(Stroke. 1995;26:361-367.)
© 1995 American Heart Association, Inc.
Articles |
Stroke Incidence, Case Fatality, and Mortality in the WHO MONICA Project
From the WHO MONICA Project Annex; Glostrup Population Studies, Glostrup University Hospital (P.T., M.S.) (Denmark); the Department of Medicine, Umeå University (K.A.) (Sweden); and the MONICA Data Center, Department of Epidemiology and Health Promotion, National Public Health Institute (K.K., A.-M.R.), Helsinki, Finland.
Correspondence to Dr Per Thorvaldsen, Glostrup Population Studies, Glostrup University Hospital, DK-2600 Glostrup, Denmark.
Background and Purpose This report compares stroke incidence, case fatality, and mortality rates during the first years of the WHO MONICA Project in 16 European and 2 Asian populations.
Methods In the stroke component of the WHO MONICA Project, stroke registers were established with uniform and standardized rules for case ascertainment and validation of events.
Results A total of 13 597 stroke events were registered from 1985 through 1987 in a total background population of 2.9 million people aged 35 to 64 years. Age-standardized stroke incidence rates per 100 000 varied from 101 to 285 in men and from 47 to 198 in women. The combined stroke attack rates for first and recurrent events were approximately 20% higher than incidence rates in most populations and varied to the same extent. Stroke incidence rates were very high among the population of Finnish men tested. The incidence of stroke was, in general, higher among populations in eastern than in western Europe. It was also relatively high in the Chinese population studied, particularly among women. The case-fatality rates at 28 days varied from 15% to 49% among men and from 18% to 57% among women. In half of the populations studied, there were only minor differences between official stroke mortality rates and rates measured on the basis of fatal events registered and validated for the WHO MONICA stroke study.
Conclusions The WHO MONICA Project provides a unique opportunity to perform cross-sectional and longitudinal comparisons of stroke epidemiology in many populations. The present data show how large differences in stroke incidence and case-fatality rates contribute to the more than threefold differences in stroke mortality rates among populations.
Key Words: cerebrovascular disorders • epidemiology • incidence • mortality
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|
|
|
 |
|
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|
|
|
|
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|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
 B. Stegmayr and K. Asplund Stroke in Northern Sweden Scand J Public Health, October 1, 2003; 31(5): 60 - 69. [Abstract] [PDF]
|
|
|
|
|
|
Bibliography Scand J Public Health, October 1, 2003; 31(5): 85 - 91. [PDF]
|
|
|
|
|
|
K. Okamoto Editorial Comment--Stroke Incidence and Quality Standard for Comparison Stroke, September 1, 2003; 34(9): 2107 - 2108. [Full Text] [PDF]
|
|
|
|
|
|
C. Sarti, B. Stegmayr, H. Tolonen, M. Mahonen, J. Tuomilehto, and K. Asplund Are Changes in Mortality From Stroke Caused by Changes in Stroke Event Rates or Case Fatality?: Results From the WHO MONICA Project Stroke, August 1, 2003; 34(8): 1833 - 1840. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Fogelholm Editorial Comment--Explanations for International Trends in Stroke Mortality Stroke, August 1, 2003; 34(8): 1840 - 1841. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Y. Liu, A. K. Death, and D. J. Handelsman Androgens and Cardiovascular Disease Endocr. Rev., June 1, 2003; 24(3): 313 - 340. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Wolf-Maier, R. S. Cooper, J. R. Banegas, S. Giampaoli, H.