One-year case fatality rate following stroke in the Mashhad Stroke Incidence Study: A population-based study of stroke in Iran

Ali Shoeibi, Maryam Salehi, Amanda G. Thrift, Moira K. Kapral, Mohammad Taghi Farzadfard, Amir Azarpazhooh, Parvaneh Layegh, Peyman Hashemi, Amin Amiri, Naghmeh Mokhber, Bahare Hassankhani, Mahmoud Reza Azarpazhooh

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Background: In developing countries, there are few comprehensive studies of mortality following stroke. Aims and/or hypothesis: We aimed to determine the one-year case fatality rate following stroke and to identify factors associated with death in a population-based stroke incidence study in Iran. Methods: Six hundred eighty-four patients who had suffered a stroke between November 21, 2006, and November 20, 2007, and were recruited to the Mashhad Stroke Incidence Study were followed up at one-year. Most patients were seen in an outpatient visit. When patients had died, a verbal autopsy was conducted by telephone with the next of kin. Results: A total of 226 (34·3%) patients died during the first year following stroke. The cumulative one-year case fatality rate was 30·6% following ischemic stroke and 53·0% following hemorrhagic stroke (55·8% after intracerebral hemorrhage and 35·7% after subarachnoid hemorrhage). The majority of these deaths occurred in the first 28 days after stroke (17·7% with ischemic and 43·0% with hemorrhagic stroke). Factors associated with greater mortality at one-year (excluding those who died during the first week) were hemorrhagic stroke [hazard ratio (HR) 3·99; 95% confidence interval 1·90-8·37], age (HR 1·05; 95% confidence interval 1·03-1·08), previous transient ischemic attack (HR 2·45; 95% confidence interval 1·00-5·99), and National Institutes of Health Stroke Scale on admission (HR 1·14; 95% confidence interval 1·10-1·17). Conclusion: Despite the younger age of stroke occurrence in Iran, the one-year case fatality rate following stroke is similar to that reported in developed countries.

Original languageEnglish
Pages (from-to)96-102
Number of pages7
JournalInternational Journal of Stroke
Issue numberSA100
Publication statusPublished - 1 Oct 2015


  • Case fatality
  • Epidemiology
  • Iran
  • Mashhad
  • Mortality
  • Stroke

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