From the Department of Medicine, Umeå University, Umeå,
Sweden.
Correspondence to Markku Peltonen, Department of Medicine, Umeå University, S-901 87 Umeå, Sweden. E-mail markku.peltonen{at}medicin.umu.se
Background and Purpose—Stroke
mortality rates and case fatality of stroke have declined since the
beginning of the 1970s in Sweden, but the incidence of stroke has been
stable. The aim of this study was to analyze trends in
long-term survival after stroke.
Methods—Within the framework of the population-based WHO
Multinational Monitoring of Trends and Determinants in
Cardiovascular Disease (MONICA) Project,
all acute stroke events were recorded in the age group 25 to 74
years in northern Sweden during the period 1985 to 1994. All first-ever
stroke patients were followed for information on vital status (minimum
follow-up time was 1 year). Survival time was related to time period of
stroke onset, stroke diagnosis, and concomitant diseases.
Results—Survival times for a total of 6819 first-ever stroke
patients (4057 men and 2762 women) were analyzed. Age-adjusted
odds ratio for death within 1 year after stroke was 0.70 (95%
confidence interval [CI], 0.55 to 0.88) in the period 1993 to 1994 as
compared with the period 1985 to 1986 in men and 0.69 (95% CI, 0.53 to
0.90) in women. Corresponding odds ratios were 0.73 in men and 0.70 in
women among those who survived the first 28 days. Similar improvements
were seen for 3- and 5-year survival. Improvements in survival over
time were most marked among patients with ischemic stroke.
There was no improvement in survival over time among patients with the
most severe deficits at onset.
Conclusions—Gradually improved survival, both short and long
term, was observed during the 10-year study period. The improvements
are not explained by changes in known confounding prognostic factors.
© 1998 American Heart Association, Inc.
Original Contributions
Time Trends in Long-term Survival After Stroke
The Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Study, 1985–1994
Key Words: stroke outcome • survival • case fatality • time trend • Sweden
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