on August 31, 2006
Published online before print August 31, 2006, doi: 10.1161/01.STR.0000242766.65550.92
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on June 8, 2006
From the University of Cincinnati, Cincinnati, Ohio. * To whom correspondence should be addressed. E-mail: Dawn.kleindorfer{at}uc.edu.
Background and Purpose--Many advances were made in stroke prevention strategies during the 1990s, and yet temporal trends in stroke incidence and case-fatality have not been reported in the United States. Blacks have a 2-fold higher risk of stroke; however, there are no data over time showing if any progress has been made in reducing racial disparity in stroke incidence. The objective of this study was to examine temporal trends in stroke incidence and case-fatality within a large, biracial population during the 1990s. Methods--Within a biracial population of 1.3 million, all strokes were ascertained at all local hospitals using International Classification of Diseases, 9th Revision codes during July 1993 to June 1994 and again in 1999. A sampling scheme was used to ascertain cases in the out-of-hospital setting. Race-specific incidence and case-fatality rates were calculated and standardized to the 2000 US Census population. A population-based telephone survey regarding stroke risk factor prevalence and medication use was performed in 1995 and 2000. Results--There were 1954 first-ever strokes in 1993-1994 and 2063 first-ever strokes in 1999. The annual incidence of first-ever hospitalized stroke did not significantly change between study periods: 158 per 100 000 in both 1993-1994 and 1999 (P=0.97). Blacks continue to have higher stroke incidence than whites, especially in the young; however, case-fatality rates continue to be similar between races and are not changing over time. Medication use for treatment of stroke risk factors significantly increased in the general population between study periods. Conclusions--Despite advances in stroke prevention treatments during the 1990s, the incidence of hospitalized stroke did not decrease within our population. Case-fatality also did not change between study periods. Excess stroke mortality rates seen in blacks nationally are likely the result of excess stroke incidence and not case-fatality, and the racial disparity in stroke incidence did not change over time.
Accepted on June 30, 2006
The Unchanging Incidence and Case-Fatality of Stroke in the 1990s. A Population-Based Study
Dawn Kleindorfer MD*;
Key words: epidemiology • incidence • stroke
This article has been cited by other articles:
 |
|
 |
|
  K.-S. Hong and J. L. Saver Quantifying the Value of Stroke Disability Outcomes: WHO Global Burden of Disease Project Disability Weights for Each Level of the Modified Rankin Scale * Supplemental Mathematical Appendix Stroke, December 1, 2009; 40(12): 3828 - 3833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Liao, K. J. Greenlund, J. B. Croft, N. L. Keenan, and W. H. Giles Factors Explaining Excess Stroke Prevalence in the US Stroke Belt Stroke, October 1, 2009; 40(10): 3336 - 3341. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Feng, P. J. Nietert, and R. J. Adams Influence of Age on Racial Disparities in Stroke Admission Rates, Hospital Charges, and Outcomes in South Carolina Stroke, September 1, 2009; 40(9): 3096 - 3101. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Harmsen, L. Wilhelmsen, and A. Jacobsson Stroke Incidence and Mortality Rates 1987 to 2006 Related to Secular Trends of Cardiovascular Risk Factors in Gothenburg, Sweden Stroke, August 1, 2009; 40(8): 2691 - 2697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Kleindorfer, J. Khoury, J. P. Broderick, E. Rademacher, D. Woo, M. L. Flaherty, K. Alwell, C. J. Moomaw, A. Schneider, A. Pancioli, et al. Temporal Trends in Public Awareness of Stroke: Warning Signs, Risk Factors, and Treatment Stroke, July 1, 2009; 40(7): 2502 - 2506. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Page, J. P. Szaflarski, J. C. Eliassen, H. Pan, and S. C. Cramer Cortical Plasticity Following Motor Skill Learning During Mental Practice in Stroke Neurorehabil Neural Repair, May 1, 2009; 23(4): 382 - 388. [Abstract] [PDF]
|
|
|
|
 |
|
