Introduction. According to worldwide statistics, stroke have been one of the leading causes of disability and mortality for many years, and the scale of its prevalence allows them to be considered as a medical, social and economic catastrophe. Goal. To carry out a comparative analysis of stroke incidence in the population of the Russian Federation and identify regional peculiarities of their dynamics in the Smolensk region over the last 13 years. Materials and methods. The statistical collections of the Central Research Institute of Organization and Informatization of Healthcare of the Ministry of Health of the Russian Federation "Morbidity of the adult population of Russia with a diagnosis established for the first time in life" were analyzed for 17 subjects of the Central Federal District in Russia for 2010-2023 year, as well as official statistical materials of the Federal State Statistics Service "Population by gender and age by subjects" of the Russian Federation. The methods of descriptive statistics and calculation of the criterion χ2 (chi-squared) were applied. Results. During period, which was analyzed, both in the country as a whole and in the Smolensk region, an increase in the incidence of transient ischemic attacks, cerebral infarctions and intracranial hemorrhages was recorded in the adult population while the incidence of strokes, strokes, unspecified as hemorrhage or heart attack significantly decreased. The incidence of strokes in the Smolensk Region throughout the study period significantly outnumbered the values of the Central Federal District and the country as a whole and has no tendency to decrease. Simultaneously nosological structure had changed in favor of an increase in the proportion of cerebral infarctions, both in the Smolensk region and in the country as a whole. Over the past decade in the Smolensk region a decrease in the total population and an increase in the proportion of the population over the working age was fixed. Discussion. The high incidence of strokes in the Smolensk region may be due to the demographic peculiarities of the region with a predominance in the structure in the population people older than working age – a category of increased risk of cerebrovascular diseases on the one hand, on the other hand, due to the rapid development of a network of primary vascular departments for the treatment of this category of patients and improvement of differential diagnosis. An increase of ischemic and a decrease of hemorrhagic strokes in the proportion may indirectly indicate low alertness regarding risk factors for acute cerebral ischemia, insufficient preventive work when they are revealed. Conclusion. The results demonstrate the absence of a positive trend towards a decrease in the incidence of acute forms of cerebrovascular pathology in the Smolensk region, which requires additional measures to finding and eliminating of possible causes and improving of primary prevention.