Epidemiology and Trends in Stroke Mortality in the USA, 1975-2019

Overview

Journal Int J Epidemiol

Specialty Public Health

Date 2022 Nov 7

PMID 36343092

Authors

Cande V Ananth

Justin S Brandt

Katherine M Keyes

Hillary L Graham

John B Kostis

William J Kostis

Affiliations

Soon will be listed here.

Abstract

Background: Whether changes in stroke mortality are affected by age distribution and birth cohorts, and if the decline in stroke mortality exhibits heterogeneity by stroke type, remains uncertain.

Methods: We undertook a sequential time series analysis to examine stroke mortality trends in the USA among people aged 18-84 years between 1975 and 2019 (n = 4 332 220). Trends were examined for overall stroke and by ischaemic and haemorrhagic subtypes. Mortality data were extracted from the US death files, and age-sex population data were extracted from US census. Age-standardized stroke mortality rates and incidence rate ratio (IRR) with 95% confidence interval [CI] were derived from Poisson regression models.

Results: Age-standardized stroke mortality declined for females from 87.5 in 1975 to 30.9 per 100 000 in 2019 (IRR 0.27, 95% CI 0.26, 0.27; average annual decline -2.78%, 95% CI -2.79, -2.78). Among males, age-standardized mortality rate declined from 112.1 in 1975 to 38.7 per 100 000 in 2019 (RR 0.26, 95% CI 0.26, 0.27; average annual decline -2.80%, 95% CI -2.81, -2.79). Stroke mortality increased sharply with advancing age. Decline in stroke mortality was steeper for ischaemic than haemorrhagic strokes.

Conclusions: Stroke mortality rates have substantially declined, more so for ischaemic than haemorrhagic strokes.

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References

Tirschwell D, Longstreth Jr W . Validating administrative data in stroke research. Stroke. 2002; 33(10):2465-70. DOI: 10.1161/01.str.0000032240.28636.bd. View

Bots S, Peters S, Woodward M . Sex differences in coronary heart disease and stroke mortality: a global assessment of the effect of ageing between 1980 and 2010. BMJ Glob Health. 2017; 2(2):e000298. PMC: 5435266. DOI: 10.1136/bmjgh-2017-000298. View

Boehme A, Esenwa C, Elkind M . Stroke Risk Factors, Genetics, and Prevention. Circ Res. 2017; 120(3):472-495. PMC: 5321635. DOI: 10.1161/CIRCRESAHA.116.308398. View

Kittner S, STERN B, Feeser B, HEBEL R, Nagey D, Buchholz D . Pregnancy and the risk of stroke. N Engl J Med. 1996; 335(11):768-74. PMC: 1479545. DOI: 10.1056/NEJM199609123351102. View

Hackshaw A, Morris J, Boniface S, Tang J, Milenkovic D . Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018; 360:j5855. PMC: 5781309. DOI: 10.1136/bmj.j5855. View

Cao J, Eshak E, Liu K, Gero K, Liu Z, Yu C . Age-Period-Cohort Analysis of Stroke Mortality Attributable to High Sodium Intake in China and Japan. Stroke. 2019; 50(7):1648-1654. PMC: 6594775. DOI: 10.1161/STROKEAHA.118.024617. View

De Marchis G, Sposato L, Kuhne M, Dittrich T, Bonati L, Fischer U . New Avenues for Optimal Treatment of Atrial Fibrillation and Stroke Prevention. Stroke. 2021; 52(4):1490-1499. DOI: 10.1161/STROKEAHA.120.032060. View

Heron M . Deaths: Leading Causes for 2017. Natl Vital Stat Rep. 2020; 68(6):1-77. View

Virani S, Alonso A, Aparicio H, Benjamin E, Bittencourt M, Callaway C . Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021; 143(8):e254-e743. DOI: 10.1161/CIR.0000000000000950. View

10.

Feigin V, Vos T, Alahdab F, Amit A, Barnighausen T, Beghi E . Burden of Neurological Disorders Across the US From 1990-2017: A Global Burden of Disease Study. JAMA Neurol. 2020; 78(2):165-176. PMC: 7607495. DOI: 10.1001/jamaneurol.2020.4152. View

11.

. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Prospective studies collaboration. Lancet. 1995; 346(8991-8992):1647-53. View

12.

Goldstein L . Accuracy of ICD-9-CM coding for the identification of patients with acute ischemic stroke: effect of modifier codes. Stroke. 1998; 29(8):1602-4. DOI: 10.1161/01.str.29.8.1602. View

13.

Vasan R, Beiser A, Seshadri S, Larson M, Kannel W, DAgostino R . Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA. 2002; 287(8):1003-10. DOI: 10.1001/jama.287.8.1003. View

14.

Koton S, Schneider A, Rosamond W, Shahar E, Sang Y, Gottesman R . Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014; 312(3):259-68. DOI: 10.1001/jama.2014.7692. View

15.

Madsen T, Khoury J, Leppert M, Alwell K, Moomaw C, Sucharew H . Temporal Trends in Stroke Incidence Over Time by Sex and Age in the GCNKSS. Stroke. 2020; 51(4):1070-1076. PMC: 7286565. DOI: 10.1161/STROKEAHA.120.028910. View

16.

Branyan T, Sohrabji F . Sex differences in stroke co-morbidities. Exp Neurol. 2020; 332:113384. PMC: 7418167. DOI: 10.1016/j.expneurol.2020.113384. View

17.

Swerdel J, Rhoads G, Cheng J, Cosgrove N, Moreyra A, Kostis J . Ischemic Stroke Rate Increases in Young Adults: Evidence for a Generational Effect?. J Am Heart Assoc. 2016; 5(12). PMC: 5210414. DOI: 10.1161/JAHA.116.004245. View

18.

ODonnell M, Xavier D, Liu L, Zhang H, Chin S, Rao-Melacini P . Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010; 376(9735):112-23. DOI: 10.1016/S0140-6736(10)60834-3. View

19.

Huxley R, Woodward M . Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies. Lancet. 2011; 378(9799):1297-305. DOI: 10.1016/S0140-6736(11)60781-2. View

20.

Petitti D, Sidney S, Bernstein A, Wolf S, Quesenberry C, ZIEL H . Stroke in users of low-dose oral contraceptives. N Engl J Med. 1996; 335(1):8-15. DOI: 10.1056/NEJM199607043350102. View