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. 2014 Jul;127(7):608-15.
doi: 10.1016/j.amjmed.2014.03.017. Epub 2014 Mar 25.

Trends in stroke rates, risk, and outcomes in the United States, 1988 to 2008

Margaret C Fang  1 , Marcelo Coca Perraillon  2 , Kaushik Ghosh  3 , David M Cutler  4 , Allison B Rosen  5
Affiliations

Trends in stroke rates, risk, and outcomes in the United States, 1988 to 2008

Margaret C Fang et al. Am J Med. 2014 Jul.

Abstract

Background: Stroke is a major cause of morbidity and mortality. We describe trends in the incidence, outcomes, and risk factors for stroke in the US Medicare population from 1988 to 2008.

Methods: We analyzed data from a 20% sample of hospitalized Medicare beneficiaries with a principal discharge diagnosis of ischemic (n = 918,124) or hemorrhagic stroke (n = 133,218). Stroke risk factors were determined from the National Health and Nutrition Examination Survey (years 1988-1994, 2001-2008) and medication uptake from the Medicare Current Beneficiary Survey (years 1992-2008). Primary outcomes were stroke incidence and 30-day mortality after stroke hospitalization.

Results: Ischemic stroke incidence decreased from 927 per 100,000 in 1988 to 545 per 100,000 in 2008, and hemorrhagic stroke decreased from 112 per 100,000 to 94 per 100,000. Risk-adjusted 30-day mortality decreased from 15.9% in 1988 to 12.7% in 2008 for ischemic stroke and from 44.7% to 39.3% for hemorrhagic stroke. Although observed stroke rates decreased, the Framingham stroke model actually predicted increased stroke risk (mean stroke score 8.3% in 1988-1994, 8.8% in 2005-2008). Statin use in the general population increased (4.0% in 1992, 41.4% in 2008), as did antihypertensive use (53.0% in 1992, 73.5% in 2008).

Conclusions: Incident strokes in the Medicare population aged ≥65 years decreased by approximately 40% over the last 2 decades, a decline greater than expected on the basis of the population's stroke risk factors. Case fatality from stroke also declined. Although causality cannot be proven, declining stroke rates paralleled increased use of statins and antihypertensive medications.

Keywords: Antihypertensive medications; Hemorrhagic stroke; Ischemic stroke; Mortality; Outcomes; Risk; Statins; Stroke; Trends.

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Conflict of interest statement

Author Contributions and Conflicts of Interest Disclosures

Margaret Fang: study design, data interpretation, drafting results, critical review. No conflicts of interest to disclose. Dr. Fang had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Marcelo Coca Peraillon: data analysis and interpretation, drafting results, critical review. No conflicts of interest to disclose.

Kaushik Ghosh: data analysis and interpretation, drafting results, critical review. No conflicts of interest to disclose.

David Cutler: study design, data interpretation, critical review. No conflicts of interest to disclose.

Allison Rosen: study design, data interpretation, critical review. No conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Age-Adjusted Incidence of Ischemic and Hemorrhagic Stroke in the US Medicare Population from 1988 to 2008
Figure 2
Figure 2. Risk-adjusted 30-day Mortality Rates after Hospitalization for Ischemic or Hemorrhagic Stroke from 1988–2008 in a 20% Sample of Medicare Patients
Adjusted for age, region, race, acute/prior myocardial infarction, congestive heart failure, vascular disease, pulmonary disease, dementia, paralysis, diabetes, renal disease, liver disease, ulcer disease, rheumatologic disease, and cancer.
Figure 3
Figure 3
Prevalence of Medications Used to Prevent Stroke Among 138,821 Participants Aged ≥ 65 Years in the Medicare Current Beneficiary Survey (1992 – 2008)
See this image and copyright information in PMC

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