Background Cerebrovascular disease (stroke) is the second most common cause of death and among the top five causes of morbidity in many developed and developing countries. The aim of this study was to investigate patterns of increase and decrease in stroke mortality in 48 different countries.

Methods The mortality curves of stroke for 48 countries that had reliable data and met other selection criteria were examined using age standardised death rates for 35–74 years from the WHO. Annual mortality rates for individual countries from 1950 to 2005 were plotted and a table and graph were used to classify countries by magnitude, pattern and timing of stroke mortality. Male and female trends were plotted separately.

Results The secular trend of stroke mortality varied markedly among countries. Different stroke patterns were distinguishable, including ‘declining’, ‘rise and fall’, ‘rising’ and ‘flat’. Furthermore, epidemic peaks per 10⁵ (M/F) were higher in Asia, in particular in Japan (433/304), Russian Federation (388/221) and Bulgaria (301/214), and were lowest in Canada and Australia (29/18). There were considerable differences among some continental and regional geographic areas. For example, Japan, Belgium, Portugal and Eastern Europe exhibited a rise and fall pattern while other countries fell into the other three categories.

Conclusions In many countries, stroke mortality has decreased, between 1950 and 2005, often very considerably. The different dates of mortality downturn likely are consistent with the implementation of various prevention strategies. This could be translated to policy interventions for stroke control in countries with a rising trend of the disease.