A population study of stroke in West Ukraine - Incidence, stroke services,and 30-day case fatality

Background and Purpose-According to World Health Organization statistics, U kraine has extremely high stroke mortality. No population-based prospective studies of stroke incidence have been performed yet in this European count ry with approximate to 50 million inhabitants. High reported rates of strok e mortality in official statistics conflict with some locally published inc idence data in Ukraine. To obtain accurate data, we evaluated stroke incide nce and 30-day case fatality in a prospective population study in the West Ukrainian city of Uzhgorod with a population of 126 000 inhabitants. Methods-Case certification by neurologists and follow-up at 30 days after s troke for all patients identified by any level of the health service system were performed for a 12-month period. Results-We identified 352 stroke cases. The age-standardized incidence was 341 and 238 of 100 000 and mortality was 83 and 69 of 100 000 with the use of the European or world standard population for standardization. Mean age of stroke patients was 63.4 +/- 12.5 years. Rate of hospitalization was 66% . Hospitalized patients were > 10 years younger than those treated in their homes. The 30-day case fatality rates were 15.4% among hospitalized patien ts and 36.8% among those treated at home. Overall 30-day case fatality was 23.3%. Conclusions-Stroke incidence and 30-day case fatality in this West Ukrainia n city were similar to those of some West European countries and were much lower than what could be expected from World Health Organization statistics . The relatively low incidence rate seems accurate; because of the organiza tion of local stroke services, it is not probable that a considerable propo rtion of patients with acute stroke could bypass all levels of the acute ca re health system. Local health statistics reported a much lower number of s troke cases and stroke deaths than found in our survey; thus, further study is needed to clarify the reason for the discrepancy between local data and the high reported stroke mortality in Ukraine.