Trends in stroke incidence in high-income countries in the 21st Century

Journal article

Background and Purpose: Population-based studies provide the most reliable data on stroke incidence. A previous systematic review of population-based studies suggested that stroke incidence in high-income countries decreased by 42% between the 1970s and early 2000s. However, it is uncertain whether this trend of steady decline has been maintained in more recent periods.

Methods: Data from OCSP (Oxfordshire Community Stroke Project; 1981–1986) and OXVASC (Oxford Vascular Study; 2002–2017) along with other published population-based stroke incidence studies that reported temporal trends of stroke incidence since 1990 in high-income countries were included. Age-standardized relative incidence rate ratios were calculated for each study and then pooled with inverse-variance weighted random-effects meta-analysis. Projection estimates were calculated for the number of incident stroke patients in the United Kingdom from year 2015 to 2045.

Results: In Oxfordshire, stroke incidence fell by 32% from OCSP to OXVASC, with a similar trend before or after year 2000. With the projected aging population, if the age-specific stroke incidence continued to decrease at its current rate (6% every 5 years), there would still be a 13% increase of the number of first-ever strokes in the United Kingdom up to year 2045. Incorporating the Oxfordshire data with other 12 population-based studies, stroke incidence declined steadily between the 1990s and 2010s within each study, resulting in a 28% decline over an average period of 16.5 years (pooled incidence rate ratio, 0.72 [95% CI, 0.66–0.79]; P<0.0001). The trend was the same for men (0.69 [95% CI, 0.61–0.77]; P<0.0001) and women (0.66 [95% CI, 0.59–0.74]; P<0.0001) and remained consistent after year 2010 in OXVASC. Proportion of disabling or fatal stroke also decreased over time (early versus later period, 53.6% versus 46.1%; P=0.02).

Conclusions: Stroke incidence is continuing to decline with steady rate in Oxfordshire and in other high-income settings. However, the absolute number of strokes occurring is not falling.

Authors: Li, L; Scott, CA; Rothwell, PM

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Heart Association
• Journal: Stroke
• Volume: 51
• Issue: 5
• Pages: 1372–1380
• Publication date: 2020-03-25
• Acceptance date: 2020-02-17
• DOI: 10.1161/strokeaha.119.028484
• EISSN: 1524-4628
• ISSN: 0039-2499
• Language: English
• Keywords: systematic review; FFR; incidence; stroke; cohort study