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After 40 years of decline, stroke death rates are rising again

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

Source: rutgers university

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

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

Total stroke deaths have fallen despite an increase in age-adjusted risk because stroke rates skyrocket as people age. A 10% reduction in the death rate for 75-year-olds would more than offset the doubling of the 35-year-old death rate, because strokes are 100 times more common in 75-year-olds.

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

“From 1960 onwards, the later you were born, the greater your risk of suffering a fatal ischemic stroke at any given age,” said Cande Ananth, head 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 the main culprits are rising rates of obesity and diabetes.”

The analysis used a comprehensive database of death certificates to identify virtually all adults under age 85 who died of stroke during the 44 years. 4,332,220 deaths in all.

This shows a model of a body and a brain
Stroke mortality (per 100,000) dropped from 88 to 31 for women and 112 to 39 for men between 1975 and 2019 in the United States. The image is in the public domain

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

This “age-period-cohort analysis,” which further divided patients by age at time of death, also allowed the study team to make two other new insights:

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

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

About this stroke and neurology research news

Author: Andre Smith
Source: rutgers university
Contact: Andrew Smith – Rutgers University
Image: The image is in the public domain

Original search: Closed access.
“Epidemiology and Trends in US Stroke Mortality, 1975–2019” by Cande Ananth et al. International Journal of Epidemiology


Summary

Epidemiology and trends in stroke mortality in the US, 1975–2019

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Background

Whether changes in stroke mortality are affected by age distribution and birth cohorts, and whether the decline in stroke mortality exhibits heterogeneity by stroke type, remains unclear.

Methods

We undertook a sequential time-series analysis to examine trends in stroke mortality in the US among 18-year-olds.84 years between 1975 and 2019 (n= 4 332 220). Trends were examined for overall stroke and by ischemic and hemorrhagic subtypes. Mortality data were drawn from US death files and population data by age and sex were drawn from the US census. Age-standardized stroke mortality rates and incidence rate (IRR) with 95% confidence intervals [CI] were derived from Poisson regression models.

Results

Age-standardized stroke mortality decreased for 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 dropped 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 increased markedly with advancing age. The decline in stroke mortality was more pronounced in ischemic than in hemorrhagic strokes.

Conclusions

Stroke mortality rates decreased substantially, more for ischemic strokes than for hemorrhagic strokes.