Deaths from cerebrovascular diseases, such as stroke, have declined significantly in most European countries over the past 37 years, according to new research published today (15 August 2018).
However, the study, led by Dr Nick Townsend, associate professor in public health epidemiology at the University of Bath, England, found that death rates had increased in some other countries.
Using data from the World Health Organisation (WHO), Dr Townsend and colleagues examined mortality trends in ischaemic stroke, haemorrhagic stroke, and sub-arachnoid haemorrhage (SAH) in Europe for 37 years between 1980 and 2016.
Although not all countries had data available for the full 37 years, they found that across the whole of the WHO European region for the most recent period for which data were available, there had been significant decreases in death rates in these types of stroke in 33 (65%) countries for men and women.
However, in Azerbaijan, Georgia and Tajikistan, the data showed increased death rates among men while in Azerbaijan and Uzbekistan, the rates rose for women.
In seven countries – Austria, Denmark, France, Germany, Greece, Czech Republic and Hungary – the death rates had plateaued in men, while rates had plateaued in six countries – Austria, Belgium, France, Germany, Ireland and Switzerland – among women.
There was no change in death rates in eight countries for men and ten for women, according to the report, which is published in the European Heart Journal.
Age-standardised mortality rates from stroke were found to be higher in men than in women for all countries.
For stroke, death rates in western Europe in men ranged from 49 per 100,000 of the population in France to 131 per 100,000 in San Marino, while in central Europe, male death rates ranged from 110 per 100,000 in the Czech Republic to 391 per 100,000 in Bulgaria.
In eastern Europe, male death rates ranged from 82 in Estonia to 331 in Russia per 100,000. In central Asia, they ranged from 152 in Armenia to 345 in Azerbaijan per 100,000. In the UK, the death rate was 68 per 100,000 in men and 65 per 100,000 in women.
“Over the last 35 years there have been large overall declines in deaths from cerebrovascular disease in the majority of European countries,” said Dr Townsend.
“While these declines have continued in more than half of the countries, these have not been consistent across Europe and our analysis has revealed evidence of recent plateauing and even increases in stroke deaths in certain countries.
“We have seen this in both sexes and in countries across the whole of Europe, particularly in eastern and central Europe and central Asia. We have also found differences in death rates by stroke type. Therefore, it is not enough to consider cerebrovascular disease as just one condition and we must consider each individual stroke type.”
He said their findings highlighted the need to counter inequalities by understanding local contexts in disease occurrence and treatment.
“In particular, we need to encourage the implementation of evidence-based recommendations in the prevention and treatment of stroke in all countries,” said Dr Townsend.
“Many countries have been able to reduce the mortality burden from stroke in recent years. We must understand why this is not happening in all countries and identify barriers to the implementation of evidence-based recommended practice in countries that are slow to adopt them. In addition, we only studied between-country inequalities, but we must consider within-country inequalities as well if we are to have an impact on the disease.”
Shah R et al. Epidemiology report: trends in sex-specific cerebrovascular disease mortality in Europe based on WHO mortality data. European Heart Journal 15 August 2018; doi:10.1093/eurheartj/ehy378
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