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RESEARCH PRODUCT

Incidence and case-fatality rates of stroke in Burgundy (France). Comparison between a rural (Avallon) and an urban (Dijon) population, between 1989 and 1993

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The decline of mortality from stroke observed in some countries may result from a fall in incidence or a decrease in case-fatality rates from stroke. The present study was conducted to evaluate the role of geographical parameters, comparing an urban and a rural population in Burgundy, France to look for differences in risk factor distribution. The study was a prospective, and complete case-ascertainment in a population-based survey. It was conducted on a well-defined population-based survey in a rural town (Avallon 8900 subjects) and an urban town (Dijon 140,000 subjects) in the area of Burgundy (France), from 1989 through 1993. All first-ever stroke events occurring in these two populations, whatever the age, were registered by a special six-level case-registration system. 1118 strokes cases were identified, 986 in Dijon and 132 in Avallon. In the rural area (Avallon), the incidence and case-fatality rates at 28 days were higher than those of Dijon. The higher incidence rate in Avallon may be explained by the fact that there was a higher rate of non-treated hypertension. The higher case-fatality rate in Avallon may be explained by a higher rate of hemorrhagic strokes and of comatous patients. Rural and urban populations perhaps have not the same risk factors for stroke. The differences observed in incidence and case-fatality rates should lead to a survey on the risk factors and their diagnosis and treatment between rural and urban populations.