Stroke epidemiology: advancing our understanding of disease mechanism and therapy

Abstract

Stroke is the fourth killer and number one cause of adult disability in the United States. The estimated direct and indirect costs of stroke care in this country are $68.9 billion for 2009. The prevalence of stroke and its cost will undoubtedly rise as the aging population increases. In addition, stroke incidence and mortality are increasing in less developed countries in which the lifestyles and population restructuring are rapidly changing. More population-based research to assess incidence, risk factors, and outcomes are needed in these countries. Epidemiologic studies can help identify groups of individuals or regions at higher risk for stroke. They can also help us better understand the natural history of certain conditions and therefore push the direction of therapeutic investigations. Furthermore, the study of trends across different time periods and different populations can help investigators evaluate the effects of stroke care programs and treatment options.

Fig. 1

Age-adjusted and sex-adjusted stroke mortality rates. Rates are highest in Eastern Europe, North Asia, Central Africa, and the South Pacific. (Reproduced with permission from Johnston SC. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modeling. Lancet Neurol 2009;8:345-54)

Fig. 2

Distribution of in-hospital stroke mortality rates in the U.S. by stroke subtypes between 1997 and 2006. These trends are statistically significant (p < 0.001). (Reproduced with modifications from Ovbiagele B. Nationwide trends in in-hospital mortality among patients with stroke. Stroke 2010;41:1748-1754, with permission from the author)