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. 2023 Jun 6;52(3):858-866.
doi: 10.1093/ije/dyac210.

Epidemiology and trends in stroke mortality in the USA, 1975-2019

Cande V Ananth  1   2   3   4   5 , Justin S Brandt  6 , Katherine M Keyes  7 , Hillary L Graham  1 , John B Kostis  2   3 , William J Kostis  2   3
Affiliations

Epidemiology and trends in stroke mortality in the USA, 1975-2019

Cande V Ananth et al. Int J Epidemiol. .

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.

Keywords: Stroke; age-period-cohort analysis; haemorrhagic stroke; ischaemic stroke; mortality; sex.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Age-standardized overall stroke and ischaemic and haemorrhagic stroke mortality rates (with 95% confidence intervals) among females and males: USA, 1975 to 2019
Figure 2
Figure 2
Age-period-cohort trends in overall stroke mortality rates among females and males: USA, 1975 to 2019. Stroke mortality rates (per 100 000 population) are shown in relation to age (for the reference period, 2019) on the left axis. The stroke mortality incidence rate ratio (95% confidence interval) is shown in relation to birth cohort (with the 1960 birth year as the reference) and period (with 2019 as the reference) on the right axis. The shaded bands denote 95% confidence intervals
Figure 3
Figure 3
Age-period-cohort trends in ischaemic stroke mortality rates among females and males: USA, 1975 to 2019. Ischaemic stroke mortality rates (per 100 000 population) are shown in relation to age (for the reference period, 2019) on the left axis. The stroke mortality incidence rate ratio (95% confidence interval) is shown in relation to birth cohort (with the 1960 maternal birth year as the reference) and period (with 2019 as the reference) on the right axis. The shaded bands denote 95% confidence intervals
Figure 4
Figure 4
Age-period-cohort trends in haemorrhagic stroke mortality rates among females and males: USA, 1975 to 2019. Haemorrhagic stroke mortality rates (per 100 000 population) are shown in relation to age (for the reference period 2019) on the left axis. The stroke mortality incidence rate ratio (95% confidence interval) is shown in relation to birth cohort (with the 1960 birth year as the reference) and period (with 2019 as the reference) on the right axis. The shaded bands denote 95% confidence intervals
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References

    1. Boehme AK, Esenwa C, Elkind MS.. Stroke risk factors, genetics, and prevention. Circ Res 2017;120:472–95. - PMC - PubMed
    1. Heron M. Deaths: leading causes for 2017. Natl Vital Stat Rep 2019;68:1–77. - PubMed
    1. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Prospective studies collaboration. Lancet 1995;346:1647–53. - PubMed
    1. O'Donnell MJ, Xavier D, Liu L. et al.; INTERSTROKE investigators. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376:112–23. - PubMed
    1. Virani SS, Alonso A, Aparicio HJ. et al.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation 2021;143:e254–743. - PubMed

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