Stable stroke incidence rates but improved case-fatality 06 in Dijon, France, from 1985 to 2004

Background and Purpose-With the progress in stroke prevention, it is important to evaluate the epidemiological trends of strokes over a long period and from a nonselected population-based perspective. Methods-We estimated changes in incidence, case-fatality rates, severity, risk factors and prestroke use of preventive treatments for first-ever strokes, from a continuous 20-year well-defined population-based registry, from 1985 to 2004. Results-We recorded 3142 ischemic strokes, 341 primary cerebral hemorrhages and 74 subarachnoid hemorrhages. During the 20-year study, the age at first stroke onset increased by 5 years in men and 8 years in women. Comparing the 1985 to 1989 and the 2000 to 2004 periods, age- and sex-standardized incidences of first-ever strokes were stable except for lacunar strokes whose incidence significantly increased (P = 0.01) and for cardioembolic stroke whose incidence significantly decreased (P = 0.01). Twenty-eight-day case-fatality rates decreased significantly mainly for lacunar strokes (P = 0.05) and for primary cerebral hemorrhages (P = 0.03). The proportion of hypercholesterolemia and diabetes significantly increased (P < 0.01). In contrast, the proportion of myocardial infarction significantly decreased (P = 0.02). Prestroke antiplatelets and anticoagulants treatment significantly increased (P < 0.01). Conclusions-The age- and sex-standardized incidences of first strokes in Dijon have been stable over the past 20 years and were associated with an increase in age at stroke onset, a decrease in case-fatality rates, and an increased use of antiplatelet treatments.