A PROSPECTIVE COMMUNITY-BASED STUDY OF STROKE IN GERMANY - THE ERLANGEN STROKE PROJECT (ESPRO) INCIDENCE AND CASE-FATALITY AT 1, 3, AND 12 MONTHS

Background and Purpose-In Germany, basic data on stroke morbidity are lacking. If a population-based register in former East Germany is excl uded, only routine mortality statistics have thus far provided informa tion on epidemiology of stroke. Therefore, a population-based register of stroke was set up in Southern Germany to determine incidence and c ase fatality in a defined German population. Methods-The Erlangen Stro ke Project (ESPro) is a prospective community-based study among the 10 1 450 residents of the city of Erlangen, Bavaria, Germany. Standard de finitions and overlapping case-finding methods were used to identify a ll cases of first-ever stroke in all age-groups, occurring in the 2 ye ars of registration (April 1, 1994, to March 31, 1996). All identified cases of first-ever strokes were followed up at 3 and 12 months from onset. Results-During 2 years of registration, 354 first-ever-in-a-lif etime strokes (FELS) were registered. The diagnosis and stroke type we re confirmed by CT scan in 95% of cases. Fifty-one percent of all FELS occurred in the age group greater than or equal to 75 years of age. T he crude annual incidence rate was 1.74 per 1000 (1.47 for men and 2.0 1 for women). After age-adjustment to the European population, the inc idence rate was 1.34 per 1000 (1.48 for men and 1.25 for women). The a nnual crude incidence rate of cerebral infarction was 1.37/1000, intra cerebral hemorrhage 0.24/1000, subarachnoid hemorrhage 0.06/1000, and unspecified stroke 0.08/1000. Overall case fatality at 28 days was 19. 4%, at 3 months it was 28.5%, and at 1 year 37.3%. Conclusions-The fir st prospective community-based stroke register including all age group s in Germany revealed incidence rates of stroke similar to those repor ted from other population-based studies in western industrialized coun tries, but lower than that observed in former East Germany.