Stroke, Vol 20, 14-21, Copyright © 1989 by American Heart Association
MJ Klag, PK Whelton and AJ Seidler
Stroke mortality has been falling rapidly in this country since 1973. To
investigate age-race-sex effects on stroke mortality, we studied US vital
statistics during 1950-1972 and 1973-1981 in 55-64-, 65-74-, and
75-84-year-old race-sex groups. The accelerated rate of decline in stroke
mortality since 1973 has had a substantial public health impact, with
greater than 200,000 fewer stroke deaths than would otherwise have
occurred. For all groups, stroke mortality declined at a greater rate (p
less than 0.05) in 1973-1981 than during 1950-1972. The rates of decline
during 1973-1981 were greater with increasing age (p less than 0.05) and
were more substantial for younger blacks. There were no consistent
differences in the rate of decline by sex. The greater rate of decline in
absolute stroke mortality in the older age groups and blacks was explained
by higher baseline mortality in these groups. Overall, stroke mortality
decreased by approximately 2%/yr in 1950-1972 and by approximately 7%/yr
after 1973. Rank order of average annual percent decline after 1973 by
age-race-sex groups did not correspond to rates of change in treatment or
control of hypertension obtained from three national surveys. The
accelerated rate of decline after 1973 may have resulted from improved
antihypertensive therapy, but our findings fail to confirm this hypothesis
and suggest that treatment of hypertension may not be the principal reason
for the decline in stroke mortality.
ARTICLES
Decline in US stroke mortality. Demographic trends and antihypertensive treatment
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.
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