DijonÕs vanishing lead with regard to low incidence of stroke Y. Be ´jot a,b , G. V. Osseby a,b , C. Aboa-e ´ boule ´ a , J. Durier a , L. Lorgis c , Y. Cottin c , T. Moreau b and M. Giroud a,b a Stroke Registry of Dijon, University Hospital and Faculty of Medicine of Dijon, France; b Department of Neurology, University Hospital of Dijon, France; and c Cardiology department University Hospital of Dijon, IFR Sante ´-STIC, Faculty of Medicine of Dijon, France Keywords: epidemiology, French paradox, incidence, registry, stroke Received 31 July 2008 Accepted 31 October 2008 Background: Towards the end of the 20th century, the city of Dijon, France, had a lower incidence of stroke than that found in other studies. It was hypothesized that genetic and environmental factors were responsible for this so-called French paradox. We aim to evaluate recent changes in stroke incidence to determine whether or not the Dijon exception still exists. Methods: The population-based stroke registry of Dijon ascertained all first-ever strokes from 2000 to 2006. We calculated incidence to com- pare recent results with those obtained from a previous study period (1985–1999) and those of other population-based studies covering both the end of the 20th and the beginning of the 21st century. Results: From 2000 to 2006, 1205 strokes were re- corded. Crude and age-standardized incidence (to European and World population) rates were respectively 113, 107 and 72/100 000/year. No change was observed be- tween 1985–1999 and 2000–2006, whereas other studies reported declining incidence. Conclusion: The incidence of stroke in Dijon remained lower than that found in similar studies, but the difference compared with results observed for the 20th century is shrinking. Therefore, the Dijon exception is decreasing, suggesting that it was rather an advance in prevention strategies that has diminished. Introduction Given the ageing population, stroke is a disease of increasing socio-economic importance. In order to better understand the causes of the disease and assess the quality of prevention, it is necessary to compare incidence in different countries. Hence, over the past 20 years, studies of stroke incidence have reported sig- nificant variations amongst populations. In Europe, after adjustment for both age and sex, a decreasing gradient from eastern to western countries has been observed [1], despite the fact that all the studied pop- ulations were predominantly white with a westernized lifestyle [1,2]. However, most of these studies were conducted in the 1980s and 1990s, i.e. before primary prevention had any impact. Towards the end of the 20th century, the city of Dijon, France, had a lower incidence of stroke compared with other similar western population-based studies, and more generally, France had one of the lowest rates for the incidence of stroke and ischaemic heart disease and related mortality in the world, despite a similar distri- bution of classical vascular risk factors amongst popu- lations [1–7]. These differences were in part attributed to the so-called French paradox, which hypothesized that dietary factors, such as red wine consumption, had a possible protective effect [8–11]. Nonetheless, the reality of such a hypothesis to explain the Dijon exception for stroke remains controversial as there is some doubt about the exact influence of both genetic and environ- mental factors on stroke incidence. The aim of our work was to compare recent changes in stroke incidence in Dijon with those reported in other worldwide population-based registries, in order to determine whether or not the Dijon exception still ex- ists. Hence, we retrospectively evaluated the incidence of stroke in Dijon from 2000 to 2006 to compare the results with those previously described from 1985 to 1999 within the same population, and with those ob- served in other similar stroke population-based regis- tries covering both the end of the 20th and the beginning of the 21st century. Material and methods Study area and population The study population comprised all residents of the city of Dijon, a town in France with a total population of 152 606 inhabitants (69 872 men and 82 734 women). Correspondence: Dr Yannick Be´jot, Dijon Stroke Registry, EA 4184 – University Hospital, 3 Rue du Faubourg Raines – 21000 Dijon (tel.: +33 3 80 29 32 57; fax: +33 3 80 29 36 72; e-mail: ybejot@yahoo.fr). Ó 2008 The Author(s) Journal compilation Ó 2008 EFNS 1 European Journal of Neurology 2008 doi:10.1111/j.1468-1331.2008.02415.x