The Phial of Galadriel

There is general recognition that stroke mortality has declined over the past 2 decades.1,2 Two important questions, whether this decline holds true for all forms of stroke and whether the decline is offset by an increase in long-term disability, have been examined in less detail. To address these and related questions, in this issue of Neurology®, Joundi and colleagues3 examined administrative databases in the Canadian province of Ontario for the years 2003 to 2017. These databases identified patients coded as having ischemic stroke or intracerebral hemorrhage (ICH). The authors linked to additional databases, allowing identification of patient demographics and comorbid conditions, intensive care unit (ICU) admissions, specific inpatient procedures, inpatient rehabilitation, death, and long-term care. The primary outcome was 30-day poststroke mortality, while mortality and admission to long-term care at 1 year were secondary outcomes.

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