Background and Purpose Stroke mortality has been declining in Finland
during the past 20 years. It is not known, however, whether this favor
able development is attributable to the decline in the incidence or ca
se-fatality of stroke. For this reason we examined the trends in case-
fatality of stroke, including trends by subtype of stroke. Methods The
analyses were carried out using data of the community-based FINMONICA
Stroke Register, which was operating in three geographic areas of Fin
land during 1983 to 1992. All stroke events (n = 11 171) in persons ag
ed 35 to 74 years were included in this register. Results The 28-day c
ase-fatality of stroke fell yearly by 3.6% (P = .01) in men and by 2.6
% (P = .2) in women. At the end of the study period, the average 28-da
y case-fatality of all strokes was 20% in men and 21% in women. Consid
erable differences by subtype of stroke were observed. The 28-day case
-fatalities at the end of the study period were in men-56% for subarac
hnoid hemorrhage, 42% for intracerebral hemorrhage, and 14% for cerebr
al infarction. In women, the corresponding figures were 49%, 49%, and
14%. The 28-day case-fatality of subarachnoid hemorrhage did not chang
e during the study period, but for intracerebral hemorrhage, a signifi
cant decline was observed in men and there was a declining trend also
in women. The 28-day case-fatality of cerebral infarction declined sig
nificantly in both genders. Conclusions With the exception of subarach
noid hemorrhage, the 28-day case-fatality of stroke has fallen in Finl
and. It is likely that this fall has contributed to the decline in str
oke mortality.