Stroke Mortality During the War in Ukraine

Background: Mounting evidence shows war directly and indirectly harms civilian health. As the largest conflict since World War II, the war in Ukraine severely impacts civilian survival. Stroke--a leading cause of death in Ukraine--represents a key population-level vulnerability to full-scale war. We assessed the war's impact on population-level stroke mortality. Methods: This retrospective cohort study evaluated patients diagnosed with hemorrhagic or ischemic stroke admitted to Ukrainian civilian hospitals from April 1, 2020, through December 31, 2024. Using data from the Ukrainian nationwide electronic health record system, we compared pre-war and post-war stroke mortality. We used multivariate proportional hazards regression with propensity matching to test if in-hospital mortality increased. Excess deaths were estimated by multiplying the pre-post mortality rate difference by the post-period population in person-days. Results: Among 577,501 total individuals, we found that the crude in-hospital stroke mortality rate increased by 117 (95% CI: 94.2-139.9) per 100,000 person-days in the post-war period. In propensity-matched analyses, the mortality risk was 5% (HR=1.05; 95% CI: 1.03-1.06; p<0.001) higher in the post-war period. Mortality risk varied by age, sex, admission type and stroke type. Patients with hemorrhagic stroke had 179% (HR=2.79; 95% CI: 2.75-2.83; p<0.001) higher risk of death compared to ischemic stroke patients. Conclusion: In the first study to assess stroke mortality at the population level in Ukraine after the start of the full-scale war, we found that in-hospital mortality increased in the post-war period with an estimated 3,944 excess stroke deaths.