This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Stegmayr, B. Articles by Asplund, K. Search for Related Content PubMed Articles by Stegmayr, B. Articles by Asplund, K. Social Bookmarking                         What's this?

Stroke in Northern Sweden

Medicine, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden, birgitta.stegmayr{at}medicine.umu.se

Kjell Asplund

Medicine, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden

Background: Stroke is one of the most common causes of death and long-term disability worldwide. Although stroke mortality has decreased in most industrialized countries, there are populations, particularly in East Europe, in which the mortality has increased. The WHO initiated, 20 years ago, the MONICA Project. The aim of the study was to measure trends in coronary heart disease and stroke and to assess the extent to which these were related to changes in known risk factors. Design: The Northern Sweden MONICA stroke study started in 1985 and is still ongoing. All individuals with an acute stroke in the age group 25 - 74 years have been included in the stroke register. Death certificates, discharge records, and GPs' records are screened and validated using strict MONICA criteria. Results: Stroke event rates (first ever and recurrent stroke) per 100,000 and year in the age group 25 - 74 years varied little over the years. Between 1985 and 1998 the annual incidence varied between 318 and 372 in men and between 195 and 240 in women, with no secular trends at all. The 28-day case fatality decreased in both men and women, from 19% to 11%. Logistic regression analyses showed a risk reduction in dying from stroke to 0.55 (p<0.0001) the last year compared with the first, with an absolute annual reduction in case fatality of 3%, in both men and women. In international comparison Northern Sweden shows an intermediately high incidence and one of the lowest case fatality rates of all participating populations. The incidence in subarachnoid haemorrhage was among the highest. Conclusion: The ongoing decline in stroke mortality in Sweden is driven exclusively by declining case fatality, whereas event rates (first ever and recurrent stroke) have remained the same since 1985. This, together with more people entering advanced, stroke-prone age groups, implies that the burden of stroke will continue to increase in Sweden.

