Variations in case fatality and dependency from stroke in western and central Europe

Background and Purpose - There are significant variations in mortality rate s from stroke in Europe. a European Union BIOMED Concerted Action was estab lished to assess and determine the reasons for the variations in case fatal ity and disability after stroke. Methods - Hospital-based stroke registers were established in 12 centers in 7 western and central European countries to collect demographic, clinical, and resource use details at the time of first-ever stroke during 1993-1994 , At 3 months, details of survival, activity of daily living score, and use of health services were recorded. Multinomial logistic regression was used to estimate the relationship between centers and outcome (dead, functional ly independent, functionally dependent), with adjustment for case mix and r esource use variables, and to predict outcomes for the full cohort. This sh ould minimize the bias due to loss to follow-up. Results - A total of 4534 stroke events were registered. The mean age was 7 1.9 years (SD, 12.53). There were significant differences between centers f or all case mix and resource use variables (P < 0.001). Multinomial logisti c regression modeling of outcome indicated that for those patients initiall y unconscious (588), center was not significantly related to outcome (P = 0 .427). For those initially conscious, there were wide variations in death a nd dependency between centers after adjustment for case mix, type of bed, a nd use of CT scan. The predicted proportion dead at 3 months ranged from 42 % (95% CI, 35% to 49%) in one UK center to 19% (95% CI, 14% to 24%) in Fran ce. Conclusions - Areas with high mortality rates within western and central Eu rope have been identified for stroke outcome, and there appears to be oppor tunity for considerable health gain in certain centers. adjustment for case mix and health service resource use does not explain these differences in outcome. Although there are true differences in outcome,the aspects of care that need to be altered to improve outcome remain unclear despite detailed data collection, Comparisons of outcome of the same design used in the pre sent study do not allow rational policy decisions to be made.