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Changes in Long-Term Survival After Stroke Between 2013 and 2020 : A Nationwide Cohort Study from the Swedish Stroke Register

Johnsson, Marcus LU ; Sennfält, Stefan ; Apostolaki-Hansson, Trine LU orcid ; Pihlsgård, Mats LU ; Wasselius, Johan LU ; Norrving, Bo LU ; Ullberg, Teresa LU and Hansen, Björn M LU orcid (2026) In International Journal of Stroke
Abstract

IntroductionChanges in long-term survival after stroke at the population level are incompletely characterized, particularly using recent data and stratified by stroke type.Patients and MethodsThis nationwide, register-based cohort study used data from the Swedish Stroke Register (Riksstroke) and the Swedish Causes of Death Register. Adults (≥18 years) hospitalized with ischemic stroke or intracerebral hemorrhage in Sweden during either 2013 or 2020 were included. Patients were followed for 3 years after the index stroke. The primary outcome was difference in all-cause mortality within 3 years. Survival was assessed using Kaplan-Meier analyses and Cox proportional hazards regression, stratified by stroke type.ResultsThe study included 42... (More)

IntroductionChanges in long-term survival after stroke at the population level are incompletely characterized, particularly using recent data and stratified by stroke type.Patients and MethodsThis nationwide, register-based cohort study used data from the Swedish Stroke Register (Riksstroke) and the Swedish Causes of Death Register. Adults (≥18 years) hospitalized with ischemic stroke or intracerebral hemorrhage in Sweden during either 2013 or 2020 were included. Patients were followed for 3 years after the index stroke. The primary outcome was difference in all-cause mortality within 3 years. Survival was assessed using Kaplan-Meier analyses and Cox proportional hazards regression, stratified by stroke type.ResultsThe study included 42 926 patients. Among patients with ischemic stroke, 3-year survival increased from 63.8% in 2013 to 69.3% in 2020, corresponding to an absolute difference of 5.5 percentage points, with survival differences increasing progressively during follow-up. Ischemic stroke in 2020 was associated with a lower risk of 3-year mortality compared with 2013 in both unadjusted (hazard ratio (HR), 0.83; 95% CI, 0.80-0.86) and multivariable analyses (adjusted HR, 0.92; 95% CI, 0.89-0.96). Survival improvements after ischemic stroke were most pronounced among patients aged 75 years or older. In contrast, long-term survival after intracerebral hemorrhage did not change between cohorts (3-year survival, 50.9% in both years; adjusted hazard ratio, 0.97; 95% CI, 0.89-1.05).ConclusionsIn this nationwide cohort study, 3-year survival after ischemic stroke improved between 2013 and 2020, particularly among patients aged 75 years or older, whereas long-term survival after intracerebral hemorrhage remained unchanged. These findings suggest a contemporary population-level improvement in long-term survival after ischemic stroke over a relatively short calendar period and indicate that survival differences between cohorts increased progressively over long-term follow-up.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
International Journal of Stroke
article number
17474930261448295
publisher
Wiley-Blackwell
external identifiers
  • scopus:105039708141
  • pmid:42033194
ISSN
1747-4949
DOI
10.1177/17474930261448295
language
English
LU publication?
yes
id
e6e0a147-d685-4bb5-ab1a-a9627c22be08
date added to LUP
2026-05-07 14:32:57
date last changed
2026-07-03 04:00:49
@article{e6e0a147-d685-4bb5-ab1a-a9627c22be08,
  abstract     = {{<p>IntroductionChanges in long-term survival after stroke at the population level are incompletely characterized, particularly using recent data and stratified by stroke type.Patients and MethodsThis nationwide, register-based cohort study used data from the Swedish Stroke Register (Riksstroke) and the Swedish Causes of Death Register. Adults (≥18 years) hospitalized with ischemic stroke or intracerebral hemorrhage in Sweden during either 2013 or 2020 were included. Patients were followed for 3 years after the index stroke. The primary outcome was difference in all-cause mortality within 3 years. Survival was assessed using Kaplan-Meier analyses and Cox proportional hazards regression, stratified by stroke type.ResultsThe study included 42 926 patients. Among patients with ischemic stroke, 3-year survival increased from 63.8% in 2013 to 69.3% in 2020, corresponding to an absolute difference of 5.5 percentage points, with survival differences increasing progressively during follow-up. Ischemic stroke in 2020 was associated with a lower risk of 3-year mortality compared with 2013 in both unadjusted (hazard ratio (HR), 0.83; 95% CI, 0.80-0.86) and multivariable analyses (adjusted HR, 0.92; 95% CI, 0.89-0.96). Survival improvements after ischemic stroke were most pronounced among patients aged 75 years or older. In contrast, long-term survival after intracerebral hemorrhage did not change between cohorts (3-year survival, 50.9% in both years; adjusted hazard ratio, 0.97; 95% CI, 0.89-1.05).ConclusionsIn this nationwide cohort study, 3-year survival after ischemic stroke improved between 2013 and 2020, particularly among patients aged 75 years or older, whereas long-term survival after intracerebral hemorrhage remained unchanged. These findings suggest a contemporary population-level improvement in long-term survival after ischemic stroke over a relatively short calendar period and indicate that survival differences between cohorts increased progressively over long-term follow-up.</p>}},
  author       = {{Johnsson, Marcus and Sennfält, Stefan and Apostolaki-Hansson, Trine and Pihlsgård, Mats and Wasselius, Johan and Norrving, Bo and Ullberg, Teresa and Hansen, Björn M}},
  issn         = {{1747-4949}},
  language     = {{eng}},
  month        = {{04}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{International Journal of Stroke}},
  title        = {{Changes in Long-Term Survival After Stroke Between 2013 and 2020 : A Nationwide Cohort Study from the Swedish Stroke Register}},
  url          = {{http://dx.doi.org/10.1177/17474930261448295}},
  doi          = {{10.1177/17474930261448295}},
  year         = {{2026}},
}