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(Stroke. 2003;34:1840.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Explanations for International Trends in Stroke Mortality

Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Stroke mortality varies greatly from country to country. In 1985, the highest figures in eastern European countries were 6- to 7-fold those of countries with the lowest mortality rates,¹ and the same trend has continued in the 1990s.² The mortality rates have not, however, remained stable during the last decades. In most countries, a significant reduction has occurred, whereas in some countries the opposite is true: during 1970 to 1985, the annual changes ranged from +3.9% to -7.1%, and during 1985 to 1994, from +3.2% to -6.8%.^1,2 The obvious causes of the reduced mortality rates have been either a decreased incidence of stroke or the case-fatality rate, or both. The explanations for the growing mortality rates, mainly in the eastern European countries, have been more or less speculative.

In the present study, Sarti and associates have answered these questions. Their impressive patient material consisted of 36 000 young (35 to 64 years) acute stroke victims from the WHO MONICA project. The patient data were collected during 1982 to1995 from 14 centers in 9 countries with as complete case finding as possible. The subtypes of stroke were considered together. The attack rate included all patients, both first-ever and recurrent strokes, and the case-fatality rate was calculated on the basis of patients dying within 28 days of stroke onset.³

Age-standardized (World Standard Population) average attack rate (per 100 000 per year), case fatality (%), and MONICA mortality rate (per 100 000 per year) were calculated, as well as the annual trends. MONICA . . . [Full Text of this Article]

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