-W. Hense, M. Joffres, M. Kastarinen, N. Poulter, P. Primatesta, F. Rodriguez-Artalejo, et al. Hypertension Prevalence and Blood Pressure Levels in 6 European Countries, Canada, and the United States JAMA, May 14, 2003; 289(18): 2363 - 2369. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Di Carlo, M. Lamassa, M. Baldereschi, G. Pracucci, A. M. Basile, C. D.A. Wolfe, M. Giroud, A. Rudd, A. Ghetti, and D. Inzitari Sex Differences in the Clinical Presentation, Resource Use, and 3-Month Outcome of Acute Stroke in Europe: Data From a Multicenter Multinational Hospital-Based Registry Stroke, May 1, 2003; 34(5): 1114 - 1119. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. Sun, R. Cade, Z. Zhang, J. Alouidor, and H. Van Angiotensinogen Gene Knockout Delays and Attenuates Cold-Induced Hypertension Hypertension, February 1, 2003; 41(2): 322 - 327. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Seibert, E. Barbouche, J. Fagan, E. Myint, T. Wetterneck, and M. Wittemyer Prescribing Oral Contraceptives for Women Older Than 35 Years of Age Ann Intern Med, January 7, 2003; 138(1): 54 - 64. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Piriyawat, M. Smajsova, M. A. Smith, S. Pallegar, A. Al-Wabil, N. M. Garcia, J. M. Risser, L. A. Moye, and L. B. Morgenstern Comparison of Active and Passive Surveillance for Cerebrovascular Disease: The Brain Attack Surveillance in Corpus Christi (BASIC) Project Am. J. Epidemiol., December 1, 2002; 156(11): 1062 - 1069. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Tolonen, M. Mahonen, K. Asplund, D. Rastenyte, K. Kuulasmaa, D. Vanuzzo, and J. Tuomilehto Do Trends in Population Levels of Blood Pressure and Other Cardiovascular Risk Factors Explain Trends in Stroke Event Rates?: Comparisons of 15 Populations in 9 Countries Within the WHO MONICA Stroke Project Stroke, October 1, 2002; 33(10): 2367 - 2375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Liu, S.-H. Yang, E. Perez, K. D. Yi, S. S. Wu, K. Eberst, L. Prokai, K. Prokai-Tatrai, Z. Y. Cai, D. F. Covey, et al. Neuroprotective Effects of a Novel Non-Receptor-Binding Estrogen Analogue: In Vitro and In Vivo Analysis Stroke, October 1, 2002; 33(10): 2485 - 2491. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Kemmeren, B. C. Tanis, M. A.A.J. van den Bosch, E. L.E.M. Bollen, F. M. Helmerhorst, Y. van der Graaf, F. R. Rosendaal, and A. Algra Risk of Arterial Thrombosis in Relation to Oral Contraceptives (RATIO) Study: Oral Contraceptives and the Risk of Ischemic Stroke Stroke, May 1, 2002; 33(5): 1202 - 1208. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C D A Wolfe, A G Rudd, R Howard, C Coshall, J Stewart, E Lawrence, C Hajat, and T Hillen Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register J. Neurol. Neurosurg. Psychiatry, February 1, 2002; 72(2): 211 - 216. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M L Bots, P C Elwood, Y Nikitin, J T Salonen, A Freire de Concalves, D Inzitari, J Sivenius, A Trichopoulou, J Tuomilehto, P J Koudstaal, et al. The EUROSTROKE cohorts: a short description and data analytical approach J. Epidemiol. Community Health, February 1, 2002; 56(90001): i2 - 7. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M L Bots, Y Nikitin, J T Salonen, P C Elwood, S Malyutina, A Freire de Concalves, J Sivenius, A Di Carlo, P Lagiou, J Tuomilehto, et al. Left ventricular hypertrophy and risk of fatal and non-fatal stroke. EUROSTROKE: a collaborative study among research centres in Europe J. Epidemiol. Community Health, February 1, 2002; 56(90001): i8 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M L Bots, P C Elwood, Y Nikitin, J T Salonen, A Freire de Concalves, D Inzitari, J Sivenius, V Benetou, J Tuomilehto, P J Koudstaal, et al. Total and HDL cholesterol and risk of stroke. EUROSTROKE: a collaborative study among research centres in Europe J. Epidemiol. Community Health, February 1, 2002; 56(90001): i19 - 24. