One-year case fatality rate following stroke in the Mashhad Stroke Incidence Study: a population-based study of stroke in Iran.
BACKGROUND
In developing countries, there are few comprehensive studies of mortality following stroke.


OBJECTIVE
We aimed to determine the one-year case fatality rate following stroke and to identify factors associated with death in a population-based stroke incidence study in Iran.


METHODS
Six hundred eighty-four patients who had suffered a stroke between November 21, 2006, and November 20, 2007, and were recruited to the Mashhad Stroke Incidence Study were followed up at one-year. Most patients were seen in an outpatient visit. When patients had died, a verbal autopsy was conducted by telephone with the next of kin.


RESULTS
A total of 226 (34·3%) patients died during the first year following stroke. The cumulative one-year case fatality rate was 30·6% following ischemic stroke and 53·0% following hemorrhagic stroke (55·8% after intracerebral hemorrhage and 35·7% after subarachnoid hemorrhage). The majority of these deaths occurred in the first 28 days after stroke (17·7% with ischemic and 43·0% with hemorrhagic stroke). Factors associated with greater mortality at one-year (excluding those who died during the first week) were hemorrhagic stroke [hazard ratio (HR) 3·99; 95% confidence interval 1·90-8·37], age (HR 1·05; 95% confidence interval 1·03-1·08), previous transient ischemic attack (HR 2·45; 95% confidence interval 1·00-5·99), and National Institutes of Health Stroke Scale on admission (HR 1·14; 95% confidence interval 1·10-1·17).


CONCLUSIONS
Despite the younger age of stroke occurrence in Iran, the one-year case fatality rate following stroke is similar to that reported in developed countries.
School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Ali
A
Shoeibi
Departments of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.|Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Maryam
M
Salehi
Stroke and Ageing Research, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.|Stroke Division, the Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
Amanda G
AG
Thrift
Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Institute for Clinical Evaluative Sciences and Toronto General Research Institute, Toronto, Canada.
Moira K
MK
Kapral
School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Mohammad Taghi
MT
Farzadfard
Faculty of Dentistry and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada.
Amir
A
Azarpazhooh
School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Parvaneh
P
Layegh
Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.
Peyman
P
Hashemi
Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.
Amin
A
Amiri
School of Medicine, Department of the Elderly, Ave Sina Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.|Psychiatry and Behavioural Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Naghmeh
N
Mokhber
School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Bahare
B
Hassankhani
School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.|London Health Science Center, London, Ontario, Canada.
Mahmoud Reza
MR
Azarpazhooh
D000704:Analysis of Variance; D002423:Cause of Death; D018672:Community Health Planning; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality*; D013997:Time Factors
Iran; Mashhad; case fatality; epidemiology; mortality; stroke