments to set targets to reduce stroke risk and death from stroke, prospective comparison of such data across countries may identify what drives the variation in risk and outcome. Methods-Population-based stroke registers, using multiple sources of notification, ascertained cases of first in a lifetime stroke between 1995 and 1997 for all age groups. The study populations were in Erlangen, Germany; Dijon, France; and London, UK. Crude incidence rates were age-standardized to the European population for comparative purposes. Case-fatality rates up to 1 year after the stroke were obtained, and logistic regression adjusting for age group, sex, and pathological subtype of stroke was used to compare survival in the 3 communities. Results-A total of 2074 strokes were registered over the 3 years. The age-standardized rate to the European population was 100.4 (95% CI 91.7 to 109.1) per 100 000 in Dijon, 123.9 (95% CI 115.6 to 132.2) in London, and 136.4 (95% CI 124.9 to 147.9) in Erlangen. Both crude and adjusted rates were lowest in Dijon, France. The incidence rate ratio, with Dijon as the baseline comparison (1), was 1.21 (95% CI 1.09 to 1.34) in London and 1.37 (95% CI 1.22 to 1.54) in Erlangen (PϽ0.0001). There were significant differences in the proportion of the subtypes of stroke between populations, with London having lower rates of cerebral infarction and higher rates of subarachnoid hemorrhage and unclassified stroke (PϽ0.001). Case-fatality rates varied significantly between centers at 1 year, after adjustment for age, sex, and subtype of stroke (35% overall, 34% Erlangen, 41% London, and 27% Dijon; PϽ0.001). Conclusions-The impact of stroke is considerable, and the risk of stroke varies significantly between populations in Europe as does the risk of death. The striking differences in survival require clarification but lend weight to the evidence that stroke management may differ between northern and central Europe and influence outcome. (Stroke.

Baseline Renal Dysfunction in Acute Ischemic Stroke Patients: Prevalence and Impact on Early Mortality.

“…Similar rates were reported from the European Registries of Stroke Collaboration in which 1-month mortality after stroke ranged from 13 to 27% 26 . While a lower rates of 13% were observed by Yahalom and colleagues.…”

Stroke Incidence and Survival in Ludwigshafen am Rhein, Germany

“…10,12,17,18 Results in IS mainly contributed to relatively high age-adjusted incidence rates for FES in our study (1.25 95% CI 1.14 to 1.35; Erlangen: 1.06 95% CI 0.95 to 1.16; South London: 0.86 95% CI 0.79 to 0.93; Dijon: 0.87 95% CI 0.79 to 0.92). 17 A recent comparative study also showed that variations in stroke incidence between different European regions were mainly related to differences in incidence of IS.…”

“…10,12,17,18 Results in IS mainly contributed to relatively high age-adjusted incidence rates for FES in our study (1.25 95% CI 1.14 to 1.35; Erlangen: 1.06 95% CI 0.95 to 1.16; South London: 0.86 95% CI 0.79 to 0.93; Dijon: 0.87 95% CI 0.79 to 0.92). 17 A recent comparative study also showed that variations in stroke incidence between different European regions were mainly related to differences in incidence of IS. 16 Crude case-fatality rates for FES were clearly lower than those reported by the German stroke register from Erlangen approximately 10 years ago (13 10,18 As mentioned, we found higher incidence rates mainly in younger patients with stroke, a group of patients with usually lower mortality rates after stroke.…”

ERMANCIA: Epidemiology of Stroke in Martinique, French West Indies

“…The rate adjusted to the European population in our study (151/100 000) is high compared with that of continental France (100/100 000). 30 However, such comparison is not as valid as one from a biracial cohort because these 2 populations differ not only in ethnicity but also in a number of environmental factors, including climate, alimentation, and cultural customs. If we nevertheless use French data as the baseline category, the adjusted incidence rate ratio of Martinican to French is 1.6.…”