Supplementary Material for: Trends In Stroke Burden In Central And Eastern Europe 1990-2019

Introduction: During the last decades there has been wide recognition of the health divide between Western Europe and the former socialist countries from Central and Eastern Europe. However, these have not been assessed in terms of burden of disease and the effect of stroke has not been fully elucidated, especially in terms of time trends. Methods: The West-Eastern European stroke burden was analysed using data from the Global Burden of Stroke (GBD) Study 2019 in terms of disability-adjusted life-years lost (DALYs) and years of life lost (YLL) over the period 1990 - 2019 by gender. Data were extracted on regional (West, Central and East Europe) and country level for the twenty former socialist countries from Central and East Europe according to GBD regional definitions. We focused on the trends of age-standardised stroke burden rates across the three decades and compared them with the average rates for West Europe. Main Findings: All Central and East European countries experienced a decline in all-cause disease burden between 1990 - 2019 and a gap was confirmed between the East, the Central and the West European region for men, but not for women. The age-standardised stroke rates declined in the three European regions and in all twenty Central and East European countries but at a different pace. The stroke burden among women exhibited the greatest decline in the West -59% [95% UI (-60; -57)] followed by the Central European region -48% [95% UI (-53; -42)] and lowest among women in East Europe -37% [95% UI (-43; -29)]. The decline of stroke burden among Western men was even higher than among women -61% [95% UI (-63; -60)], while in Central Europe it was -43% [95% UI (-50; -37)] and in the East -25% [95% UI (-34; -14)], leading to widening of the gap between East, Central and West Europe in relation to stroke burden. Conclusions: The burden of stroke contributes to the European health gap through preventable premature stroke deaths. There are some very successful countries in stroke burden management from both Central (Slovenia, Czech Republic, Hungary) and East Europe (Estonia), suggesting that closing the health gap between East and West is a realistic aim.

引言：近数十年来，西欧与中东欧前社会主义国家之间的健康差距已得到广泛认知。然而，现有研究尚未从疾病负担视角对该差距展开评估，且卒中（stroke）的影响尚未被完全阐明，尤其是在时间趋势层面。

研究方法：本研究借助《2019年全球卒中负担研究（Global Burden of Stroke, GBD）》的数据，以1990年至2019年按性别划分的伤残调整寿命年（disability-adjusted life-years lost, DALYs）与早死寿命损失年（years of life lost, YLL）为指标，分析了东西欧的卒中负担差异。研究依据GBD的区域划分标准，提取了中东欧20个前社会主义国家的区域（西欧、中欧、东欧）与国家级数据。本研究聚焦近30年年龄标化卒中负担率的变化趋势，并将其与西欧的平均卒中负担率进行对比。

主要研究结果：1990年至2019年间，所有中东欧国家的全因疾病负担均有所下降；男性群体中，东欧、中欧与西欧区域间的健康差距已得到证实，但女性群体中未出现该现象。三个欧洲区域以及全部20个中东欧国家的年龄标化卒中负担率均有所下降，但下降速率各不相同。女性群体的卒中负担下降幅度以西欧最为显著，达59%[95% UI (-60; -57)]，其次为中欧区域（48%，95% UI (-53; -42)），东欧女性的下降幅度最低，为37%[95% UI (-43; -29)]。西欧男性群体的卒中负担下降幅度甚至高于女性，达61%[95% UI (-63; -60)]；中欧男性为43%[95% UI (-50; -37)]，东欧男性为25%[95% UI (-34; -14)]，这导致东欧、中欧与西欧区域间的卒中负担差距进一步扩大。

结论：卒中负担通过可预防的卒中过早死亡加剧了欧洲的健康差距。从中欧（斯洛文尼亚、捷克共和国、匈牙利）与东欧（爱沙尼亚）均能找到卒中负担管理成效显著的国家，这表明缩小东西欧健康差距是一个切实可行的目标。