A population study of stroke in West Ukraine: incidence, stroke services, and 30-day case fatality.
OBJECTIVE
According to World Health Organization statistics, Ukraine has extremely high stroke mortality. No population-based prospective studies of stroke incidence have been performed yet in this European country with approximately 50 million inhabitants. High reported rates of stroke mortality in official statistics conflict with some locally published incidence data in Ukraine. To obtain accurate data, we evaluated stroke incidence and 30-day case fatality in a prospective population study in the West Ukrainian city of Uzhgorod with a population of 126 000 inhabitants.


METHODS
Case certification by neurologists and follow-up at 30 days after stroke for all patients identified by any level of the health service system were performed for a 12-month period.


RESULTS
We identified 352 stroke cases. The age-standardized incidence was 341 and 238 of 100 000 and mortality was 83 and 69 of 100 000 with the use of the European or world standard population for standardization. Mean age of stroke patients was 63.4+/-12.5 years. Rate of hospitalization was 66%. Hospitalized patients were >10 years younger than those treated in their homes. The 30-day case fatality rates were 15.4% among hospitalized patients and 36.8% among those treated at home. Overall 30-day case fatality was 23.3%.


CONCLUSIONS
Stroke incidence and 30-day case fatality in this West Ukrainian city were similar to those of some West European countries and were much lower than what could be expected from World Health Organization statistics. The relatively low incidence rate seems accurate; because of the organization of local stroke services, it is not probable that a considerable proportion of patients with acute stroke could bypass all levels of the acute care health system. Local health statistics reported a much lower number of stroke cases and stroke deaths than found in our survey; thus, further study is needed to clarify the reason for the discrepancy between local data and the high reported stroke mortality in Ukraine.
Mihálka
L
L
Department of Neurology, University of Uzhgorod, Ukraine.
Smolanka
V
V
Bulecza
B
B
Mulesa
S
S
Bereczki
D
D
D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality*; D014455:Ukraine / Q000453:epidemiology