Stroke Mortality in Greece (2001–2021): Trends, Sex Differences, and the Impact of Population Aging

Background: Despite stroke being a leading cause of mortality in Greece, long-term national data on stroke mortality trends remain limited. This study aimed to describe trends in stroke mortality in Greece between 2001 and 2021, accounting for demographic shifts and changes in care delivery, using nationwide mortality and population data. Methods: We analyzed cause-of-death data from the Hellenic Statistical Authority (ELSTAT) for 2001–2021. Stroke deaths were defined using ICD-9 (430–438) and ICD-10 (I60–I69, G45x) codes. Crude and age-standardized mortality rates (using the GBD 2019 standard) were computed annually and stratified by sex. Negative binomial regression was used to estimate the average annual percent change (AAPC) in mortality. Sex-specific trends, age-specific rate ratios, and time interactions were examined. A decomposition analysis using the Das Gupta method was conducted to quantify the contribution of population aging versus changes in age-specific stroke mortality. Results: Between 2001 and 2021, crude stroke mortality declined from 171.1 to 116.5 per 100,000, and age-standardized mortality declined from 90.5 to 36.4 per 100,000. Crude mortality remained higher in women, but age-standardized mortality was consistently lower compared to men. The female advantage in age group-specific stroke mortality has narrowed over time and reversed in the ≥80 age group where females experience higher mortality than men. The estimated AAPC for the overall population was −1.90%, corresponding to approximately 292 fewer stroke deaths per year. Decomposition analysis revealed that improvements in age-specific mortality outweighed the adverse effects of population aging. Conclusion: Despite substantial population aging and rising crude all-cause mortality, stroke mortality in Greece has declined significantly over the past two decades. This trend likely reflects improvements in acute stroke care and reduced case fatality, rather than a decrease in incidence. Although recent efforts have expanded access to acute reperfusion therapies and stroke units, further gains are possible. Continued investment in national stroke systems and implementation of a comprehensive stroke registry are essential for sustaining and accelerating progress.