title: The incidence of all stroke and stroke subtype in the United Kingdom, 1985 to 2008: a systematic review.
abstract: BACKGROUND
  There is considerable geographic variation in stroke mortality around the United Kingdom (UK). Whether this is due to geographical differences in incidence or case-fatality is unclear. We conducted a systematic review of high-quality studies documenting the incidence of any stroke and stroke subtypes, between 1985 and 2008 in the UK. We aimed to study geographic and temporal trends in relation to equivalent mortality trends.
  
  
  METHODS
  MEDLINE and EMBASE were searched, reference lists inspected and authors of included papers were contacted. All rates were standardised to the European Standard Population for those over 45, and between 45 and 74 years. Stroke mortality rates for the included areas were then calculated to produce rate ratios of stroke mortality to incidence for each location.
  
  
  RESULTS
  Five papers were included in this review. Geographic variation was narrow but incidence appeared to largely mirror mortality rates for all stroke. For men over 45, incidence (and confidence intervals) per 100,000 ranged from 124 (109-141) in South London, to 185 (164-208) in Scotland. For men, premature (45-74 years) stroke incidence per 100,000 ranged from 79 (67-94) in the North West, to 112 (95-132) in Scotland. Stroke subtype data was more geographically restricted, but did suggest there is no sizeable variation in incidence by subtype around the country. Only one paper, based in South London, had data on temporal trends. This showed that there has been a decline in stroke incidence since the mid 1990 s. This could not be compared to any other locations in this review.
  
  
  CONCLUSIONS
  Geographic variations in stroke incidence appear to mirror variations in mortality rates. This suggests policies to reduce inequalities in stroke mortality should be directed at risk factor profiles rather than treatment after a first incident event. More high quality stroke incidence data from around the UK are needed before this can be confirmed.
authors.affiliation: Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK. prachi.bhatnagar@dphpc.ox.ac.uk
authors.forename: Prachi
authors.initials: P
authors.lastname: Bhatnagar
authors.forename: Peter
authors.initials: P
authors.lastname: Scarborough
authors.forename: Nigel C
authors.initials: NC
authors.lastname: Smeeton
authors.forename: Steven
authors.initials: S
authors.lastname: Allender
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology
references.citation: J Epidemiol Community Health. 1997 Oct;51(5):472-8
references.pmid: 9425454
references.citation: Lancet Neurol. 2009 Apr;8(4):355-69
references.pmid: 19233729
references.citation: J Public Health (Oxf). 2007 Jun;29(2):191-8
references.pmid: 17456532
references.citation: Stroke. 2005 Sep;36(9):1837-43
references.pmid: 16081859
references.citation: BMJ. 2005 Aug 20;331(7514):414-5
references.pmid: 16110054
references.citation: Lancet. 1987 Nov 21;2(8569):1196-200
references.pmid: 2890819
references.citation: Circulation. 2004 Mar 9;109(9):1101-7
references.pmid: 14993137
references.citation: Stroke. 1996 Mar;27(3):550-8
references.pmid: 8610328
references.citation: J Epidemiol Community Health (1978). 1978 Dec;32(4):244-9
references.pmid: 744814
references.citation: Lancet. 2004 Jun 12;363(9425):1920
references.pmid: 15194247
references.citation: Lancet Neurol. 2003 Jan;2(1):43-53
references.pmid: 12849300
references.citation: Stroke. 2008 Aug;39(8):2204-10
references.pmid: 18535279
references.citation: Health Stat Q. 2004 Summer;(22):14-20
references.pmid: 15704390
references.citation: Stroke. 2009 Apr;40(4):1038-43
references.pmid: 19211485
references.citation: Stroke. 1997 Mar;28(3):491-9
references.pmid: 9056601
references.citation: J Neurol Neurosurg Psychiatry. 2001 Mar;70(3):340-3
references.pmid: 11181855
references.citation: Stroke. 2009 Apr;40(4):1082-90
references.pmid: 19211488
references.citation: Stroke. 2007 Dec;38(12):3133-8
references.pmid: 17962604
references.citation: Stroke. 2003 Nov;34(11):2623-8
references.pmid: 14576369
references.citation: BMJ. 1999 Apr 10;318(7189):967-71
references.pmid: 10195965
references.citation: Lancet. 2005 Nov 19;366(9499):1773-83
references.pmid: 16298214
references.citation: J Neurol Neurosurg Psychiatry. 2002 Feb;72(2):211-6
references.pmid: 11796771
references.citation: BMJ. 2005 Aug 20;331(7514):431
references.pmid: 16055452