title: Stroke mortality and trends from 1990 to 2006 in 39 countries from Europe and Central Asia: implications for control of high blood pressure.
abstract: OBJECTIVE
  The aim of the present study was to extend our understanding of international trends in stroke and major sequelae in Europe and countries peripheral to Europe by assessing: (1) current mortality rates, (2) the most recent 15-year prevalence trends, and (3) the relationship between systolic blood pressure in community surveys and national stroke mortality.
  
  
  RESULTS
  Data were obtained from the World Health Organization (WHO www.who.int/whosis/database/mort/table.cfm), and represent national vital statistics as reported by 39 countries (European and Central Asian countries) using a standard format and population-based cardiovascular surveys. Total numbers of deaths by stroke (International Classification of Diseases 430-438, 444) and the age, sex-adjusted incidence rates were obtained and grouped according to three standard demographic categories: A, B, and C (WHO). A Bayesian linear mixed effect model was fitted to the annual mortality rates. Higher rates of stroke mortality were observed for B and C group countries as compared with those countries belonging to Group A (e.g. Bulgaria 273.9 and 281.1; Israel 37.7 and 45.4 per 100 000 men and women, respectively). Even though the mortality rates within the country groupings were relatively similar, countries with marked deviation from the average were observed, mainly in Groups B and C. Stroke mortality decreased sharply in Group A during the period of study; conversely it had increased substantially in Group B and to a lesser extent in Group C. For both sexes markedly higher rates were noted moving from west to east, with some exceptions.
  
  
  CONCLUSIONS
  We have entered a period of rapidly increasing international inequality in stroke risk, where countries with low adult mortality in the latter 20th century extended their downward trend and countries with moderate as well as high mortality have on average seen unprecedented increases in death rates from stroke.
authors.affiliation: Hypertension Clinic, Hospital Clinico, University of Valencia (INCLIVA) and CIBERObn Institute of Health Carlos III, Avda Blasco Ibañez, 17, 46010 Madrid, Spain. josep.redon@uv.es
authors.forename: Josep
authors.initials: J
authors.lastname: Redon
authors.forename: Michael H
authors.initials: MH
authors.lastname: Olsen
authors.forename: Richard S
authors.initials: RS
authors.lastname: Cooper
authors.forename: Oscar
authors.initials: O
authors.lastname: Zurriaga
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Martinez-Beneito
authors.forename: Stephane
authors.initials: S
authors.lastname: Laurent
authors.forename: Renata
authors.initials: R
authors.lastname: Cifkova
authors.forename: Antonio
authors.initials: A
authors.lastname: Coca
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D017677:Age Distribution; D000368:Aged; D001209:Asia, Central / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015995:Prevalence; D012111:Residence Characteristics; D020521:Stroke / Q000401:mortality*