From the Departments of Medicine (A.M.E., P.F.) and Community Medicine,
Division of Epidemiology (M.G., L.J.), Lund University, University Hospital,
Malmö, Sweden.
Correspondence to Dr Ali M. Elneihoum, Department of Medicine, University of Lund, University Hospital, S-205 02 Malmö, Sweden.
Background and Purpose—Data from
the Malmö Stroke Registry were analyzed to determine
whether any change in survival or nonfatal stroke recurrence
rates had occurred during the 4-year period from 1989 through 1992 and
whether prognosis was related to area of residence.
Methods—The series comprised 2290 patients, 1051 men and 1239
women, followed up for 3 years after their first stroke during the
period 1989 through 1992.
Results—Of the series as a whole, 959(43.4%) died and 137(6%)
suffered a second nonfatal stroke. Multivariate
analysis showed age, type of stroke, severity of stroke, and
the presence of diabetes mellitus or cardiac disease each to be an
independent predictor of mortality, and the presence of diabetes,
atrial fibrillation, and history of transient ischemic attacks
each to be associated with increased risk of recurrence.
Treatment for hypertension was associated with a protective effect. As
compared to those with first stroke in 1989, those with first stroke in
1992 were characterized by a lower recurrence rate, which was
reduced by 70% in the male subgroup (P=0.003) and by
80% in the female subgroup (P=0.006), the corresponding
reduction in all-cause mortality being 30% (P=0.007)
and 10% (P=0.5, NS). Recurrence-free survival
rates differed markedly between the 17 residential areas studied.
Conclusions—The present study showed that survival rates
after stroke have improved and recurrence rates have declined
in this urban population. Further studies are needed to ascertain to
what extent intraurban variation in the proportion of
recurrence-free 3-year survivors is to be explained by
differences in the severity of initial stroke and other prognostic
markers, or in initial treatment and secondary preventive measures.
© 1998 American Heart Association, Inc.
Original Contributions
Three-Year Survival and Recurrence After Stroke in Malmö, Sweden
An Analysis of Stroke Registry Data
Key Words: epidemiology • mortality • recurrence • stroke
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