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(Stroke. 1998;29:1366-1372.)
© 1998 American Heart Association, Inc.

Original Contributions

Opposing National Stroke Mortality Trends in Poland and for African Americans and Whites in the United States, 1968 to 1994

Mark W. Massing, MD, MPH; Stefan L. Rywik, MD, PhD; Bogdan Jasinski, MSC; Teri A. Manolio, MD, MHS; O. Dale Williams, PhD; Herman A. Tyroler, MD

From the Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill (M.W.M., H.A.T.); Department of Cardiovascular Epidemiology and Prevention of Cardiovascular Disease, National Institute of Cardiology, Warsaw, Poland (S.L.R., B.J.); Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); and Departments of Medicine and Biostatistics, University of Alabama at Birmingham (O.D.W.).

Correspondence to Mark W. Massing, MD, MPH, Department of Epidemiology, UNC School of Public Health, Suite 306, 137 E Franklin St, Chapel Hill, NC 27514. E-mail mark_massing{at}unc.edu

Background and Purpose—The United States (US) has experienced declines in stroke mortality in contrast to the increases reported for Poland. As part of the Poland and US Agreement on Cardiovascular and Cardiopulmonary Research, stroke mortality trends in Polish and US subpopulations were compared in the context of cross-population differences in competing causes of death and determinants of stroke.

Methods—Age-adjusted annual stroke, cardiovascular disease (CVD), non-CVD, and all-cause mortality rates were determined for men and women aged 35 to 64 and 65 to 74 years from 1968 to 1994 for African Americans and US whites and in Poland. Mean annual percent changes of mortality rates were estimated during 1968 to 1980 and 1981 to 1994 with the use of piecewise log-linear regression.

Results—US stroke mortality rates declined 3.7% to 4.8% annually during 1968 to 1980 and 2.0% to 3.1% during 1981 to 1994, with similar declines in each ethnic, gender, and age group. Polish rates increased 3.3% to 5.5% annually for all age-gender groups in Poland during 1968 to 1980. Polish men aged 35 to 64 experienced increasing rates during 1981 to 1994 (1.6% annually), while Polish women and older men experienced slight declines or little change. Only Polish men aged 35 to 64 years exhibited increases in stroke, CVD, and non-CVD mortality rates during both time intervals.

Conclusions—Poland and the US experienced opposing stroke mortality rate trends between 1968 and 1994. These national and ethnic trends occurring in just one generation suggest major effects of lifestyle, socioenvironmental, and/or medical care determinants.

Key Words: cardiovascular diseases • cerebrovascular disorders • epidemiology • mortality

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