1.2 Incidence – how many people have a stroke?

There is great variation in the reported number of strokes as a proportion of the population between different studies. Some of the variation is due to real differences in stroke incidence between different countries and regions. But some of this variation is also due to the different criteria and methods used to collect the data. Despite this some trends do emerge. Table 1 shows that there are major differences in stroke incidence rates across Europe. Some of the highest rates are in Eastern and Northern Europe (Croatia, Estonia, Lithuania, Sweden); and some of the lowest are in Western and Southern European countries (France, Italy, Spain).

This is similar to findings from the European Registers of Stroke project[10]. Large variations in incidence are also seen within countries (e.g. Italy, Spain, Sweden, UK). Possible explanations for these large inter- and intra-country differences include different risk factor profiles (e.g. high blood pressure or cholesterol, smoking, diet, alcohol, exercise), socio-economic and environmental factors (air pollution, deprivation), but also standards of and access to healthcare, leading to different levels of risk factor control, and of acute and long term care.

”I never had before thought about that disease; I had no way of [knowing], nobody in the family had ever had a stroke. I thought everything was fine, and I was relatively young. I was 47.”
(Female stroke survivor, Austria)

Table 1: Annual incidence rates of first-ever stroke since 2000 reported by population- based registers in European/SAFE countries, ranked by magnitude of incidence

Table 2: Annual incidence and case fatality rates (at 1 month) in population-based registers in Europe, ranked by falling, stable, or rising incidence rates

 
Some long-running stroke registers have reported increasing incidence rates. Better diagnosis and case ascertainment due to the increasing use of radiological scans are possible explanations as well as still insufficient prevention efforts[39].