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Maron, I. Olivotto, P. Bellone, M. R. Conte, F. Cecchi, B. P. Flygenring, S. A. Casey, T. E. Gohman, S. Bongioanni, and P. Spirito Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy J. Am. Coll. Cardiol., January 16, 2002; 39(2): 301 - 307. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Tanne, A. Shotan, U. Goldbourt, M. Haim, V. Boyko, Y. Adler, L. Mandelzweig, and S. Behar Severity of Angina Pectoris and Risk of Ischemic Stroke Stroke, January 1, 2002; 33(1): 245 - 250. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Yusuf, S. Reddy, S. Ounpuu, and S. Anand Global Burden of Cardiovascular Diseases: Part II: Variations in Cardiovascular Disease by Specific Ethnic Groups and Geographic Regions and Prevention Strategies Circulation, December 4, 2001; 104(23): 2855 - 2864. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Mihalka, V. Smolanka, B. Bulecza, S. Mulesa, and D. Bereczki A Population Study of Stroke in West Ukraine: Incidence, Stroke Services, and 30-Day Case Fatality Stroke, October 1, 2001; 32(10): 2227 - 2231. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Bronnum-Hansen, M. Davidsen, and P. Thorvaldsen Long-Term Survival and Causes of Death After Stroke Stroke, September 1, 2001; 32(9): 2131 - 2136. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. U. Weir, P. A. G. Sandercock, S. C. Lewis, D. F. Signorini, and C. P. Warlow Variations Between Countries in Outcome After Stroke in the International Stroke Trial (IST) Stroke, June 1, 2001; 32(6): 1370 - 1377. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. McKevitt, R. Dundas, and C. Wolfe Two Simple Questions to Assess Outcome After Stroke : A European Study Stroke, March 1, 2001; 32(3): 681 - 686. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Tilling Capture-recapture methods--useful or misleading? Int. J. Epidemiol., February 1, 2001; 30(1): 12 - 14. [Full Text] [PDF]
|
|
|
|
|
|
M. Lamassa, A. Di Carlo, G. Pracucci, A. M. Basile, G. Trefoloni, P. Vanni, S. Spolveri, M. C. Baruffi, G. Landini, A. Ghetti, et al. Characteristics, Outcome, and Care of Stroke Associated With Atrial Fibrillation in Europe : Data From a Multicenter Multinational Hospital-Based Registry (The European Community Stroke Project) Stroke, February 1, 2001; 32(2): 392 - 398. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. I. Qureshi, M. F. K. Suri, L. R. Guterman, and L. N. Hopkins Cocaine Use and the Likelihood of Nonfatal Myocardial Infarction and Stroke : Data From the Third National Health and Nutrition Examination Survey Circulation, January 30, 2001; 103(4): 502 - 506. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D.A. Wolfe, M. Giroud, P. Kolominsky-Rabas, R. Dundas, M. Lemesle, P. Heuschmann, and A. Rudd Variations in Stroke Incidence and Survival in 3 Areas of Europe Stroke, September 1, 2000; 31(9): 2074 - 2079. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Yepes, M. Sandkvist, M. K. K. Wong, T. A. Coleman, E. Smith, S. L. Cohan, and D. A. Lawrence Neuroserpin reduces cerebral infarct volume and protects neurons from ischemia-induced apoptosis Blood, July 15, 2000; 96(2): 569 - 576. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Ingall, K. Asplund, M. Mahonen, and R. Bonita A Multinational Comparison of Subarachnoid Hemorrhage Epidemiology in the WHO MONICA Stroke Study Stroke, May 1, 2000; 31(5): 1054 - 1061. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Stegmayr, T. Vinogradova, S. Malyutina, M. Peltonen, Y. Nikitin, and K. Asplund Widening Gap of Stroke Between East and West : Eight-Year Trends in Occurrence and Risk Factors in Russia and Sweden Stroke, January 1, 2000; 31(1): 2 - 8. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|