Abstract
Introduction: Data are scarce on both stroke incidence rates and outcomes in Greece and in rural areas in particular. We performed a prospective population-based study evaluating the incidence of first-ever stroke in the Evros perfecture, a region of a total 147,947 residents located in North Eastern Greece. Methods: Adult patients with first ever stroke were registered during a 24-month period (2010-2012) and followed up for 12 months. To compare our stroke incidence with that observed in other studies, we standardized our incidence rate data according to the European Standard Population (ESP) of 2013 and applied criteria of data quality, as proposed by the Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) project. Stroke diagnosis and classification was performed using WHO criteria on the basis of neuroimaging and/or autopsy data. Results: We prospectively documented 703 stroke cases (mean age: 75±12 years; 52.8% males; ischemic stroke (IS): 80.8%, intracerebral hemorrhage (ICH): 11.8%, subarachnoid hemorrhage (SAH): 4.4%, undefined: 3.0%) with a total follow-up time of 119,805 person-years. The unadjusted and ESP adjusted incidences of all strokes were 586.8 (95%CI: 543.4-630.2) and 534.3 (95%CI: 532.3-536.3) per 100,000 person-years, respectively. The unadjusted incidence rates for IS, ICH and SAH were 474.1 (95%CI: 435-513), 69.3 (95%CI: 54-84) and 25.8 (95%CI: 25.7-25.9) per 100,000 person-years, respectively. The corresponding ESP-adjusted incidence rates per 100,000 person-years were 425.9 (95%CI: 424-427), 63.3 (95%CI: 63-63.5) and 25.8 (95%CI: 25.7-25.9) for IS, ICH and SAH, respectively. The overall 30-day case fatality rate was 21.3% (95%: 18.3-24.4%) for all strokes, and was higher in hemorrhagic strokes than IS (40.4%, 95%CI: 31.3-49.4% vs 16.2%, 95%CI: 13.2%-19.2%). Conclusion: This is the largest to date population-based study in Greece documenting one of the highest stroke incidences in South-Eastern Europe.
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