References

• World Development Report 1993. Investing in health. Oxford: Oxford University Press, 1993.
• Thom TJ Stroke mortality trends. An international perspective. Ann Epidemiol 1993; 3: 509 - 18.[Medline] [Order article via Infotrieve]
• Asplund K. Stroke in Europe: widening gap between East and West. Cerebrovasc Dis 1996; 6: 3-6.[CrossRef][Web of Science]
• Thorvaldsen P., Kuulasmaa K., Rajakangas AM, Rastenyte D., Sarti C., Wilhelmsen L. Stroke trends in the WHO MONICA project. Stroke 1997; 28: 500 - 6.[Abstract/Free Full Text]
• Bonita R., Stewart A., Beaglehole R. International trends in stroke mortality: 1970 - 1985. Stroke 1990; 21: 989-92.[Abstract/Free Full Text]
• Wolf PA, D'Agostino RB, O'Neal MA, Sytkowski P., Kase CS, Belanger AJ, et al. Secular trends in stroke incidence and mortality. The Framingham Study. Stroke 1992; 23: 1551-5.[Abstract/Free Full Text]
• Stegmayr B., Asplund K., Wester PO Trends in incidence, case-fatality rate, and severity of stroke in northern Sweden, 1985 - 1991. Stroke 1994; 25: 1738 - 45.[Abstract]
• Rastanyté D., Tuomilehto J., Sarti C., Cepaitis Z., Bluzhas J. Trends in the incidence and mortality of stroke in Kaunas, Lithuania, 1986 - 1993. Cerebrovasc Dis 1996; 6: 13 - 20.[Medline] [Order article via Infotrieve]
• Eisenblätter D., Heinemann L., Classen E. Communitybased stroke incidence trends from the 1970s through the 1980s in East Germany. Stroke 1995; 26: 919 - 23.[Abstract/Free Full Text]
• Tuomilehto J., Rastenyte D., Sivenius J., Sarti C., Immonen-Räihä P., Kaarsalo E., et al. Ten-year trends in stroke incidence and mortality in the FINMONICA stroke study. Stroke 1996; 27: 825 - 32.[Abstract/Free Full Text]
• Sarti C., Stegmayr B., Tolonen H., Möhnen M., Wu Z., Tumilehto J. Are changes in stroke mortality due to changes in stroke event rates or case fatality. Stroke 2003; 38: 1833-1840.
• Tunstall-Pedoe H. for the WHO MONICA Project. The World Health Organization MONICA Project (Monitoring of Trends and Determinants in Cardiovascular Diseases): a major international collaboration. J Clin Epidemiol 1988; 41: 105-14.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Stegmayr B., Asplund K., Hulter-Asberg K., Norrving B., Peltonen M., Terent A., et al. Stroke units in their natural habitat: can results of randomized trials be reproduced in routine clinical practice? Riks - Stroke Collaboration. Stroke 1999; 30: 709-14.[Abstract/Free Full Text]
• Stegmayr B., Asplund K., Kuulasmaa K., Rajakangas AM, Thorvaldsen P., Tuomilehto J. Stroke incidence and mortality correlated to stroke risk factors in the WHO MONICA Project. An ecological study of 18 populations. Stroke 1997; 28: 1367-74.[Abstract/Free Full Text]
• Ingall T., Asplund K., Mahonen M., Bonita R. A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke 2000; 31: 1054-61.[Abstract/Free Full Text]
• Modan B., Wagener DK Some epidemiological aspects of stroke: mortality/morbidity trends, age, sex, race, socioeconomic status. Stroke 1992; 23: 1230-6.[Abstract/Free Full Text]
• Bennett S. Socioeconomic inequalities in coronary heart disease and stroke mortality among Australian men, 1979-1993. Int J Epidemiol 1996; 25: 266-75.[Abstract/Free Full Text]
• Salonen JT Socioeconomic status and risk of cancer, cerebral stroke, and death due to coronary heart disease and any disease: a longitudinal study in eastern Finland. J Epidemiol Community Health 1982; 36: 294-7.[Abstract/Free Full Text]
• Harmsen P., Rosengren A., Tsipogianni A., Wilhelmsen L. Risk factors for stroke in middle-aged men in Goteborg, Sweden. Stroke 1990; 21: 223 - 9.[Abstract/Free Full Text]
• Peltonen M., Rosén M., Lundberg V., Asplund K. Social patterning of myocardial infarction and stroke in Sweden:i and survival. Am J Epidemiol 2000; 151: 283 - 92.[Abstract/Free Full Text]
• Peltonen M., Stegmayr B., Asplund K. Time trends in long-term survival after stroke: the Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, 1985- 1994. Stroke 1998; 29: 1358 - 65.[Abstract/Free Full Text]
• Bonita R. Epidemiology of stroke. Lancet 1992; 339: 342 - 4.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Asplund K., Stegmayr B., Peltonen M. From the twentieth to the twenty-first century: a public health perspective on stroke. In Ginberg MD, Bogousslavsky J, editors. Cerebrovascular disease: pathophysiology, diagnosis and management. Oxford: Blackwell Scientific Publications, 1998, pp 901 - 18.
• Stegmayr B., Asplund K. Measuring stroke in the population: quality of routine statistics in comparison with a population-based stroke registry. Neuroepidemiology 1992; 11: 204 - 13.[Web of Science][Medline] [Order article via Infotrieve]
• Thorvaldsen P., Asplund K., Kuulasmaa K., Rajakangas A-M., Schroll M.for the WHO MONICA Project. Stroke incidence, case fatality, and mortality in the WHO MONICA Project. Stroke 1995; 26: 361 - 7.[Abstract/Free Full Text]
• Tunstall - Pedoe H., Kuulasmaa K., Mähönen M., Tolonen H., Ruokokoski E., Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Lancet 1999; 353: 1547 - 57.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Kuulasmaa K., Tunstall-Pedoe H., Dobson A., Fortmann S., Sans S., Tolonen H., et al. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations [see comments]. Lancet 2000; 355: 675 - 87.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Shahar E., McGovern PG, Pankow JS, Doliszny KM, Smith MA, Blackburn H., et al. Stroke rates during the 1980s the Minnesota stroke survey. Stroke 1997; 28: 275 - 9.[Abstract/Free Full Text]
• Lemesle M., C M., Faivre J., Moreau T., Giroud M., Dumas R. Incidence trends of ischemic stroke and transient ischemic attacks in a well-defined French population from 1985 through 1994. Stroke 1999; 30: 371 - 7.[Abstract/Free Full Text]
• Johansson B., Norrving B., Lindgren A. Increased stroke incidence in Lund-Orup, Sweden, between 1983 to 1985 and 1993 to 1995. Stroke 2000; 31: 481 - 6.[Abstract/Free Full Text]
• Bonita R. Stroke trends in Australia and New Zealand: Mortality, morbidity, and risk factors. Ann Epidemiol 1993; 3: 529 - 33.[Medline] [Order article via Infotrieve]
• Sarti C., Tuomilehto J., Sivenius J., Kaarsalo E., Narva EV, Salmi K., et al. Declining trends in incidence, case-fatality and mortality of stroke in three geographic areas of Finland during 1983 - 1989. Results from the FINMONICA stroke register. J Clin Epidemiol 1994; 47: 1259 - 69.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Jamrozik K., Broadhurst RJ, Lai N., Hankey GJ, Burvill PW, Anderson CS Trends in the incidence, severity, and short-term outcome of stroke in Perth, Western Australia. Stroke 1999; 30: 2105-11.[Abstract/Free Full Text]
• Howard G., Howard VJ, Katholi C., Oli MK, Huston S. Decline in US stroke mortality: an analysis of temporal patterns by sex, race, and geographic region. Stroke 2001; 32: 2213 - 20.[Abstract/Free Full Text]
• Asplund K. The decline in stroke mortality: An ending or never ending story. Stroke 2001; 32: 2218- 19.[Medline] [Order article via Infotrieve]
• Peltonen M., Huhtasaari F., Stegmayr B., Lundberg V., Asplund K. Secular trends in social patterning of cardiovascular risk factor levels in Sweden. The Northern Sweden MONICA Study 1986 - 1994. Multinational Monitoring of Trends and Determinants in Cardiovascular Disease. J Intern Med 1998; 244: 1 - 9.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Stegmayr B., Vinogradova T., Malyutina S., Peltonen M., Nikitin Y., Asplund K. Widening gap of stroke between east and west. Eight-year trends in occurrence and risk factors in Russia and Sweden. Stroke 2000; 31: 2 - 8.[Abstract/Free Full Text]
• Langhorne P., Dennis M. Stroke units: an evidence based approach. London: BMJ Books, 1998.

Scandinavian Journal of Public Health, Vol. 31, No. 61 suppl, 60-69 (2003)
DOI: 10.1080/14034950310001379


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Stegmayr, B. Articles by Asplund, K. Search for Related Content PubMed Articles by Stegmayr, B. Articles by Asplund, K. Social Bookmarking                         What's this?