STROKE INCIDENCE, CASE-FATALITY, AND MORTALITY IN THE WHO MONICA PROJECT

Background and Purpose This report compares stroke incidence, case fat ality, and mortality rates during the first years of the WHO MONICA Pr oject in 16 European and 2 Asian populations. Methods In the stroke co mponent of the WHO MONICA Project, stroke registers were established w ith uniform and standardized rules for case ascertainment and validati on of events. Results A total of 13 597 stroke events were registered from 1985 through 1987 in a total background population of 2.9 million people aged 35 to 64 years. Age-standardized stroke incidence rates p er 100 000 varied from 101 to 285 in men and from 47 to 198 in women. The combined stroke attack rates for first and recurrent events were a pproximately 20% higher than incidence rates in most populations and v aried to the same extent. Stroke incidence rates were very high among the population of Finnish men tested. The incidence of stroke was, in general, higher among populations in eastern than in western Europe. I t was also relatively high in the Chinese population studied, particul arly among women. The case-fatality rates at 28 days varied from 15% t o 49% among men and from 18% to 57% among women. In half of the popula tions studied, there were only minor differences between official stro ke mortality rates and rates measured on the basis of fatal events reg istered and validated for the WHO MONICA stroke study. Conclusions The WHO MONICA Project provides a unique opportunity to perform cross-sec tional and longitudinal comparisons of stroke epidemiology in many pop ulations. The present data show how large differences in stroke incide nce and case-fatality rates contribute to the more than threefold diff erences in stroke mortality rates among populations.