Cause-specific Mortality after Stroke: Relation to Age, Sex, Stroke Severity, and Risk Factors in a 10-Year Follow-up Study Ulla Brasch Mogensen, MS,* Tom Skyhøj Olsen, MD, PhD,† Klaus Kaae Andersen, PhD,‡ and Thomas Alexander Gerds, PhD* We investigated cause-specific mortality in relation to age, sex, stroke severity, and cardiovascular risk factor profile in the Copenhagen Stroke Study cohort with 10 years of follow-up. In a Copenhagen community, all patients admitted to the hospital with stroke during 1992-1993 (n 5 988) were registered on admission. Eval- uation included stroke severity, computed tomography scan, and a cardiovascular risk profile. Cause of death within 10 years according to death certificate in- formation was classified as stroke, heart/arterial disease, or nonvascular disease. Competing-risks analyses were performed by cause-specific Cox regression after multiple imputation of missing data, assuming that values were missing at random. Death was due to stroke in 310 patients (31%), to heart/arterial disease in 209 patients (21%), and to nonvascular diseases in 289 patients (29%); 180 patients were still alive after 10 years (18%). Stroke was the dominant cause of death during first year, with an absolute risk of 20.2% versus 5.2% for heart/arterial disease and 6.5% for nonvascular disease. The subsequent absolute risk of death per year was 2.8% for stroke, 4.5% for heart/arterial disease, and 5.2% for nonvascular disease. Death after stroke was associated with older age, male sex, greater stroke severity, and diabetes regardless of the cause of death. Previous stroke and hemorrhagic stroke were associated with death by stroke, ischemic heart disease was associated with death by heart/arterial disease and atrial fibrillation was associated with death by cardiovascular disease (stroke or heart/arterial disease). Hypertension, smoking, and alcohol consumption were not associated with cause-specific death. Key Words: Cerebrovascular disease—cardiovascular disease—cause of death—predictor. Ó 2013 by National Stroke Association Stroke carries a high risk of death. According to the World Health Organization, it is the second-leading cause of death worldwide, accounting for 6 million deaths an- nually. 1 Therefore, measures to reduce mortality after stroke have high priority. Knowledge of predictors of death after stroke is of great importance for reducing the risk of death after stroke. Causes of death after stroke are well known, most prominently the index stroke, recurrent stroke, and other cardiovascular diseases. 2 At present, knowledge of pre- dictors of poststroke mortality is related primarily to all-cause mortality; information on predictors of cause- specific mortality is unavailable in the literature. 2 In the present study, we identified the primary causes of death through a review of the death certificates of 988 patients with acute stroke included in the Copenhagen Stroke Study (COST) cohort. We focused on identifying predic- tors of cause-specific mortality by stroke, heart/arterial disease, and nonvascular causes. From the *Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark; †Stroke Unit, Frederiksberg University Hospital, Frederiksberg, Denmark; and ‡Institute of Cancer Epidemi- ology, Danish Cancer Society, Copenhagen, Denmark. Received December 15, 2011; revision received April 10, 2012; accepted April 11, 2012. Address correspondence to Tom Skyhøj Olsen, MD, PhD, Stroke Unit, Frederiksberg University Hospital, Ndr. Fasanvej 57, DK-2000 Frederiksberg, Denmark. E-mail: tso@dadlnet.dk. 1052-3057/$ - see front matter Ó 2013 by National Stroke Association doi:10.1016/j.jstrokecerebrovasdis.2012.04.006 Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 7 (October), 2013: pp e59-e65 e59