title: Comparing ischaemic stroke in six European countries. The EuroHOPE register study.
abstract: OBJECTIVE
  The incidence of hospitalizations, treatment and case fatality of ischaemic stroke were assessed utilizing a comprehensive multinational database to attempt to compare the healthcare systems in six European countries, aiming also to identify the limitations and make suggestions for future improvements in the between-country comparisons.
  
  
  METHODS
  National registers of hospital discharges for ischaemic stroke identified by International Classification of Diseases codes 433-434 (ICD-9) and code I63 (ICD-10), medication purchases and mortality were linked at the patient level in each of the participating countries and regions: Finland, Hungary, Italy, the Netherlands, Scotland and Sweden. Patients with an index admission in 2007 were followed for 1 year.
  
  
  RESULTS
  In all, 64,170 patients with a disease code for ischaemic stroke were identified. The number of patients registered per 100,000 European standard population ranged from 77 in Scotland to 407 in Hungary. Large differences were observed in medication use. The age- and sex-adjusted all-cause case fatality amongst hospitalized patients at 1 year from stroke was highest in Hungary at 31.0% (95% confidence interval 30.5-31.5). Regional differences in age- and sex-adjusted 1-year case fatality within countries were largest in Hungary (range 23.6%-37.6%) and smallest in the Netherlands (20.5%-27.3%).
  
  
  CONCLUSIONS
  It is feasible to link population-wide register data amongst European countries to describe incidence of hospitalizations, treatment patterns and case fatality of ischaemic stroke on a national level. However, the coverage and validity of administrative register data for ischaemic stroke should be developed further, and population-based and clinical stroke registers should be created to allow better control of case mix.
authors.affiliation: Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Malmivaara
authors.forename: A
authors.initials: A
authors.lastname: Meretoja
authors.forename: M
authors.initials: M
authors.lastname: Peltola
authors.forename: D
authors.initials: D
authors.lastname: Numerato
authors.forename: R
authors.initials: R
authors.lastname: Heijink
authors.forename: P
authors.initials: P
authors.lastname: Engelfriet
authors.forename: S H
authors.initials: SH
authors.lastname: Wild
authors.forename: É
authors.initials: É
authors.lastname: Belicza
authors.forename: D
authors.initials: D
authors.lastname: Bereczki
authors.forename: E
authors.initials: E
authors.lastname: Medin
authors.forename: F
authors.initials: F
authors.lastname: Goude
authors.forename: G
authors.initials: G
authors.lastname: Boncoraglio
authors.forename: T
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: T
authors.initials: T
authors.lastname: Seppälä
authors.forename: U
authors.initials: U
authors.lastname: Häkkinen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data*; D012606:Scotland / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology
keywords: Europe; benchmarking; case fatality; hospitalization; international differences; ischaemic stroke; mortality; quality; register