Variations in stroke incidence and survival in 3 areas of Europe

Background and Purpose-Comparison of incidence and case-fatality rates for stroke in different countries may increase our understanding of the etiolog y of the disease, its natural history, and management. Within the context o f an aging population and the trend for governments to set targets to reduc e stroke risk and death from stroke, prospective comparison of such data ac ross countries may identify what drives the variation in risk and outcome. Methods-Population-based stroke registers, using multiple sources of notifi cation, ascertained cases of first in a lifetime stroke between 1995 and 19 97 for all age groups. The study populations were in Erlangen, Germany; Dij on, France; and London, UK. Crude incidence fates 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 f or age group, sex, and pathological subtype of stroke was used to compare s urvival in the 3 communities. Results-A total of 2074 strokes were registered over the 3 years. The age-s tandardized 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 low est 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 (P<0.0001). There were significant differences in the proportion of the subtypes of stroke between populations, with London h aving lower rates of cerebral infarction and higher rates of subarachnoid h emorrhage and unclassified stroke (P<0.001). Case-fatality rates varied sig nificantly between centers at 1 year, after adjustment for age, sex, and su btype of stroke (35% overall, 34% Erlangen, 41% London, and 27% Dijon; P<0. 001). Conclusions-The impact of stroke is considerable, and the risk of stroke va ries 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 cen tral Europe and influence outcome.