title: Trends and regional inequalities in mortality from stroke in the context of health care reform in Lithuania.
abstract: OBJECTIVE
  The objective of the study was to analyze mortality from stroke in Lithuania the context of health care reform with particular interest in urban/rural and regional inequalities. Based on the analysis of trends in mortality, and to detection of break-points over two decades of socioeconomic transition, it focused on the challenges in stroke care provision.
  
  
  METHODS
  The analysis covered the entire country. Information on deaths from 1991 to 2012 was gathered from death certificates held by the Lithuanian Department of Statistics. The joinpoint analysis was used to identify the best-fitting points, wherever a statistically significant change in mortality occurred. Age-standardized mortality rates were calculated for 60 municipalities of Lithuania.
  
  
  RESULTS
  The positive break-points in mortality from stroke were registered in 2007 for females and 2008 for males, when the increasing trends reversed to the declining. More positive changes occurred in urban areas, where stroke mortality is lower compare to rural since 1996. Considerable inequalities were disclosed among administrative regions of Lithuania: ratio between the highest and the lowest rates in different municipalities reached 4.88 for males and 3.35 for females.
  
  
  CONCLUSIONS
  There are good reasons to expect the favorable stroke mortality trends observed will follow the same direction in the future. Stroke centers are growing up in their competence while networking is also under the development. The new strategies in stroke care should result not only in the declining mortality rates and numbers of severely handicapped stroke patients, but also in diminishing regional and urban/rural inequalities.
authors: Department of Health Management, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: ramune.kalediene@lsmuni.lt.
authors: Ramunė
authors: R
authors: Kalėdienė
authors: Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors: Daiva
authors: D
authors: Rastenytė
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018166:Health Care Reform; D006801:Humans; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D012044:Regression Analysis; D012423:Rural Health / Q000706:statistics & numerical data / Q000639:trends; D012922:Social Change; D012959:Socioeconomic Factors; D020521:Stroke / Q000401:mortality*; D014504:Urban Health / Q000706:statistics & numerical data / Q000639:trends
keywords: Inequalities; Joinpoint analysis; Mortality; Stroke