Elsevier

The Lancet Neurology

Volume 2, Issue 1, January 2003, Pages 43-53
The Lancet Neurology

Review
Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century

https://doi.org/10.1016/S1474-4422(03)00266-7Get rights and content

Summary

This overview of population-based studies of incidence, prevalence, mortality, and case-fatality of stroke was based on studies from 1990. Incidence (first stroke in an individual's lifetime) and prevalence were computed by age, sex, and stroke type. Age-standardised incidence and prevalence with the corresponding 95% CI were plotted for each study to facilitate comparisons. The review shows that the burden of stroke is high and is likely to increase in future decades as a result of demographic and epidemiological transitions in populations. The main features of stroke epidemiology include modest geographical variation in incidence, prevalence, and case-fatality among the—predominantly white—populations studied so far, and a stabilisation or reversal in the declining secular trends in the pre-1990s rates, especially in older people. However, further research that uses the best possible methods to study the incidence, risk factors, and outcome of stroke are urgently needed in other populations of the world, especially in less developed countries where the risk of stroke is high, lifestyles are changing rapidly, and population restructuring is occurring.

Section snippets

Search strategy and selection criteria

Data for this review were identified by searches of Medline (January, 1966, to August, 2002), and from the references of relevant articles. Different subsets of studies were potentially eligible for different parts of this review. The search terms “population-based”, “community-based”, “community”, “epidemiology”, “epidemiological”, “incidence”, “prevalence”, “attack rates”, “survey”, “surveillance”, “mortality”, “morbidity”, “fatality”, “case-fatality”, “stroke”, “isch(a)emic stroke”,

Stroke incidence

15 population-based stroke incidence studies that met our eligibility criteria were identified and included in the analysis (table 1, figure 1).22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 These studies covered a population of 3 266 366 people in 13 countries, with 4 398 158 person-years of observation. The frequency of admission to hospital ranged from 41% in Japan to 94·6% in Germany (mean 81%). In five of the 15 studies, the information on timing of CT or MRI after stroke

Discussion

We have reviewed the epidemiology of stroke predominantly in more developed countries on the basis of well-designed population-based studies. Compared with the two most recent reviews of stroke incidence in various countries published in 199712 and 1998,13 our review included 17 new population-based studies (nine new stroke-incidence studies published since 1990 and eight new studies on secular trends in stroke incidence) and nine stroke-prevalence studies that have not been reviewed

References (106)

  • WHO

    The world health report

    (1998)
  • FoulkesMA et al.

    The stroke data bank: design, methods, and baseline characteristics

    Stroke

    (1988)
  • CaroJJ et al.

    Management patterns and costs of acute ischemic stroke: an international study

    Stroke

    (2000)
  • WHO

    The world health report 2000: Health systems - improving performance

    (2000)
  • BonitaR et al.

    International trends in stroke mortality: 1970-1985

    Stroke

    (1990)
  • ThorvaldsenP et al.

    Stroke trends in the WHO MONICA project

    Stroke

    (1997)
  • BonitaR et al.

    The worldwide problem of stroke

    Curr Opin Neurol

    (1994)
  • SudlowCL et al.

    Comparable studies of the incidence of stroke and its pathological types: results from an international collaboration

    Stroke

    (1997)
  • WarlowCP

    Epidemiology of stroke

    Lancet

    (1998)
  • KhawKT

    Epidemiology of stroke

    J Neurol Neurosurg Psychiatry

    (1996)
  • PosnerJD et al.

    Stroke in the elderly, I: epidemiology

    J Am Geriatr Soc

    (1984)
  • KurtzkeJF

    Epidemiology of stroke: methods and trends

    Health Rep

    (1994)
  • MasJL et al.

    Epidemiology of stroke

    J Neuroradiol

    (1993)
  • ViriyavejakulA

    Stroke in Asia: an epidemiological consideration

    Clin Neuropharmacol

    (1990)
  • HatanoS

    Experience from a multicentre stroke register: a preliminary report

    Bull World Health Organ

    (1976)
  • SudlowCLM et al.

    Comparing stroke incidence worldwide: what makes studies comparable?

    Stroke

    (1996)
  • AhmadOB et al.
  • ThriftAG et al.

    Incidence of the major stroke subtypes: initial findings from the north east Melbourne stroke incidence study (NEMESIS)

    Stroke

    (2001)
  • JamrozikK et al.

    Trends in the Incidence, severity, and short-term outcome of stroke in Perth, western Australia

    Stroke

    (1999)
  • JorgensenHS et al.

    Marked increase of stroke incidence in men between 1972 and 1990 in Frederiksberg, Denmark

    Stroke

    (1992)
  • StewartJA et al.

    Ethnic differences in incidence of stroke: prospective study with stroke register

    BMJ

    (1999)
  • NumminenH et al.

    Declining incidence and mortality rates of stroke in Finland from 1972 to 1991: results of three population-based stroke registers

    Stroke

    (1996)
  • SmadjaD et al.

    ERMANCIA: epidemiology of stroke in Martinique, French West Indies, part I: methodology, incidence, and 30-day case fatality rate

    Stroke

    (2001)
  • MorikawaY et al.

    Trends in stroke incidence and acute case fatality in a Japanese rural area: the Oyabe study

    Stroke

    (2000)
  • Kolominsky-RabasPL et al.

    Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes, a population-based study

    Stroke

    (2001)
  • Kolominsky-RabasPL et al.

    A prospective community-based study of stroke in Germany, the Erlangen stroke project (ESPro): incidence and case fatality at 1, 3, and 12 months

    Stroke

    (1998)
  • VemmosKN et al.

    Stroke incidence and case fatality in southern Greece: the Arcadia stroke registry

    Stroke

    (1999)
  • LauriaG et al.

    Incidence and prognosis of stroke in the Belluno province, Italy: first-year results of a community-based study

    Stroke

    (1995)
  • CaroleiA et al.

    High stroke incidence in the prospective community-based L'Aquila registry (1994-1998): first year's results

    Stroke

    (1997)
  • EllekjaerH et al.

    Epidemiology of stroke in Innherred, Norway, 1994 to 1996: incidence and 30-day case-fatality rate

    Stroke

    (1997)
  • MihalkaL et al.

    A population study of stroke in West Ukraine: incidence, stroke services, and 30-day case fatality

    Stroke

    (2001)
  • BonitaR et al.

    Prevalence of stroke and stroke-related disability: estimates from the Auckland stroke studies

    Stroke

    (1997)
  • BotsML et al.

    Prevalence of stroke in the general population: the Rotterdam study

    Stroke

    (1996)
  • NicolettiA et al.

    Prevalence of stroke: door-to-door survey in rural Bolivia

    Stroke

    (2000)
  • MittelmarkMB et al.

    Prevalence of cardiovascular diseases among older adults: the cardiovascular health study

    Am J Epidemiol

    (1993)
  • GeddesJM et al.

    Prevalence of self reported stroke in a population in northern England

    J Epidemiol Community Health

    (1996)
  • O'MahonyPG et al.

    The prevalence of stroke and associated disability

    J Public Health Med

    (1999)
  • LindebergS et al.

    Apparent absence of stroke and ischaemic heart disease in a traditional Melanesian island: a clinical study in Kitava

    J Intern Med

    (1993)
  • HuangZS et al.

    Stroke prevalence in Taiwan: findings from the 1994 national health interview survey

    Stroke

    (1997)
  • PrencipeM et al.

    Stroke, disability, and dementia: results of a population survey

    Stroke

    (1997)
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