gms | German Medical Science

Background and Purpose: While stroke mortality data are generally available only few data for estimating stroke incidence in Germany exist. The registry “Ludwigshafen Stroke Study (LuSSt)” exists since Jan, 1st, 2006 providing population-based data [1]. Stroke mortality ranks the third position after cardiovascular heart diseases and cancer. Here, we present detailed results on stroke incidence rates.

Methods: LuSSt is a population-based stroke registry in the city of Ludwigshafen (168.000. residents), Rhineland-Palatine, Germany. Multiple overlapping methods of patient identification were used based on a cooperation of all providers of in- and outpatient care in and around the city of Ludwigshafen in order to achieve complete case ascertainment. Stroke was defined according to the WHO criteria.

We calculated crude, age-specific and age-adjusted incidence rates by sex both for all cases and stroke subtypes. The standard European population was used for standardization. Exact 95% confidence intervals for the rates based on the Poisson distribution were calculated.

Results: 1231 cases with stroke or transient ischemic attack (TIA) were registered between Jan, 1st, 2006 and Dec, 31st, 2007 with age mean 71.6 years (SD 12.9; range 26 to 102 years). Among all cases, 51.1% occurred in males; 21.7% experienced a TIA while 19.3% suffered from recurrent stroke. A first-ever stroke (FES) was diagnosed in 725 (58.9%) patients with a mean age of 71.5 years (SD 13.1). 48.3% of FES occurred in men (mean age 69.5, SD 12.2) and 51.7% in women (mean age 73.4, SD 13.5). Incidence rates showed a strong increase with age in males and females and were lower in women than in men except from the age group between 45 and 54 years. Age standardized FES incidence rate was 1.46 (95%CI 1.35-1.57), in males 1.63 (1.46-1.81) and in females 1.29 (1.15-1.43). While crude incidence rates did not differ by sex, after age-adjustment a significant preponderance for men in total stroke incidence was observed, and a non-significant trend regarding the incidence of ischemic stroke. In patients with FES, 656 (86%) suffered from ischemic stroke (IS), 68 (8.9%) were diagnosed with intracerebral hemorrhage and 17 (2.2%) had subarachnoid hemorrhage. A comparison with data from other industrialized countries will be presented.

Conclusion: 59% of all cases observed were first ever strokes, and among these 86% were ischemic strokes and 11% hemorrhagic. Potentials and limitations to run a stroke registry will be discussed.