This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by KULLER, L. Articles by SELSTER, R. Search for Related Content PubMed PubMed Citation Articles by KULLER, L., DR. Articles by SELSTER, R.

(Stroke. 1970;1:86.)
© 1970 American Heart Association, Inc.

---

Nationwide Cerebrovascular Disease Morbidity Study

LEWIS KULLER DR. M.D.,P.H.¹; HERBERT ANDERSON ¹; DONALD PETERSON M.D., M.P.H.¹; JOHN CASSEL M.D.¹; PHILLIP SPIERS P.H.D.¹; HIRAM CURRY M.D.¹; BERTHA PAEGEL M.D.¹; MILTON SASLAW M.D., M.P.H.¹; CHARLES SISK M.D., M.P.H.¹; JOSEPH WILBER M.D.¹; DAVID MILLWARD M.D.¹; WARREN WINKELSTEIN JR. M.D., M.P.H.¹; ABRAHAM LILIENFELD M.D., M.P.H.¹; RAYMOND SELSTER M.D., M.P.H.¹

¹ Department of Chronic Diseases, The Johns Hopkins University School of Hygiene and Public Health; Seattle-King County Department of Public Health, Department of Epidemiology, University of North Carolina School of Public Health, Division of Neurology, Medical College of South Carolina, City and County of Denver Department of Health and Hospitals; Dade County, Florida Department of Public Health, University of Kansas School of Medicine, Georgia State Department of Public Health; State University of New York at Buffalo Department of Epidemiology

Previous studies have noted that the geographic differences in stroke mortality among areas of the United States were not due to artifacts of certification practices or accuracy of the diagnosis. A study of hospitalized stroke patients was completed in order to determine whether the mortality differences were due to a higher incidence or case fatality following a stroke in areas with high stroke death rates. Eight of the nine areas that participated in the Nationwide Mortality Study were included in this study. A total of 2,619 stroke cases were ascertained including 1,631 (62.3%) who were alive at the time of hospital discharge, 937 (35.8%) dead at discharge, 46 (1.7%) who were discharged alive but died outside of the hospital, and five (0.2%) who were dead at discharge and certified by the medical examiner.

The incidence of stroke was higher in the high stroke death rate areas especially for men. The ratio of the incidence of stroke in men as compared to women was higher in the younger age groups (45–54, 55–64) and in the high-incidence as compared to low-incidence areas.

The case-fatality percentage was lowest in Denver and highest in South Carolina. Presence of coma on admission was the principal determinant of subsequent mortality in all areas.

Finally, there was no consistent difference in the distribution of symptoms of stroke among the areas, and diagnostic procedures were performed more often in urban than rural areas. Approximately 80% of the stroke cases could be substantiated by either an autopsy verifying diagnosis, arteriography, hemorrhagic spinal fluid, hemiplegia or coma on admission. Several hypotheses to explain the differences have been suggested as well as the need for new information.

Key Words: epidemiology • stroke mortality hypertension • atherosclerosis • hospitalization • coma risk factors

This article has been cited by other articles:

				M. Gillett, W. A. Davis, D. Jackson, D. G. Bruce, and T. M.E. Davis Prospective Evaluation of Carotid Bruit as a Predictor of First Stroke in Type 2 Diabetes: The Fremantle Diabetes Study Stroke, September 1, 2003; 34(9): 2145 - 2151. [Abstract] [Full Text] [PDF]

				T. M. E. Davis, H. Millns, I. M. Stratton, R. R. Holman, R. C. Turner, and for the UK Prospective Diabetes Study Group Risk Factors for Stroke in Type 2 Diabetes Mellitus: United Kingdom Prospective Diabetes Study (UKPDS) 29 Arch Intern Med, May 24, 1999; 159(10): 1097 - 1103. [Abstract] [Full Text] [PDF]

				L. W. Pickle, M. Mungiole, and R. F. Gillum Geographic Variation in Stroke Mortality in Blacks and Whites in the United States Stroke, August 1, 1997; 28(8): 1639 - 1647. [Abstract] [Full Text]

				D. J. Lanska and P. M. Peterson Comparison of Additive and Multiplicative Models of Regional Variation in the Decline of Stroke Mortality in the United States Stroke, June 1, 1996; 27(6): 1055 - 1059. [Abstract] [Full Text]

				D. J. Lanska and P. M. Peterson Geographic Variation in Reporting of Stroke Deaths to Underlying or Contributing Causes in the United States Stroke, November 1, 1995; 26(11): 1999 - 2003. [Abstract] [Full Text]

				D. J. Lanska and L. H. Kuller The Geography of Stroke Mortality in the United States and the Concept of a Stroke Belt Stroke, July 1, 1995; 26(7): 1145 - 1149. [Full Text]

				G. Howard, G. W. Evans, K. Pearce, V. J. Howard, R. A. Bell, E. J. Mayer, and G. L. Burke Is the Stroke Belt Disappearing? : An Analysis of Racial, Temporal, and Age Effects Stroke, July 1, 1995; 26(7): 1153 - 1158. [Abstract] [Full Text]

				D. J. Lanska and P. M. Peterson Geographic Variation in the Decline of Stroke Mortality in the United States Stroke, July 1, 1995; 26(7): 1159 - 1165. [Abstract] [Full Text]

				M. L. Casper, S. Wing, R. F. Anda, M. Knowles, and R. A. Pollard The Shifting Stroke Belt : Changes in the Geographic Pattern of Stroke Mortality in the United States, 1962 to 1988 Stroke, May 1, 1995; 26(5): 755 - 760. [Abstract] [Full Text]

				D. J. Lanska and P. M. Peterson Effects of Interstate Migration on the Geographic Distribution of Stroke Mortality in the United States Stroke, April 1, 1995; 26(4): 554 - 561. [Abstract] [Full Text]

				W. E. Stehbens Validity of Cerebrovascular Mortality Rates Angiology, April 1, 1991; 42(4): 261 - 267. [Abstract] [PDF]