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Cited by 885Acute Ischemic Stroke ManagementIntracerebral and Subarachnoid Hemorrhage ResearchHealthcare Systems and Public Health

Comparable Studies of the Incidence of Stroke and its Pathological Types: Results From an International Collaboration

Sudlow, C.L.M., Warlow, C.P.·1997·Stroke
DOI 10.1161/01.str.28.3.491
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Abstract

Background and Purpose Comparing stroke rates in different parts of the world may increase our understanding of both etiology and prevention. However, comparisons are meaningful only if studies use standard definitions and methods, with comparably presented data. We compared the incidence of stroke and its pathological types (cerebral infarction, primary intracerebral hemorrhage, and subarachnoid hemorrhage) in recent studies from around the world. Methods Studies with a midyear of 1984 or later, fulfilling standard criteria for a comparable, community-based study, provided original data for comparative analyses. Results By mid-1995, data were available from 11 studies in Europe, Russia, Australasia, and the United States, comprising approximately 3.5 million person-years and 5575 incident strokes. Age- and sex-standardized annual incidence rates for subjects aged 45 to 84 years were similar (between approximately 300/100 000) and 500/100 000) in most places but were significantly lower in Dijon, France (238/100 000), and higher in Novosibirsk, Russia (627/100 000). In subjects aged 75 to 84 years, however, Novosibirsk no longer ranked higher than the other studies. The distribution of pathological types, when these were reliably distinguished, did not differ significantly between studies. Conclusions The similarities in stroke incidence and pathological types are perhaps not surprising given that all the populations were westernized and mainly white. The higher rates in Novosibirsk, disappearing in the elderly, and the lower rates in Dijon have several potential explanations. These include methodological artifact and different patterns of population risk factors. Further work is needed to explore these possibilities and to extend our knowledge of stroke incidence to other parts of the world, especially developing countries.

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  • Unspecified stroke deaths were redistributed to ischemic and hemorrhagic stroke using proportions from large epidemiological studies with high-quality diagnosis and cause-of-death assignment, stratified by age using a meta-analysis of stroke registries in Western populations.

    “We redistributed these deaths to ischemic and hemorrhagic stroke using proportions from large epidemiological studies with high-quality diagnosis and cause-of-death assignment [25], stratified by age using a meta-analysis of stroke registries in Western populations [26].”

    From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [26]

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Authors
Sudlow, C. L. M., & Warlow, C. P.
Affiliations
University of Edinburgh (GB)
ORCID
Sudlow, C.L.M.
Venue
Stroke
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1997-03
Volume
28
Issue
3
Pages
491-499
ISSN
  • 0039-2499 (ISSN-L)
  • 1524-4628
DOI
10.1161/01.str.28.3.491
OpenAlex
W2928618355
Cited by
885
References
41
Citations by year
2026: 3 · 2025: 11 · 2024: 13 · 2023: 24 · 2022: 22 · 2021: 25 · 2020: 31 · 2019: 39 · 2018: 34 · 2017: 30 · 2016: 32 · 2015: 34 · 2014: 44 · 2013: 45 · 2012: 38
FWCI
8.74
Type
journal article
Language
en
Open access
closed
Locations
  • Stroke (publishedVersion)
  • PubMed (publishedVersion)
  • ResearchSpace (University of Auckland) (submittedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
Keywords
stroke incidence, cerebral infarction, intracerebral hemorrhage, subarachnoid hemorrhage, stroke pathology, cross-national comparison, standardized incidence rate, stroke risk factors, Novosibirsk, Dijon
MeSH terms
Acute Disease, Aged, Aged, 80 and over, Australia, Cerebrovascular Disorders, Europe, Female, United Kingdom, Humans, Male, Middle Aged, Minnesota, New Zealand, Russia, Scandinavian and Nordic Countries, Incidence, Age Distribution, Sex Distribution

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