Research Article

Projecting the number of patients with first ever strokes and patients newly handicapped by stroke in England and Wales.

BMJ 1989; 298 doi: (Published 11 March 1989) Cite this as: BMJ 1989;298:656
  1. R. Malmgren,
  2. J. Bamford,
  3. C. Warlow,
  4. P. Sandercock,
  5. J. Slattery
  1. Department of Clinical Neurology, Radcliffe Infirmary, Oxford.


    The common assumption that future increases in the number of elderly people will result in a parallel increase in the burden of care of long term disabled survivors of stroke was examined. The number of patients with first ever strokes and the net number of people handicapped after these strokes in England and Wales every five years until 2023 have been projected. Between the base year 1983 and the year 2023 an increase in population of about 5% will occur; first ever strokes are projected to increase by about 30% and deaths within six months of first ever strokes by about 40%. The net number of severely handicapped people six months after a first ever stroke is projected to increase by only about 8%, however, and the net number of people who are moderately or severely handicapped by only 4%. This paradox occurs because first ever stroke often kills people who have been handicapped by other causes, particularly if they are elderly. It is concluded that despite the limitations of these data they strongly suggest that the increased burden of health care of patients with first ever strokes in the next 40 years will be primarily that of caring for those in the acute stages of stroke and not with the management of chronic handicap after a stroke.