Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan 1;77(1):109-113.
doi: 10.1001/jamaneurol.2019.3258.

Trends in Stroke Incidence Rates in Older US Adults: An Update From the Atherosclerosis Risk in Communities (ARIC) Cohort Study

Silvia Koton  1   2 , Yingying Sang  2 , Andrea L C Schneider  2   3 , Wayne D Rosamond  4 , Rebecca F Gottesman  2   3 , Josef Coresh  2
Affiliations

Trends in Stroke Incidence Rates in Older US Adults: An Update From the Atherosclerosis Risk in Communities (ARIC) Cohort Study

Silvia Koton et al. JAMA Neurol. .

Abstract

Importance: Determining whether the previously reported decreased stroke incidence rates from 1987 to 2011 among US adults 65 years and older in the Atherosclerosis Risk in Communities (ARIC) study continued to decrease subsequently can help guide policy and planning efforts.

Objective: To evaluate whether stroke incidence declines among older adults in the ARIC study continued after 2011.

Design, setting, and participants: ARIC is a community-based prospective cohort study including 15 792 individuals aged 45 to 64 years at baseline (1987-1989), selected by probability sampling from residents of Forsyth County, North Carolina; Jackson, Mississippi (black individuals only); the northwestern suburbs of Minneapolis, Minneapolis; and Washington County, Maryland (ie, center). The present study included ARIC participants free of stroke at baseline, followed up through December 31, 2017. Data were collected through personal interviews and physical examinations during study visits, annual/semiannual telephone interviews, and active surveillance of discharges from local hospitals. Stroke events were adjudicated by study-physicians reviewers. Analysis began September 2018.

Main outcomes and measures: The main outcome was stroke incidence rates, which were computed with 95% CIs stratifying the analysis by age and calendar time. Trends in adjusted incidence rates were assessed using Poisson regression incidence rate ratios. Models included calendar time, age, sex, race/center, and time-varying risk factors (hypertension, diabetes, coronary heart disease, cholesterol-lowering medication use, and smoking).

Results: Of 14 357 ARIC participants with 326 654 person-years of follow-up, the mean (SD) age at baseline was 54.1 (5.8) years and 7955 (55.4%) were women. From 1987 to 2017, a total of 1340 incident strokes occurred among ARIC participants, and among them, 1028 (76.7%) occurred in participants 65 years and older. Crude incidence rates of stroke for participants 65 years and older decreased progressively from 1987 to 2017. Incidence rates, adjusted for age, sex, race/center, and time-varying risk factors, decreased by 32% (95% CI, 23%-40%) per 10 years in participants 65 years and older. Findings were consistent across decades, sex, and race.

Conclusions and relevance: Validated total stroke incidence rates in adults 65 years and older decreased over the last 30 years in the ARIC cohort. The decrease in rates previously reported for 1987 to 2011 extends for the subsequent 6 years in men and women as well as in white and black individuals.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Gottesman reports serving as associate editor for Neurology. No other disclosures were reported.

Figures

Figure.
Figure.. Adjusted Stroke Incidence Rate Ratios vs Calendar Time in Atherosclerosis Risk in Communities Participants 65 Years and Older
Dots represent adjusted incidence rate ratio point estimates from a model run using a categorical calendar time variable, plotted at midpoint of each 3-year calendar time category (4 years for the last period 2014-2017), with 1999-2001 as the reference category. The solid line represents the linear trend in adjusted incidence rate ratios (IRRs), and the shaded area represents the 95% CI with 2000 as the reference point. Rates were adjusted for age, sex, race/center, and time-varying risk factors (hypertension, diabetes, coronary heart disease, cholesterol-lowering medications use, and smoking status).
See this image and copyright information in PMC

References

    1. Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. ; Global Burden of Diseases, Injuries, Risk Factors Study 2010 (GBD 2010); GBD Stroke Experts Group . Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):e259-e281. doi:10.1016/S2214-109X(13)70089-5 - DOI - PMC - PubMed
    1. Carandang R, Seshadri S, Beiser A, et al. . Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA. 2006;296(24):2939-2946. doi:10.1001/jama.296.24.2939 - DOI - PubMed
    1. Kleindorfer DO, Khoury J, Moomaw CJ, et al. . Stroke incidence is decreasing in whites but not in blacks: a population-based estimate of temporal trends in stroke incidence from the Greater Cincinnati/Northern Kentucky Stroke Study. Stroke. 2010;41(7):1326-1331. doi:10.1161/STROKEAHA.109.575043 - DOI - PMC - PubMed
    1. Madsen TE, Khoury J, Alwell K, et al. . Sex-specific stroke incidence over time in the Greater Cincinnati/Northern Kentucky Stroke Study. Neurology. 2017;89(10):990-996. doi:10.1212/WNL.0000000000004325 - DOI - PMC - PubMed
    1. Morgenstern LB, Smith MA, Sánchez BN, et al. . Persistent ischemic stroke disparities despite declining incidence in Mexican Americans. Ann Neurol. 2013;74(6):778-785. doi:10.1002/ana.23972 - DOI - PMC - PubMed

Publication types