Trends in haemorrhagic and ischaemic stroke mortality in Poland, 2000–2023: a population-based joinpoint analysis

Introduction Stroke remains a major contributor to cardiovascular mortality in Europe, despite advances in prevention and acute care. Purpose The aim of the study was to assess long-term trends in mortality due to haemorrhagic stroke (HS) and ischaemic stroke (IS) in Poland between 2000 and 2023. Methods The study material was a database including 453,982 death certificates of all Polish inhabitants who died due to HS and IS in the period 2000-2023. The data were provided by Statistics Poland. Standardized death rates (SDR) were calculated. The analysis of time trends has been carried out with joinpoint models and Joinpoint Regression Program. Annual Percentage Change (APC) for each segments of broken lines and average annual percentage change (AAPC) for the whole study period were calculated with corresponding 95% confidence intervals (CI). Results SDR due to HS among men decreased from 37.3 per 100,000 in 2000 to 20.9 in 2023 (Table 1). The APC in 2000–2009 was −1.5%, while in 2009–2023 the rate of decline accelerated to −3.1% annually (Figure 1). The AAPC for the entire study period was −2.5%. Among women, SDR due to HS decreased from 28.5 in 2000 to 12.2 in 2023 (AAPC = −3.6%). The pace of decline changed three times, with the fastest decreases observed in 2000–2003 (APC = −6.1%) and 2013–2016 (APC = −6.7%). SDR due to IS were higher in both sexes, while the rate of decline was slower compared with deaths due to HS. Among men, SDR due to IS decreased from 58.5 per 100,000 in 2000 to 35.7 in 2023 (AAPC = −2.0%) (Table 1). In 2000–2010 and 2015–2020, changes in SDR were not statistically significant. In contrast, significant declines were observed in 2010–2015 and 2020–2023, with APCs of −5.7% and −7.6%, respectively (Figure 1). Among women, SDR due to IS decreased from 45.6 in 2000 to 26.2 in 2023 (AAPC = −2.3%). Similarly to men, APC changed direction and magnitude three times. After non-significant changes in 2000–2010, a decline was observed in 2010–2016 at a rate of −4.6%. In 2016–2020, a non-significant increase in SDR was recorded, followed by a rapid decline after 2020 at a rate of −9.4%. Conclusions Stroke mortality declined significantly in Poland over the study period in both sexes, with a more pronounced reduction for HS. However, IS remains associated with higher mortality rates and slower overall decline. These findings highlight the progress achieved in cardiovascular prevention and acute management, while underscoring the need for sustained efforts in primary prevention, risk factor control, and post-stroke care.