Measuring stroke in the population: quality of routine statistics in comparison with a population-based stroke registry

Neuroepidemiology. 1992;11(4-6):204-13. doi: 10.1159/000110933.


The validity of routine stroke data (official mortality statistics and hospital discharge registries) and a population-based MONICA stroke registry was assessed in a population of 309,806 25- to 74-year-old people in Sweden. The 'true' number of strokes in the population was estimated by screening for non-stroke diagnoses in death certificates and hospital discharge records and by a period of intensified search for otherwise unrecognized non-hospitalized stroke cases. Applying strict stroke criteria, the proportion of false-positive diagnoses was 10% and false-negative 17% in official mortality statistics. Among patients discharged alive from hospital, there were 32% false-positive and 6% false-negative stroke diagnoses. In the MONICA registry, the proportion of false-negative cases was 6% in fatal cases and 4% in non-fatal cases. Diagnostic information for subtyping stroke improved over time in non-fatal cases but remained essentially unchanged in fatal cases. We conclude that official mortality statistics give a reasonably good estimate of fatal stroke cases in Sweden, whereas hospital discharge records reflect poorly the incidence of stroke in the population. The overall quality of the population-based MONICA registry is good, although 4% of all strokes are missed. The proportion of unspecified stroke is substantial and changes over time; this makes longitudinal studies of stroke subtype difficult.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cause of Death*
  • Cerebrovascular Disorders / classification
  • Cerebrovascular Disorders / diagnosis
  • Cerebrovascular Disorders / mortality*
  • Cross-Sectional Studies
  • Data Interpretation, Statistical
  • Death Certificates
  • Female
  • Hospital Mortality
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Registries / statistics & numerical data*
  • Survival Rate
  • Sweden / epidemiology