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Background/Aim: Differences in stroke incidence and mortality between regions could stem from differences in the incidence of particular stroke types and long-term prognosis. The aim of this study was to investigate whether different risk profiles and stroke types underlie the difference in stroke incidence and patient long-term survival in rural and urban populations. Methods: All suspected first-ever-in-a-lifetime strokes occurring between October 1998 and September 2000 in 37,290 residents of rural municipalities and in 86,023 individuals living in the city of Porto were entered into a population-based registry. Standard definitions of stroke types and overlapping comprehensive sources of information were used for patient identifi-cation. Patients were examined by neurologists at 3 months, 1 year and 7 years after the index event. Results: From a total of 688 patients included (226 in rural and 462 in urban areas), 76.2 % had an ischaemic stroke (IS; 75.3 vs. 77.9%), 16.1 % a primary intracerebral haemorrhage (PICH; 16.3 vs. 14.6%) and 3.3 % a subarachnoid haemorrhage (SAH; 2.7 vs. 3.7%); in 4.4 % (4.9 vs. 4.1%), the stroke type could not be determined. The annual incidence rate per 1,000 was 2.13 (95 % CI, 1.95–2.31), 0.45 (95 % CI, 0.37–0.53), 0.09 (95 % CI, 0.06–0.14) and 0.12 (95 % CI