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Understanding stroke mortality trends in Spain: A comprehensive age-period-cohort and joinpoint analysis
L Cayuela1, E Zapata-Arriaza2, A de Albóniga-Chindurza2
1Department of Internal Medicine, Hospital Severo Ochoa, Leganés, Spain.
Neurologia
|September 3, 2025
Summary
Spanish stroke mortality rates declined between 1982-2021 due to period and cohort effects. However, recent trends show a slowing decline, emphasizing the need for continued stroke prevention strategies.
Area of Science:
- Epidemiology
- Public Health
- Gerontology
Background:
- Stroke mortality trends in Spain from 1982 to 2021.
- Analysis of age-period-cohort (A-P-C) effects on stroke mortality.
Purpose of the Study:
- To update and evaluate A-P-C effects on Spanish stroke mortality.
- To identify trends and influencing factors in stroke mortality rates.
Main Methods:
- Utilized National Institute of Statistics data (1982-2021) for stroke mortality and population demographics.
- Employed Joinpoint trend analysis software for rate estimation and trend analysis.
- Applied a log-linear Poisson model with a likelihood penalty function to estimate A-P-C effects.
Main Results:
- Age-standardized stroke mortality rates decreased for both sexes (-4.3% men, -4.6% women).
- The rate of decline has slowed in recent years, with stabilization in women aged 30-64 since 2012.
- Birth cohorts show a downward trend in relative risk, though this decline has slowed for women born 1947-1962 and stabilized/slowed in the last decade for both sexes.
Conclusions:
- Period and cohort effects significantly influenced the decline in Spanish stroke mortality.
- Decreased mortality may not offset potential increases in incidence in younger cohorts, leading to slowed/stagnant declines.
- Continued focus on stroke prevention is crucial given current trends.
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