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(Stroke. 1995;26:541-542.)
© 1995 American Heart Association, Inc.

Articles

Monitoring Stroke

An International Challenge

Ruth Bonita, MPH, PhD Robert Beaglehole, MD, FRACP

From the University Geriatric Unit, Department of Medicine (R. Bonita), and the Department of Community Health (R. Beaglehole), School of Medicine, University of Auckland (New Zealand).

Correspondence to Ruth Bonita, MPH, PhD, University Geriatric Unit, North Shore Hospital, PB 93-503, Takapuna, Auckland 9, New Zealand.

Key Words: epidemiology • incidence • mortality • registries • stroke • World Health Organization

	Introduction

 
Worldwide, there are approximately 4.6 million deaths from stroke each year, and three quarters of these occur in developing countries.¹ This estimate is based on death certificate data, which cover only about one third of the world's population, and extrapolation from total mortality rates. Despite their limitations, death certificate data show that in recent decades stroke death rates have declined dramatically, at least in industrial countries, with as much as a 7% per annum decline occurring in Japan since the mid-1970s.² Where death certificate information is available in developing countries, the general trend is also downward. Not all countries have benefited, however; countries in the eastern European region are still registering high stroke death rates. Within countries, ethnic, geographic, and social class differences remain, with the persistent "Stroke Belt" in the southern United States providing an excellent example of within-country geographic variation.³

Such variations should help our understanding of the epidemiology of stroke. If first strokes are being prevented, then the decline in death rates represents a major public health achievement. If, on the other hand, the decline is a result of improvements in survival of stroke patients, there are major implications for health planners because of the global aging of populations.

To a large extent, explanations for the differing mortality trends have been a matter of speculation and supposition. What is needed is information on changes over time in incidence and case-fatality rates. Two types of studies have been used to explain long-term trends: cohort studies and stroke registers. . . . [Full Text of this Article]

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