Trends in Cerebrovascular Mortality in Western and Eastern Europe

Trends in Cerebrovascular Mortality in Western and Eastern Europe Fabio Levi, MD, Registre Vaudois des Tumeurs, Institut Universitaire de Médecine Sociale et Préventive, CHUV-Falaises 1, CH-1011 Lausanne (Switzerland) During the current century, major declines in mortality from cerebrovascular disease have been registered in most developed countries [1-3]. These favourable trends have almost certainly a number of different determinants, but can be partly or largely explained in terms of better control of hypertension [4]. A general overview of data and statistics on mortality from cerebrovascular disease from the early 1950s onwards can be derived for most European countries from the World Health Organization (WHO) mortality datafile [5]. This includes official death certification numbers, and estimates of resident population, for all or part of the last 4 decades (1950-1989) for all major European countries. After exclusion of a few small countries, such as Albania, Andorra or Liechtenstein, 30 countries were considered in figure 1, which includes age-standardized rates at all ages and truncated from 35 to 64 years on the World Standard Population. Data from the former Soviet Union, recently made available to the WHO database, were added to previously published work [5]. Overall age-standardized mortality from cerebrovascular diseases in the late 1950s was between 80 and 130/ 100,000 males in most European countries. Values were somewhat lower for females, particularly at a younger age and hence in the truncated rates from 35 to 64 years. The lowest rates were observed in East Germany (about 40/ 100,000) and Poland (about 35/100,000). Over the following 3 decades in all Western European countries, except Greece and Portugal, substantial declines in overall cerebrovascular disease mortality were observed and in the late 1980s rates ranged between 40 and 80/100,000 males and 30 and 60/100,000 females in most countries. Thus in most Western European countries cerebrovascular disease death rates were approximately halved between 1950 and 1990. This has been the major advancement on a public health scale for any important cause of death during the second part of this century. In several countries these falls became steeper over more recent calendar periods. The downward trends were even larger in young and middle age; in 1985-1989, for instance, Switzerland had a truncated rate (35-64 years) of 17/100,000 males and 10/ 100,000 females, and several other Western European countries had truncated rates around 20-30/100,000 males and 15-25/100,000 females. Only two Western European countries had less favourable trends. In Greece, overall mortality from cerebrovascular diseases remained stable at around 80/100,000 in both sexes, although appreciable declines were observed in the truncated rates, particularly in females. In Portugal, mortality markedly increased until the late 1970s, to approach 200/100,000 males and 145/100,000 females, and only later started to decline, still remaining at over 140/100,000 males and 100/100,000 females (i.e., the third highest on a worldwide scale) in the late 1980s. In contrast, cerebrovascular disease mortality increased in the whole of Eastern Europe, including both countries with low rates in the past (i.e., Poland or former East Germany, where rates in the late 1980s were over 60/100,000 males and over 40/100,000 females), and ©1994 S.Karger AG, Basel 0014-3022/94/0346-0301 $8.00/0