Trends in Stroke Burden in Central and Eastern Europe from 1990-2019

There has been wide recognition of the health divide between Western Europe and the former socialist countries from Central and Eastern Europe. However, these have not been assessed in terms of burden of disease, and the effect of stroke has not been fully elucidated, especially in terms of time trends.

The West-Eastern European stroke burden was analysed using data from the Global Burden of Stroke (GBD) Study 2019 in terms of disability-adjusted life years lost (DALYs) and years of life lost (YLL) over the period 1990-2019 by gender. Data were extracted on a regional (West, Central, and East Europe) and country level for the twenty former socialist countries from Central and East Europe according to GBD regional definitions. We focused on the trends of age-standardized stroke DALY rates across the three decades and compared them with the average rates for West Europe.

All Central and East European countries experienced a decline in all-cause disease burden between 1990 and 2019, and a gap was confirmed between the East, the Central, and the West European region for men but not for women. The age-standardized stroke DALY rates declined in the three European regions and in all twenty Central and East European countries but at a different pace. The stroke DALY rates among women exhibited the greatest decline in the West -59% (95% UI [-60; -57]) followed by the Central European region -48% (95% UI [-53; -42]) and lowest among women in East Europe -37% (95% UI [-43; -29]). The decline in men was even higher than among women -61% (95% UI [-63; -60]), while in Central Europe it was -43% (95% UI [-50; -37]) and in the East -25% (95% UI [-34; -14]), leading to widening of the gap between East, Central, and West Europe in relation to stroke burden. YLL represented more than 70% of stroke DALYs and more than 90% of DALYs for men in East European countries.

The burden of stroke contributes to the European health gap through preventable premature stroke deaths. There are some very successful countries in stroke burden management from both Central (Slovenia, Czech Republic, and Hungary) and East Europe (Estonia), suggesting that closing the health gap between East and West is a realistic aim.