Decrease in the stroke case fatality rates in a French population-based twenty-year study. A comparison between men and women.
BACKGROUND
The aim of the study was to estimate trends in stroke case fatality in a French population-based study over the last 20 years, and to compare trends in men and women.


METHODS
We prospectively ascertained first-ever strokes in a well-defined population-based study, from 1985 to 2004, in Dijon (France) (150,000 inhabitants). The study was both specific and exhaustive. The follow-up made it possible to analyze case fatality, according to stroke subtypes and sex.


RESULTS
From the ascertainment of 3,691 strokes divided in 1,920 cerebral infarcts from large artery atheroma, 725 cerebral infarcts from small perforating artery atheroma, 497 cardioembolic infarcts, 134 cerebral infarcts from undetermined mechanism, 341 primary cerebral hemorrhages and 74 subarachnoïd hemorrhages, we observed a significant decrease in 28-day case fatality rates of almost 25% (p = 0.03). Case fatality rates decreased in men aged >75 years (p = 0.01) and in women aged >75 years (p = 0.02) and >65 years (p = 0.03). The magnitude of the decrease was smaller in women but not significantly so. According to stroke subtypes, case fatality rates significantly decreased for small perforating artery infarct (p = 0.04) and for primary cerebral hemorrhage (p = 0.03). In multivariate regression analyses, hemorrhagic stroke, the first period of the study (1985-1989), blood hypertension, previous myocardial infarction and age <85 years had a negative effect.


CONCLUSIONS
This is the first population-based study using continuous ascertainment over a period of 20 years that has demonstrated a significant reduction in case fatality rates. We did not observe any significant differences between men and women.
Bejot
Yannick
Y
Stroke Registry of Dijon (Inserm and Institut de Veille Sanitaire), Dijon, France.
Rouaud
Olivier
O
Durier
Jérôme
J
Caillier
Marie
M
Marie
Christine
C
Freysz
Marc
M
Yeguiayan
Jean-Michel
JM
Chantegret
Alban
A
Osseby
Guy
G
Moreau
Thibault
T
Giroud
Maurice
M
D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D016017:Odds Ratio; D011159:Population Surveillance; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality*; D013997:Time Factors