Decline of Stroke Mortality in Warsaw between 1991/1992 and 2005, Comparison of Two Prospective Population Based Studies

Background and purpose: According to official statistics in Eastern European countries since few decades stroke mortality rate has remained high. It has been shown, that in Poland stroke mortality failed to decline in the period 1984 through 1992. Since that time the stroke management in our country has changed, especially in the big cities, where stroke units have been developed. The aim of this study was the comparison of stroke mortality rates, estimated on the basis of two prospective population based studies performed in Warsaw in 1991/1992 and 2005. Methods: Case fatality rates and stroke mortality rates for the First Ever in Life-time Stroke (FEL) have been estimated on the basis of two population based studies: Warsaw Stroke Registry (WSR) (population 182649) registration from 1991 through 1992 and European Register of Stroke (EROS) (population 127735) registration year 2005. In both studies mortality rates were standardized to European population by the direct methods. Results: Contrary to the incidence rates which did not changed significantly between 1991/1992 and 2005: 141.3 vs. 143.3, 30-day and 1-year case fatality rates decreased significantly from 43% (95% CI: 38.1-47.2) to 17.4% (95% CI: 11.425.0) and from 59.7% (95% CI: 55.3-64.2) to 31.7% (95% CI: 25-42) respectively for WSR and EROS studies. Stroke mortality rates has also significantly declined from 90.6/100 000 in 1991/1992 to 37.57/100 000 in 2005. Conclusion: The present study has shown significant decline in stroke mortality in Warsaw, connected probably with better management of patients in the acute phase of stroke: in 2005 92% of stroke patients from catchment area were treated in Stroke Units, and 5.3% of them received rt-PA. The study was performed as a part of EU grant (QLG4-CT-2002-0191)