Cerebrovascular disease: declining incidence but increasing hospital utilisation

A total of 20,680 patients hospitalised in Helsinki during 1970-1980 due to cerebrovascular diseases were found when screening the Finnish National Hospital Discharge Register. The material was categorised according to three-digit ICD-8 diagnosis codes and age, and was analysed for case-fatality, length of stay and discharge status. By identifying all new cases an assessment of the incidence development during the study period was also possible. A fall in the overall age-standardised incidence of cerebrovascular disease was demonstrated, in accordance with disease register studies. The main reason was decline in incidence of haemorrhagic stoke (ICD-8 no. 431) and less well defined types of stroke (436-438). Ischaemic stroke (433), on the other hand, did not decrease in frequency. The diagnostic shift, occurring parallel with a growing mean age of patients, lead to decreasing acute mortality, increasing institutionalisation rates and longer stays in hospital, thus resulting in growing figures of hospital utilisation in spite of the declining incidence.