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Worldwide 1-month case fatality of ischaemic stroke and the temporal trend
  1. Runhua Zhang1,2,
  2. Yu Wang1,
  3. Jiming Fang3,
  4. Miaoxin Yu1,
  5. Yongjun Wang1,2,
  6. Gaifen Liu1,2
  1. 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2China National Clinical Research Center for Neurological Diseases, Beijing, China
  3. 3ICES, Toronto, Ontario, Canada
  1. Correspondence to Dr Gaifen Liu; liugaifen1997{at}


Background The 1-month case fatality of ischaemic stroke is an essential epidemiological metric. Whereas the case fatality after ischaemic stroke and the temporal trend is uncertain. We aimed to estimate the 1-month case fatality of ischaemic stroke and its temporal trend, as well as its regional variation.

Methods We searched PubMed and Embase to identify the studies for 1-month case fatality of ischaemic stroke . The population-based studies were included. Two investigators extracted the data and assessed the quality independently. One-month case fatality of ischaemic stroke was estimated using a random effects model. The temporal trend was evaluated using a mixed-effect meta-regression model.

Results A total of 59 articles with 77 time periods were included. The worldwide 1-month case fatality of ischaemic stroke was 13.5% (95% CI 12.3% to 14.7%). The case fatality was 10.8% (95% CI 8.3% to 13.5%) in Asia, 14.2% (95% CI 12.6% to 15.9%) in Europe, 14.0% (95% CI 11.2% to 17.1%) in South America and Caribbean, 14.0% (95% CI 9.5% to 19.1%) in North America and 12.5% (95% CI 11.1% to 13.9%) in Australia and New Zealand. Overall, there was a non-significant decrease of 0.1% per year in case fatality. It decreased significantly in Europe (−0.2% annually, 95% CI −0.4% to −0.01%) and North America (−0.2% annually, 95% CI −0.4% to −0.04%), increased significantly in Australia and New Zealand (0.2% annually, 95% CI 0.1% to 0.4%), while no evidence of change in other regions.

Conclusion The 1-month case fatality of ischaemic stroke and its temporal trend were divergent across regions. Further studies are needed to address the reason of the regional difference, which will be helpful to guide the effort of reducing stroke burden.

  • stroke

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  • Contributors RZ: study selection, data extraction, methodology and writing original draft preparation. YW: study selection and data extraction. MY: data analysis. JF: methodology and revision of the manuscript. YW: conceptualisation, supervision and funding acquisition. GL: conceptualisation, methodology, revision of the manuscript and funding acquisition.

  • Funding This study was supported by the Ministry of Science and Technology of the People’s Republic of China (2017YFC1307702), Capital’s Funds for Health Improvement and Research (2020-1-2041) and Beijing Municipal Administration of Hospitals’ Sail Plan (XMLX201712).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. You can obtain related data from the published articles.

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