30
Percent
25
Total
20
Women Men
95
Figure 101 Sweden
96
97
98
99
00
01
02
03
04
05
06
07
08
09
10
11
28-day case fatality rate for first-ever stroke. Both hospitalised patients and those who died without hospital care. Source: Patient Register and Cause of Death Register, National Board of Health and Welfare
101 First-ever Stroke – 28-day and 90-day Case Fatality Rate The OECD uses mortality after stroke as an indicator of healthcare quality in international comparisons. The indicator presented here examines quality throughout the healthcare system: preventive, ambulance, acute and follow-up. Stroke is defined as all cases that include a diagnosis of cerebral haemorrhage, cerebral infarction or unspecified stroke in the Cause of Death Register or the inpatient section of the National Patient Register. Thus, both patients who were hospitalised and those who died without being hospitalised are included. The comparison comprises only first-ever stroke cases (more than 77 000 in 2009–2011), i.e., patients who had not had a stroke during the seven preceding years. Almost 22 per cent, or over 5 500 annually, of them died within 28 days during this three-year period. More than 26 per cent died within 90 days. After adjusting for differing age structures, the case fatality rate was similar for women and men. Mortality within both 28 and 90 days had declined by half a percentage point since 2006–2008. Figure 101 reveals that the counties varied somewhat in terms of case fatality rates. Among the possible causes of the differences are diagnostic reliability, comorbidity and other background factors, social variables, random parameters and the propensity of the population to seek care. Healthcare-related factors may include distance to emergency care, the efficiency of ambulance services and acute hospital care. The 28-day case fatality rate varied from 19 to 27 per cent for women and 16 to 24 per cent for men among the various counties. The diagram of trends makes it clear that post-stroke survival has improved somewhat over the past 15 years for both women and men, though not to the same extent as for myocardial infarction.
QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2012
213