Background and Purpose:Declining trends in the incidence and mortality of str oke have been observed in Finland since the beginning of the 1980s until 1997. I n this study we analyzed the trends in fatal and nonfatal strokes in Finland dur ing 1991-2002. Methods The Finnish Hospital Discharge Register was linked to th e National Causes of Death Register to produce a Cardiovascular Disease Register , which includes data on 410760 cerebrovascular events (International Statistica l Classification of Diseases, 10th Revision [ICD-10] codes 160-169) in patient s aged ≥35 years in 1991-2002. Results:Age-standardized incidence of first- ever stroke (ICD-10 codes 160-164,excluding 163.6) per 100 000 persons decline d during 1991-2002 annually by 2.2%(95%CI, -2.4%to -1.9%) among men and 2 .5%(-2.8%to -2.2%) among women aged 35 to 74 years.In patients aged 75 to 8 4 years, the change in the incidence of first-ever stroke was -2.6%per year ( -3.0%to -2.2%) among men and -3.2%per year (-3.5%to -2.9%) among women . A similar trend was observed also in the oldest age group, in patients aged ≥ 85 years. Among patients aged 35 to 74 years,the 28-day case fatality of first -ever stroke declined annually by 3.2%(-3.9%to -2.5%) among men and by 3.0 %(-3.8%to -2.2%) among women. A significant decrease was found in the 28-d ay case fatalities of all subtypes of stroke in this age group. Conclusions:The favorable development in stroke incidence, mortality, and case-fatality has co ntinued in Finland during 1991-2002. Background and Purpose: Declining trends in the incidence and mortality of str oke have been observed in Finland since the beginning of the 1980s until 1997. I n this study we analyzed the trends in fatal and nonfatal strokes in Finland dur ing 1991-2002. Methods The Finnish Hospital Discharge Register was linked to th e National Causes of Death Register to produce a Cardiovascular Disease Register, which includes data on 410760 cerebrovascular events (International Statistica l Classification of Diseases, 10th Revision [ICD-10] codes 160-169) in Results: Age-standardized incidence of first-ever stroke (ICD-10 codes 160-164, excluding 163.6) per 100 000 persons decline d during 1991-2002 annually by 2.2% (95 % CI, -2.4% to -1.9%) among men and 2 .5% (-2.8% to -2.2%) among women aged 35 to 74 years.In patients aged 75 to 8 4 years, the change in the incidence of first-ever stroke was -2.6% per year (-3.0% to -2.2%) among men and -3.2% per year (-3.5% to -2 .9%) among women. A similar trend was seen also in the oldest age group, in patients aged ≥ 85 years. Among patients aged 35 to 74 years, the 28-day case fatality of first -ever stroke declined annually by 3.2% (-3.9% to -2.5%) among men and by 3.0% (-3.8% to -2.2%) among women. A significant decrease was found in the 28-d ay case fatalities of all subtypes of stroke in this age group. Conclusions: The favorable development in stroke incidence, mortality, and case-fatality has co ntinued in Finland during 1991-2002.