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(Stroke. 1999;30:2529.)
© 1999 American Heart Association, Inc.
Original Contributions |
Stable Stroke Occurrence Despite Incidence Reduction in an Aging Population
Stroke Trends in the Danish Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Population
From Glostrup Population Studies, Centre of Preventive Medicine, Glostrup University Hospital, Glostrup, Denmark (P.T., M.S.), and the Danish Institute for Clinical Epidemiology, Copenhagen, Denmark (M.D., H.B.-H.).
Correspondence to Dr Per Thorvaldsen, Department of Neurology, Gentofte University Hospital, DK-2900 Hellerup, Denmark. E-mail brain{at}dadlnet.dk
Background and Purpose—A stroke register was established at the Glostrup Population Studies in 1982 with the objective to monitor stroke occurrence in the population continuously during a 10-year period and contribute data to the WHO Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Project. The purpose of the current analysis was to estimate temporal trends in stroke occurrence.
Methods—All stroke events in the study population were
ascertained and validated according to standardized criteria outlined
by the WHO MONICA Project. The study population comprised all
subjects 
25 years of age. Stroke was defined by the clinical
presentation. A total of 5262 stroke events in >2 million
person-years were analyzed. Age-adjusted rates for first-ever
stroke and for all stroke events were calculated and temporal trends
estimated by means of Poisson regression.
Results—The overall annual stroke attack rate per 100 000
person-years in the age range 25 years was 272 in men and 226 in
women. Age-adjusted stroke attack rates decreased among men by 3.9%
per year and by 4.1% among women. Age-adjusted stroke incidence rates
declined by 2.9% in men and by 3.1% in women. The trends were
statistically significant in both sexes. However, the proportion of
elderly people in the study population increased during the time period
of the study. Hence the numbers of stroke victims in the population
remained largely unaltered.
Conclusions—Decreasing age-adjusted stroke incidence rates point to a reduction of stroke risk during the time period of the study. Cardiovascular prevention, in particular improved hypertension control, is believed to have contributed to the incidence reduction. However, the burden of stroke on the healthcare system did not substantially diminish. The gain likely achieved from reduction of preventable risk factors was almost counterbalanced by population aging.
Key Words: aging • cerebrovascular disorders • epidemiology • incidence
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