Gesundheitswesen 2017; 79(08/09): 656-804
DOI: 10.1055/s-0037-1605858
Vorträge
Georg Thieme Verlag KG Stuttgart · New York

Recent regional trends in mortality of stroke subtypes in Germany

V Rücker
1   Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg
,
M O'Flaherty
2   University of Liverpool, Deparment of Public Health and Policy, Liverpool
,
S Hillmann
1   Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg
,
S Wiedmann
1   Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg
,
M Busch
3   Robert Koch Institut, Deparment of Epidemiology and Health Monitoring, Berlin
,
PU Heuschmann
1   Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg
› Author Affiliations
Further Information

Publication History

Publication Date:
01 September 2017 (online)

Also available at
 

Introduction:

Studies investigating recent time trends in stroke mortality for different subtypes are scarce. We describe sex and age-standardized trends in stroke mortality for different stroke subtypes in Germany from 1998 – 2014 and potential regional variations.

Methods:

Mortality and population data from the German federal statistic were used to calculate sex and age-standardized mortality rates for hemorrhagic stroke (HS) (ICD10: I60, I61), ischemic stroke (IS) (ICD10: I63, I64) and total strokes (TS) (ICD10: I60-I69) from 1998 – 2014 for all age-groups. Joinpoint® regression was used to calculate the average annual percentage change (APC) and to examine trends and changes in the trend. We conducted separate estimations for the German old federal states including East-Berlin (OFS) and new federal states (NFS).

Results:

From 1998 – 2014 age-standardized TS mortality in male ♀ decreased by over 50% from 78.0 (62.1) to 33.4 (28.7) per 100000 as well as IS mortality (rate change: m =-65%, f =-60%). The decrease of HS mortality was less strong (m =-41%, f =-30%). TS mortality reached a plateau in 2000 – 2003 in NFS and a flatting trend after 2006 in both regions. Trends in IS mortality were not parallel (female and male p < 0.001) for the regions. IS mortality in female in OFS continuously declined (APC =-4.9) whereas in NFS there are three joinpoints (2003, 2007, 2010) with a steep decline from 2010 – 2014 (APC =-8.0). Trends in HS rates decreased parallel in both regions with zero joinpoints for males and one in 2004 for females. Almost anytime mortality in the NFS was higher than mortality in the OFS. Differences in subtype- and sex-specific mortality between the regions were small in 2014 (e.g. TS rate ratio OFS/NFS m = 0.90, f = 0.91, p < 0.001).

Conclusion:

Stroke mortality declined in OFS and NFS with different time trends in the subtypes of stroke mortality between OFS and NFS. However, the differences in mortality rates 24 years after the German reunification are negligible.