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.