title: Trends in age-standardized and age-specific cerebrovascular mortality in Germany between 1980 and 2009.
abstract: BACKGROUND
  It has been proposed that the declining stroke mortality trends will stop due to high and increasing levels of stroke risk factors. Accordingly, it has been reported that the declining mortality from coronary heart diseases, whose aetiology is comparable to that of stroke, has already started to level off in major population groups in western countries. However, there are no recent data on the development and possible change in stroke mortality trends.
  
  
  OBJECTIVE
  The objective of this study was to investigate overall as well as age- and sex-specific stroke mortality trends between 1980 and 2009 in Germany and to identify changes in these trends.
  
  
  METHODS
  Data of the German Federal Statistical Office were used to calculate age-standardized and age-specific mortality trends for women and men between 1980 and 2009. Joinpoint software was used to calculate annual percentage changes and detect changes in the direction of mortality trends. Additionally, sensitivity analyses were conducted separately for West Germany and East Germany to analyse the stroke mortality trends in the two parts of Germany. Trends of ischaemic and haemorrhagic stroke were analysed separately.
  
  
  RESULTS
  Between 1980 and 2009, the overall stroke mortality has decreased by 68.4% in women and 70.6% in men. The decrease was relatively constant throughout the whole period and trends were comparable across age groups and sexes. The overall percent decline was less pronounced in the younger age groups compared with the older ones. Additionally, the analyses showed that between 1990 and 1991, following the reunification of Germany, the stroke mortality in Germany as a whole increased in most of the population subgroups. After 2000, a flattening in the mortality trends could be detected in the age-standardized mortality of women as well as in the subgroups of women aged ≥55 and men aged 65-84.
  
  
  CONCLUSIONS
  Between 1980 and 2009, stroke mortality decreased substantially in the entire population. The increase in stroke mortality after the reunification was possibly caused by changes in the coding practice in former East Germany. During the whole period, a flattening of the decrease was observed in some population subgroups, which may be the result of relatively high levels of important risk factors. The decreasing stroke mortality rate may flatten in the entire population in the future. The results may aid in designing and improving preventive strategies.
authors.affiliation: Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany. s.rieks@student.unimaas.nl
authors.forename: Stephan
authors.initials: S
authors.lastname: Rieks
authors.forename: Stefan N
authors.initials: SN
authors.lastname: Willich
authors.forename: Falk
authors.initials: F
authors.lastname: Mueller-Riemenschneider
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors