Decline in mortality from acute stroke in England
Stroke mortality rates have been declining in almost every country. Reduction in mortality could result from a decline in disease occurrence or a decline in case fatality, or both. A reduction in stroke event rates could result from better management of risk factors, achieved through lifestyle modification and prevention.
In this week BMJ or British Medical Journal, a population based study involved 795 869 adults aged 20 and older who were admitted to hospital with acute stroke or died from stroke was published. It showed that between 2001 and 2010 stroke mortality rates decreased by 55%, stroke event rates by 20%, and case fatality by 40%. The study population included 358 599 (45%) men and 437 270 (55%) women. Average annual change in mortality rate was −6.0% in men and −6.1% (−6.3% to −6.0%) in women, in stroke event rate was −1.3% (−1.4% to −1.2%) in men and −2.1% (−2.2 to −2.0) in women, and in case fatality was −4.7% (−4.9% to −4.5%) in men and −4.4% (−4.5% to −4.2%) in wome. The study concluded that the declines in case fatality, probably driven by improvements in stroke care, contributed more than declines in event rates to the overall reduction in stroke mortality. Mortality reduction in men and women younger than 55 was solely a result of a decrease in case fatality, whereas stroke event rates increased in the age group 35 to 54 years. The increase in stroke event rates in young adults is a concern. This suggests that stroke prevention needs to be strengthened to reduce the occurrence of stroke in people younger than 55 years.