Five-Year Case Fatality Following First-Ever Stroke in the Mashhad Stroke Incidence Study: A Population-Based Study of Stroke in the Middle East

Mohammad Taghi Farzadfard, Amanda G. Thrift, Amin Amiri, Moira K. Kapral, Peyman Hashemi, Luciano A. Sposato, Maryam Salehi, Ali Shoeibi, Alireza Hoseini, Naghmeh Mokhber, Mahmoud Reza Azarpazhooh

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2 Citations (Scopus)


Background and Purpose: Despite recent declines in stroke mortality in high-income countries, the incidence and mortality of stroke have increased in many low- and middle-income countries. Population-based information on stroke in such countries is a research priority to address this rising trend. This study was designed to evaluate 5-year stroke mortality and its associated factors. Methods: During a 12-month period beginning from November 2006, 624 patients with first-ever stroke (FES) living in Mashhad, Iran, were recruited and followed longitudinally. Kaplan-Meier analyses were used to determine the cumulative risk of death. Prognostic variables associated with death were assessed using a Cox proportional hazard, backward logistic regression model. Results: The 5-year cumulative risk of death was 53.8% for women and 60.5% for men (log rank =.1). The most frequent causes of death were stroke (41.2%), myocardial infarction/vascular diseases (16.4%), and pneumonia (14.2%). In multivariable Cox proportional hazard analysis, male gender (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.01-1.64), age (HR: 1.04, 95% CI: 1.03-1.05, per 1-year increase), National Institute of Health Stroke Scale score at admission (HR: 1.11, 95% CI: 1.09-1.12, per 1-point increase), atrial fibrillation (HR: 1.78, CI: 1.24-2.54), and education < 12 years (HR: 1.61, 95% CI: 1.08-2.4) were associated with greater 5-year case fatality. Conclusions: Long-term case fatality following stroke in Iran is greater than that observed in many high-income countries. Targeting strategies to reduce the poor outcome following stroke, such as treating AF, is likely to reduce this disparate outcome.

Original languageEnglish
Pages (from-to)1085-1089
Number of pages5
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number4
Publication statusPublished - 1 Apr 2018


  • Middle East
  • mortality
  • population based
  • Stroke

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