‘Striking’ stroke mortality inequalities across Europe, Central Asia
MedWire News: Trends in stroke mortality in European and Central Asian countries over the past 15 years vary according to their World Health Organization (WHO) demographic categories, research shows.
"The striking conclusion that emerges is that stroke mortality has entered a period of rapidly increasing inequality between countries," Josep Redon (University of Valencia, Spain) and colleagues write in the European Heart Journal.
"Countries which had attained low mortality rates, reached in the latter part of the 20th century, experienced further declines, while countries with moderate as well as high stroke mortality… at the start of the period being examined had a further unprecedented increase in this cause of death."
The team's study included WHO data on 35 countries in Europe and Central Asia, which were divided according to standard WHO demographic categories: Category A - very low child and adult mortality; Category B - low child and adult mortality; Category C - low child and high adult mortality.
Across all categories, the average stroke mortality rates were higher among women than men, largely because more women live to an age at which stroke risk is highest.
Average stroke mortality rates per 100,000 men in 1998 (the study mid-point) were 93.94 for Category A countries, compared with 136.87 and 169.55 for Category B and C countries, respectively.
There were large variations within categories, however. For example, Portugal, Croatia, and Greece had stroke mortality rates about double those of other Category A countries. Nevertheless, annual stroke mortality rates for the whole group fell between 1990 and 2006, at a rate of 2.03 per 100,000 men, with Portugal having the steepest decline.
In Category B, rates per 100,000 men (for 2002) were highly variable, ranging from 57.0 for Azerbaijan to 273.9 for Bulgaria. But stroke mortality rose over time in this category as a whole, at an annual rate of 2.08 per 100,000 men, with a 95% confidence interval of -0.02 to 4.25, indicating that most countries had rising rates.
Stroke mortality was generally high in Category C, and it rose at an annual rate of 1.71 per 100,000 men. The 95% confidence interval was -1.08 to 4.23, indicating a mixture of falling and rising rates within this category.
Many previous studies have shown a strong correlation between blood pressure (BP) or hypertension and stroke mortality, say Redon et al.
They add: "If we assume that stroke mortality can serve as a proxy for average BP in a population, the data presented here clearly demonstrate the necessity to adopt actions to increase the diagnosis, treatment and hypertension control in the countries where the burden of hypertension sequelae is still growing."
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By Eleanor McDermid