Decrease in Fatal Strokes Related to Decrease in Smoking Rates?

In Finland, subarachnoid hemorrhage prevalence decreased by 45 percent and 38 percent among women and men under age 50 years, respectively. Additionally, in women and men over 50, SAH prevalence decreased by 16 percent and 26 percent, respectively. During the same period, smoking among the population aged 15-64 years decreased by about a third.

Smoking cessation in Finland might be the impetus behind a decrease in fatal strokes, according to recent findings published in Neurology.

Researchers from the University of Helsinki utilized the nationwide Cause of Death Register and Hospital Discharge Register in order to determine the nationwide incidence of the most fatal types of strokes, subarachnoid hemorrhage (SAH). The researchers also gathered data pertaining to population statistics and wanted to report on the nationwide changes in smoking rates in Finland between 1998 and 2012 from the National Institute for Health and Welfare database.

The researchers identified 6,885 people with SAH, though about a quarter of sudden SAH deaths occurred away from hospitals or emergency rooms.

Previously, researchers thought about 1,000 people per year suffered from SAH; the actual figure was about half that over the 15 year period studied. SAH prevalence decreased by 45 percent and 38 percent among women and men under age 50 years, respectively. Additionally, in women and men over 50, SAH prevalence decreased by 16 percent and 26 percent, respectively. During the same period, smoking among the population aged 15-64 years decreased by about a third.

“It is extraordinary for the incidence of any cardiovascular disease to decrease so rapidly at the population level in such a short time,” one of the study’s authors Jaakko Kaprio said in a press release. “Even though we cannot demonstrate a direct causation in nationwide studies, it is highly likely that the national tobacco policies in Finland have contributed to the decline in the incidence of this type of severe brain hemorrhage.”

The researchers pointed out that the SAH incidence in Finland is similar to other Nordic countries, though another study author, Miikka Korja, added that the SAH incidence in most countries is known. This is partly due to patients’ immediate deaths of a hemorrhage outside of hospital settings being classified erroneously as heart failure. But in Finland, autopsies are typically conducted in most cases when a patient dies outside of a hospital setting, which allows for a confirmed cause of death.

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