Post-90-Day Survival After Stroke According to 90-Day Functional Outcome in the 2013 and 2020 Cohorts: A Swedish Stroke Register Study
5 affiliations
- 1Department of Neurology, Skåne University Hospital, Lund, Sweden
- 2Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- 3Department of Radiology, Skåne University Hospital, Lund, Sweden
- 4Stroke Imaging Research Group, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- 5Perinatal and Cardiovascular Epidemiology, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
Abstract
Introduction: Ninety-day functional outcome is a strong predictor of long-term survival after stroke, but whether survival differs across calendar-year cohorts within a national stroke population at similar levels of poststroke disability remains unclear. We therefore examined whether long-term survival from 90 days to 3 years after stroke differed between 2013 and 2020, stratified by functional outcome at 90 days.
Methods: In this nationwide register-based cohort study using the Swedish Stroke Register, we included patients with ischemic stroke (IS) or intracerebral hemorrhage (ICH) admitted in 2013 or 2020 who were prestroke independent (modified Rankin Scale [mRS] 0–2) and survived 90 days. The primary outcome was all-cause mortality between day 90 and 3 years after stroke. Multivariable Cox regression models estimated adjusted hazard ratios (aHRs) and assessed whether the association between calendar-year cohort and mortality differed by 90-day mRS.
Results: Among 27,452 patients (24,574 IS and 2,878 ICH), adjusted 3-year survival improved for 90-day survivors in 2020 compared with 2013 after IS (aHR 0.86, 95% CI 0.80–0.92), whereas no improvement was observed after ICH (aHR 0.98, 95% CI 0.80–1.19). In IS, higher survival in 2020 was observed both among functionally independent patients (mRS 0–2; aHR 0.76, 95% CI 0.68–0.86; 3-year survival 93.4% vs. 91.9%) and those with dependency at 90 days (mRS 3–5; aHR 0.84, 95% CI 0.77–0.91; 76.3% vs. 71.7%). In contrast, survival was not significantly different after ICH (mRS 0–2: 90.7% vs. 91.1%; mRS 3–5: 78.5% vs. 77.8%). Across both stroke subtypes, 90-day disability remained strongly associated with long-term mortality.
Discussion: Post-90-day survival after IS was higher in the 2020 than the 2013 cohort and was observed across the full spectrum of poststroke disability. Findings suggest that gains in survival are not limited to patients with favorable recovery but extend across levels of poststroke disability, potentially reflecting improvements in post-acute stroke care and secondary prevention. In contrast, no corresponding improvement was observed across functional outcome levels after ICH. Further studies are needed to confirm these findings and investigate their underlying mechanisms.
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BibTeX
@article{johnsson2026post90day,
title = {{Post-90-Day Survival After Stroke According to 90-Day Functional Outcome in the 2013 and 2020 Cohorts: A Swedish Stroke Register Study}},
author = {Marcus Johnsson and Björn M. Hansen and Trine Apostolaki-Hansson and Mats Pihlsgård and Bo Norrving and Teresa Ullberg},
journal = {Neuroepidemiology},
year = {2026},
month = sep,
doi = {10.1159/ned/adwag044},
url = {https://doi.org/10.1159/ned/adwag044},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Post-90-Day Survival After Stroke According to 90-Day Functional Outcome in the 2013 and 2020 Cohorts: A Swedish Stroke Register Study
AU - Marcus Johnsson
AU - Björn M. Hansen
AU - Trine Apostolaki-Hansson
AU - Mats Pihlsgård
AU - Bo Norrving
AU - Teresa Ullberg
PY - 2026
DA - 2026/09/30
JO - Neuroepidemiology
DO - 10.1159/ned/adwag044
UR - https://doi.org/10.1159/ned/adwag044
AB - Introduction: Ninety-day functional outcome is a strong predictor of long-term survival after stroke, but whether survival differs across calendar-year cohorts within a national stroke population at similar levels of poststroke disability remains unclear. We therefore examined whether long-term survival from 90 days to 3 years after stroke differed between 2013 and 2020, stratified by functional outcome at 90 days. Methods: In this nationwide register-based cohort study using the Swedish Stroke Register, we included patients with ischemic stroke (IS) or intracerebral hemorrhage (ICH) admitted in 2013 or 2020 who were prestroke independent (modified Rankin Scale [mRS] 0–2) and survived 90 days. The primary outcome was all-cause mortality between day 90 and 3 years after stroke. Multivariable Cox regression models estimated adjusted hazard ratios (aHRs) and assessed whether the association between calendar-year cohort and mortality differed by 90-day mRS. Results: Among 27,452 patients (24,574 IS and 2,878 ICH), adjusted 3-year survival improved for 90-day survivors in 2020 compared with 2013 after IS (aHR 0.86, 95% CI 0.80–0.92), whereas no improvement was observed after ICH (aHR 0.98, 95% CI 0.80–1.19). In IS, higher survival in 2020 was observed both among functionally independent patients (mRS 0–2; aHR 0.76, 95% CI 0.68–0.86; 3-year survival 93.4% vs. 91.9%) and those with dependency at 90 days (mRS 3–5; aHR 0.84, 95% CI 0.77–0.91; 76.3% vs. 71.7%). In contrast, survival was not significantly different after ICH (mRS 0–2: 90.7% vs. 91.1%; mRS 3–5: 78.5% vs. 77.8%). Across both stroke subtypes, 90-day disability remained strongly associated with long-term mortality. Discussion: Post-90-day survival after IS was higher in the 2020 than the 2013 cohort and was observed across the full spectrum of poststroke disability. Findings suggest that gains in survival are not limited to patients with favorable recovery but extend across levels of poststroke disability, potentially reflecting improvements in post-acute stroke care and secondary prevention. In contrast, no corresponding improvement was observed across functional outcome levels after ICH. Further studies are needed to confirm these findings and investigate their underlying mechanisms.
SN - 0251-5350
SN - 1423-0208
ER -