 K. Lakshminarayan, D. C. Anderson, D. R. Jacobs Jr., C. A. Barber, and R. V. Luepker Stroke Rates: 1980-2000: The Minnesota Stroke Survey Am. J. Epidemiol., May 1, 2009; 169(9): 1070 - 1078. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Flaherty, O. Adeoye, P. Sekar, M. Haverbusch, C. J. Moomaw, H. Tao, J. P. Broderick, and D. Woo The Challenge of Designing a Treatment Trial for Warfarin-Associated Intracerebral Hemorrhage Stroke, May 1, 2009; 40(5): 1738 - 1742. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The European Registers of Stroke (EROS) Investigat Incidence of Stroke in Europe at the Beginning of the 21st Century Stroke, May 1, 2009; 40(5): 1557 - 1563. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. P. Waddy, G. Cotsonis, M. J. Lynn, M. R. Frankel, S. Chaturvedi, J. E. Williams, and M. Chimowitz Racial Differences in Vascular Risk Factors and Outcomes of Patients With Intracranial Atherosclerotic Arterial Stenosis Stroke, March 1, 2009; 40(3): 719 - 725. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Kleindorfer Sociodemographic Groups at Risk: Race/Ethnicity Stroke, March 1, 2009; 40(3_suppl_1): S75 - S78. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Phua, J. R. Badia, N. K. J. Adhikari, J. O. Friedrich, R. A. Fowler, J. M. Singh, D. C. Scales, D. R. Stather, A. Li, A. Jones, et al. Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time?: A Systematic Review Am. J. Respir. Crit. Care Med., February 1, 2009; 179(3): 220 - 227. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Kissela, C. J. Lindsell, D. Kleindorfer, K. Alwell, C. J. Moomaw, D. Woo, M. L. Flaherty, E. Air, J. Broderick, and J. Tsevat Clinical Prediction of Functional Outcome After Ischemic Stroke: The Surprising Importance of Periventricular White Matter Disease and Race Stroke, February 1, 2009; 40(2): 530 - 536. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 WRITING GROUP MEMBERS, D. Lloyd-Jones, R. Adams, M. Carnethon, G. De Simone, T. B. Ferguson, K. Flegal, E. Ford, K. Furie, A. Go, et al. Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 27, 2009; 119(3): e21 - e181. [Full Text] [PDF]
|
|
|
|
|
|
M. Kubo, J. Hata, Y. Doi, Y. Tanizaki, M. Iida, and Y. Kiyohara Secular Trends in the Incidence of and Risk Factors for Ischemic Stroke and Its Subtypes in Japanese Population Circulation, December 16, 2008; 118(25): 2672 - 2678. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Alberts, R. A. Felberg, L. R. Guterman, S. R. Levine, and for Writing Group 4 Atherosclerotic Peripheral Vascular Disease Symposium II: Stroke Intervention: State of the Art Circulation, December 16, 2008; 118(25): 2845 - 2851. [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Heil, L. Malinowski, A. Rinderknecht, J. P. Broderick, and D. Franz Use of Intravenous Tissue Plasminogen Activator in a 16-Year-Old Patient with Basilar Occlusion J Child Neurol, September 1, 2008; 23(9): 1049 - 1053. [Abstract] [PDF]
|
|
|
|
|
|
P. U. Heuschmann, A. P. Grieve, A. M. Toschke, A. G. Rudd, and C. D.A. Wolfe Ethnic Group Disparities in 10-Year Trends in Stroke Incidence and Vascular Risk Factors: The South London Stroke Register (SLSR) Stroke, August 1, 2008; 39(8): 2204 - 2210. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Kleindorfer, R. Miller, S. Sailor-Smith, C. J. Moomaw, J. Khoury, and M. Frankel The Challenges of Community-Based Research: The Beauty Shop Stroke Education Project Stroke, August 1, 2008; 39(8): 2331 - 2335. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Writing Group Members, W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]
|
|
|
|
|
|
D. A. Levine, C. I. Kiefe, G. Howard, V. J. Howard, O. D. Williams, and J. J. Allison Reduced Medication Access: A Marker for Vulnerability in US Stroke Survivors Stroke, May 1, 2007; 38(5): 1557 - 1564. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein and P. M. Rothwell Primary Prevention and Health Services Delivery Stroke, February 1, 2007; 38(2): 222 - 224. [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Flaherty, B. Kissela, D. Woo, D. Kleindorfer, K. Alwell, P. Sekar, C. J. Moomaw, M. Haverbusch, and J. P. Broderick The increasing incidence of anticoagulant-associated intracerebral hemorrhage Neurology, January 9, 2007; 68(2): 116 - 121. [Abstract] [Full Text] [PDF]
|
|