Trends in mortality from stroke in Austria, 1980-2008

Background: Worldwide, stroke is the third most common cause of death in developed countries with declining death rates. In 1997 Austria established a national system of acute-care stroke units; their impact on stroke mortality has not yet been determined. Methods: We assessed stroke mortality using Austrian national statistical data from Statistics Austria for the period 1980-2008. Deaths were coded using ICD-9 (430-438) or ICD-10 (I60-I69). We stratified age-standardized results by sex and stroke subtype (hemorrhagic or ischemic stroke). We also used join-point regression models (joined linear segments from Poisson regression models) to identify changes in the slope of age-specific mortality trends in selected age groups (50-59 years, 60-69 years, 70-79 years, and 80+ years) for both stroke subtypes in both sexes. Results: After adjustment for age, we found a decline in all strokes combined (-77.3% for males, -76.7% for females), and in hemorrhagic strokes and ischemic strokes considered separately, and for both sexes and all age groups. Mortality from ischemic stroke showed a steady rate of decline over the entire time period, while join-point analysis showed that, in general, for all age groups, both males and females showed differing patterns of changes in mortality from hemorrhagic strokes before 1997-2000 and a steeper decline after that period. Conclusions: Mortality from stroke declined in Austria between 1980 and 2008. Whether the establishment of acute stroke units had an impact on stroke mortality in this period remains unclear. Future studies should evaluate stroke-related changes in quality of life, as acute stroke units may have a greater impact on quality of life than on overall mortality.