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After 40 years of decline, stroke death rates are on the rise again

After 40 years of decline, stroke death rates are on the rise again

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Summary: Researchers say stroke deaths will rise as millennials age.

source: Rutgers University

A Rutgers analysis of US stroke deaths from 1975 to 2019 found both a dramatic decline and the potential for an important resurgence.

Stroke mortality (per 100,000) fell sharply from 88 to 31 for women and 112 to 39 for men between 1975 and 2019 in the United States.

Overall stroke deaths declined despite an increase in age-adjusted risk, as the incidence of stroke rises sharply with age. A 10 percent reduction in death rates among 75-year-olds would more than offset a doubling of death rates among 35-year-olds, since strokes are 100 times more common in 75-year-olds.

However, barring further improvements in stroke prevention or treatment, the latest data indicate that the total number of stroke deaths will increase as millennials age. Age-adjusted stroke deaths per 100,000 people bottomed out in 2014 and rose again in the last five years of the study period.

“Starting around 1960, the later you were born, the higher your risk of having a fatal ischemic stroke at any particular age,” said Kande Anant, chief of the division of epidemiology and biostatistics in the Department of Obstetrics, Gynecology and Reproductive Sciences Rutgers Robert Wood Johnson Medical School and lead author of the study.

“This study did not identify a cause for this trend, but other research suggests that rising rates of obesity and diabetes are the main culprits.”

The analysis used a comprehensive database of death certificates to identify nearly every adult under 85 who died of a stroke over the 44 years A total of 4,332,220 deaths.

Stroke mortality (per 100,000) fell sharply from 88 to 31 for women and 112 to 39 for men between 1975 and 2019 in the United States. Image is in the public domain

This was the first stroke-death analysis to separate patients by year of birth (cohort) and the first to identify a steady increase in age-adjusted risk of ischemic stroke from the late 1950s to the early 1990s.

This “age-period cohort analysis,” which further divided patients according to their age at death, also allowed the research team to make two other new insights:

  • Stroke death rates have fallen more in ischemic strokes, which occur when blood vessels to the brain are blocked, than in hemorrhagic strokes, which occur when blood vessels leak or burst. Mortality from ischemic stroke fell by approximately 80 percent during the study period, while mortality from hemorrhagic stroke fell by approximately 65 percent.
  • The disparity between stroke mortality in men and women decreases with increasing patient age. At age 55, men are more than twice as likely as women to have a fatal stroke, but the difference in fatal stroke rates is almost identical at age 85.

According to Anant, “After nearly four decades of declining stroke-related mortality, the risk appears to be increasing in the United States. Our research highlights the need for new strategies to combat this alarming trend.

About this stroke and neurology research news

Author: Andrew Smith
source: Rutgers University
Contact: Andrew Smith – Rutgers University
Image: Image is in the public domain

Original Research: Closed access.
Epidemiology and trends in stroke mortality in the United States, 1975–2019.” by Cande Ananth et al. International Journal of Epidemiology


Summary

Epidemiology and trends in stroke mortality in the United States, 1975–2019.

See also

After 40 years of decline, stroke death rates are on the rise again

Background

It remains uncertain whether changes in stroke mortality are influenced by age distribution and birth cohorts and whether the decline in stroke mortality shows heterogeneity by stroke type.

Methods

We undertook a sequential time-series analysis to examine trends in US stroke mortality among persons aged 18 years84 years between 1975 and 2019 (n= 4,332,220). Trends for overall stroke and by ischemic and hemorrhagic subtypes were examined. Mortality data were obtained from US death records, and population age and sex data were obtained from the US Census. Age-standardized stroke mortality rates and incidence rate ratio (IRR) with 95% confidence interval [CI] were obtained from Poisson regression models.

Results

Age-standardized stroke mortality decreased in women from 87.5 in 1975 to 30.9 per 100,000 in 2019 (IRR 0.27, 95% CI 0.26, 0.27; mean annual decline – 2.78%, 95% CI -2.79, -2.78). Among men, the age-standardized death rate decreased from 112.1 in 1975 to 38.7 per 100,000 in 2019 (RR 0.26, 95% CI 0.26, 0.27; mean annual decline -2, 80%, 95% CI -2.81, -2.79). Stroke mortality rises sharply with age. The reduction in stroke mortality was steeper in ischemic than in hemorrhagic strokes.

Conclusions

Death rates from stroke have decreased significantly, more so for ischemic than for hemorrhagic strokes.


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