Academic Journal
Stroke mortality in Greece (2001-2021): Trends, sex differences, and the impact of population aging.
| Title: | Stroke mortality in Greece (2001-2021): Trends, sex differences, and the impact of population aging. |
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| Authors: | Lioutas VA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Katsanos AH; Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada., Palaiodimou L; Second Department of Neurology, 'Attikon' University Hospital, Athens, Greece.; School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Theodorou A; Second Department of Neurology, 'Attikon' University Hospital, Athens, Greece.; School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Ellul J; Department of Neurology, University General Hospital of Patras, Patras, Greece., Karapanayiotides T; Second Department of Neurology, Faculty of Health Sciences, School of Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece., Safouris A; Second Department of Neurology, 'Attikon' University Hospital, Athens, Greece.; School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Kargiotis O; Department of Neurology, University General Hospital of Patras, Patras, Greece., Manios E; Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Giannopoulos S; Second Department of Neurology, 'Attikon' University Hospital, Athens, Greece.; School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Themistocleous M; Neurosurgical Department, Pediatric Hospital of Athens, 'Agia Sophia,' Athens, Greece., Vadikolias K; Department of Neurology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece., Mitsias PD; Department of Neurology, University General Hospital of Heraklion, Heraklion, Greece.; Department of Neurology, Henry Ford Hospital, Detroit, MI, USA., Tsivgoulis G; Second Department of Neurology, 'Attikon' University Hospital, Athens, Greece.; School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. |
| Source: | International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2026 Jun; Vol. 21 (5), pp. 688-698. Date of Electronic Publication: 2025 Oct 14. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: SAGE Publications Country of Publication: United States NLM ID: 101274068 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1747-4949 (Electronic) Linking ISSN: 17474930 NLM ISO Abbreviation: Int J Stroke Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2016- : Thousand Oaks, CA : SAGE Publications Original Publication: Oxford, UK : Blackwell Pub., c2005- |
| MeSH Terms: | Stroke*/mortality , Aging*, Greece/epidemiology ; Mortality/trends ; Humans ; Female ; Male ; Aged ; Middle Aged ; Aged, 80 and over ; Adult ; Sex Factors ; Young Adult ; Cause of Death |
| Abstract: | Background: Despite stroke being a leading cause of mortality in Greece, long-term national data on stroke mortality trends remain limited. This study aimed to describe trends in stroke mortality in Greece between 2001 and 2021, accounting for demographic shifts and changes in care delivery, using nationwide mortality and population data. Methods: We analyzed cause-of-death data from the Hellenic Statistical Authority (ELSTAT) for 2001-2021. Stroke deaths were defined using International Classification of Diseases, Ninth Revision (ICD-9) (430-438) and Tenth Revision (ICD-10) (I60-I69, G45x) codes. Crude and age-standardized mortality rates (using the GBD 2019 standard) were computed annually and stratified by sex. Negative binomial regression was used to estimate the average annual percent change (AAPC) in mortality. Sex-specific trends, age-specific rate ratios, and time interactions were examined. A decomposition analysis using the Das Gupta method was conducted to quantify the contribution of population aging versus changes in age-specific stroke mortality. Results: Between 2001 and 2021, crude stroke mortality declined from 171.1 to 116.5 per 100,000, and age-standardized mortality declined from 90.5 to 36.4 per 100,000. Crude mortality remained higher in women, but age-standardized mortality was consistently lower compared with men. The female advantage in age group-specific stroke mortality has narrowed over time and reversed in the ⩾80 age group where females experience higher mortality than men. The estimated AAPC for the overall population was -1.90%, corresponding to approximately 292 fewer stroke deaths per year. Decomposition analysis revealed that improvements in age-specific mortality outweighed the adverse effects of population aging. Conclusion: Despite substantial population aging and rising crude all-cause mortality, stroke mortality in Greece has declined significantly over the past two decades. This trend likely reflects improvements in acute stroke care and reduced case fatality, rather than a decrease in incidence. Although recent efforts have expanded access to acute reperfusion therapies and stroke units, further gains are possible. Continued investment in national stroke systems and implementation of a comprehensive stroke registry are essential for sustaining and accelerating progress.Data access statement:The study utilized publicly available aggregate data (https://www. Statistics: gr/en/home). |
| Competing Interests: | Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| Contributed Indexing: | Keywords: Greece; Stroke mortality; cerebrovascular disease; decomposition analysis; epidemiological trends; population aging; sex differences |
| Entry Date(s): | Date Created: 20251111 Date Completed: 20260523 Latest Revision: 20260613 |
| Update Code: | 20260614 |
| DOI: | 10.1177/17474930251389510 |
| PMID: | 41217260 |
| Database: | MEDLINE |
| ISSN: | 1747-4949 |
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| DOI: | 10.1177/17474930251389510 |