Two Decades of Declining Stroke Burden in Kaunas, Lithuania (2000–2023): A Population-Based Analysis of Morbidity, Mortality, and Case-Fatality Trends by Sex, Age, and Stroke Type

Background and Objectives: Stroke remains a major contributor to global morbidity and mortality, with substantial geographic variation in incidence and outcomes. Although declining trends in stroke incidence and mortality have been documented in several Western European populations, countries in Eastern Europe have historically experienced a disproportionately high cardiovascular disease burden. Comprehensive long-term evaluations assessing simultaneous trends in stroke attack rates, mortality, and case-fatality in Lithuania are limited. This study aimed to investigate 24-year trends (2000–2023) in stroke epidemiology among working-age residents of Kaunas city. Materials and Methods: Data were derived from the Kaunas population-based stroke registry and included individuals aged 25–64 years. Age-standardized attack rates, mortality rates, and case-fatality rates per 100,000 population were calculated using the World Health Organization standard population. Temporal trends were assessed using Joinpoint regression analysis to estimate annual percentage changes (APCs) with corresponding 95% confidence intervals (CIs). Analyses were stratified by sex, age group (25–54 and 55–64 years), and stroke subtype (ischemic and hemorrhagic). Results: During 2000–2023, overall stroke attack rates declined significantly in both sexes, with a more pronounced reduction observed among females. Stroke mortality decreased significantly among females over the entire study period, whereas no significant overall change was observed among males, largely due to increases during 2010–2021 that attenuated earlier and subsequent improvements. Case-fatality rates demonstrated no significant overall long-term trend in either sex but exhibited marked temporal variability, including significant increases during 2010–2021 followed by substantial declines after 2021. Age-stratified analyses confirmed significant reductions in attack rates across both age groups. Ischemic stroke incidence declined significantly in both sexes, while hemorrhagic stroke mortality decreased significantly among males and females. The period 2021–2023 was characterized by pronounced reductions in mortality and case-fatality across multiple subgroups. Conclusions: Over the past two decades, the stroke burden among working-age residents of Kaunas has declined substantially, particularly among females. Despite period-specific deteriorations, recent improvements underscore the impact of advances in stroke prevention and acute care. Sustained risk factor control and continued healthcare system development remain essential to maintain favourable trends.