(Stroke. 1995;26:355-360.)
© 1995 American Heart Association, Inc.
Articles |
Multinational Comparisons of Stroke Epidemiology
Evaluation of Case Ascertainment in the WHO MONICA Stroke Study
From the Department of Medicine, University Hospital, Umeå, Sweden (K.A.); Department of Medicine, University of Auckland (New Zealand) (R.B.); Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland (K.K., A.-M.R., J.T.); Institute of Internal Medicine, Academy of Medical Sciences, Novosibirsk, Russian Federation (V.F.); Centre for Epidemiology and Health Research, Berlin, Germany (H.S.); Department of Epidemiology, Research Institute for Brain and Blood Vessels, Akita, Japan (K.S.); and Glostrup University Hospital (Denmark) (P.T.).
Correspondence to Dr Kjell Asplund, Department of Medicine, University Hospital, S-901 85 Umeå, Sweden.
Background and Purpose As part of the WHO MONICA Project (World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease), mortality and incidence rates of acute stroke in 14 centers covering 21 populations from 11 countries were compared.
Methods In this report, coverage and quality of the MONICA stroke registers were evaluated on five key indicators using data submitted to the MONICA Data Center.
Results A low ratio of MONICA stroke register to routine statistics of stroke mortality and a low proportion of nonfatal out-of-hospital events were the most common biases; they indicate that identifications of fatal cases and/or case finding of nonfatal events occurring outside the hospital were inadequate in many MONICA centers. In 10 populations, the data quality analyses suggested that clarification of possible biases would be needed before these populations can be included in a comparative study. Data from the remaining 11 populations meet the data quality standards for multinational comparisons with respect to case ascertainment.
Conclusions These results show that multinational comparisons of stroke incidence involve considerable problems in developing and maintaining appropriate standards of data quality. However, after considerable efforts to ensure quality, comparisons of stroke data within the MONICA Project are possible among a large number of the MONICA populations. Our observations also indicate that results from multinational comparisons of stroke mortality based on routine statistics must be interpreted with caution.
Key Words: cerebrovascular disorders • epidemiology • incidence • mortality
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