Reviews Epidemiology of stroke in Italy Simona Sacco 1 , Fabrizio Stracci 2 , Davide Cerone 1 , Stefano Ricci 3 , and Antonio Carolei 1 This study reviews available data on stroke epidemiology in Italy. Data were identified through Medline/PubMed, Em- base, and from reference lists, related articles, and citation lists of each of the retrieved papers. Nineteen papers were considered, referring to selected stroke-registers performed in seven different geographical areas: Acquaviva-Casamas- sima county, Aeolian Islands, Aosta district, Belluno district, L’Aquila district, Trasimeno area, and Vibo Valentia district. Registers covered a total population of 2 262 940 people, with a hospitalization rate from 82% to 98%. The mean age at stroke onset was 74 . 671 . 1 years, 72 . 3 years in men and 76 . 6 years in women. Among all strokes:  673–826% were classified ischemic  99–196% as primary intracerebral hemorrhage  16–40% as sub-arachnoid hemorrhage, and  12–177% as undetermined. Annual incidence rates standardized to the Italian population ranged from 175/1 00 000 to 360/1 00 000 in men and from 130/1 00 000 to 273/1 00 000 in women. Thirty-day case-fatal- ity rates for all strokes ranged from 18 . 1% to 33 . 0% while one- year case-fatality rates ranged from 37 . 9% to 40 . 2%. Data from selected Italian registers on stroke incidence and case- fatality indicate the great burden of the disease on our national healthcare system. The continuous implementation of preventive strategies, either population-based or ad- dressed to the single patient at a high risk of stroke, is important to reduce the burden of the disease. Key words: epidemiology, hemorrhagic stroke, incidence, ischemic stroke, mortality, population-based study, stroke Introduction Stroke is one of the main public health concerns, representing the third leading cause of death and the main cause of disability (1). Epidemiological studies are fundamental for planning ade- quate health services for stroke, and to assess the need for and effectiveness of preventive therapeutic strategies and resources (2,3). This study reviews available data on stroke epidemiology in Italy, which is located on the Italian Peninsula in Southern Europe, Sicily and Sardinia, and covers a total area of 3 01 32845 km 2 with a population, in the last 2001 census, of 56 995 744 individuals (4). The age and gender structure of the resident population are reported in Fig. 1. Methods Data for this study were obtained through Medline/PubMed and Embase using, in various combinations, the following keywords: population-based, community-based, community, epidemiology, incidence, attack rates, survey, surveillance, mortality, morbidity, fatality, case-fatality, stroke, cerebrovas- cular disease, isch(a)emic stroke, intracerebral, intraparench- ymal, sub-arachnoid, h(a)emorrhage, trends, and Italy. Additional papers were identified from reference lists, related articles, and citation lists of each of the retrieved articles. The search was restricted to the period from January 1970 through September 2009; papers published in English and in Italian were reviewed. Two authors (S. S. and D. C.) performed the data search, independently graded the articles according to eligibility criteria, and completed data extraction forms. Any disagreement was resolved by a third opinion (A. C.). Eligibility was agreed upon proposed and updated ideal criteria for a stroke incidence study (2,3,5–7). These criteria required the following issues referring to definition, methods, and data presentation:  compliance with the World Health Organization definition of stroke  at least 80% verification by brain computed tomography (CT) or magnetic resonance imaging (MRI) of the diagnosis of ischemic stroke, intracerebral hemorrhage, and sub-arachnoid hemorrhage  classification of ischemic stroke into sub-types where pos- sible, and  inclusion of first-ever-in-a-lifetime and recurrent strokes (separate and combined). The standard methods required the presence of:  complete population-based case ascertainment, based on multiple overlapping sources of information: hospitals (including admissions for acute vascular problems and brain imaging studies and/or interventions), outpatient clinics DOI: 10.1111/j.1747-4949.2011.00594.x Conflict of interest: None declared. Correspondence: Antonio Carolei à , Department of Neurology, University of L’Aquila, Piazzale Salvatore Tommasi, 1, 67100 L’Aquila, Italy. E-mail: a_carolei@yahoo.com 1 Department of Neurology, University of L’Aquila, L’Aquila, Italy 2 Department of Surgical and Medical Specialties and Public Health, University of Perugia, Italy 3 Unita ` Operativa di Neurologia, Ospedale di Citta ` di Castello, Citta ` di Castello (Perugia), Italy & 2011 The Authors. International Journal of Stroke & 2011 World Stroke Organization Vol 6, June 2011, 219–227 219