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(Stroke. 1996;27:370-372.)
© 1996 American Heart Association, Inc.

Articles

The Enigma of the Decline in Stroke Deaths in the United States

The Search for an Explanation

Ruth Bonita, PhD, MPH Robert Beaglehole, MD, Dsc

From the University Geriatric Unit, Department of Medicine (R. Bonita), and the Department of Community Health (R. Beaglehole), School of Medicine, University of Auckland (New Zealand).

Correspondence to Ruth Bonita, MPH, PhD, University Geriatric Unit, North Shore Hospital, PB 93-503, Takapuna, Auckland 9, New Zealand.

	Introduction

 
Approximately 1 in 12 of all deaths worldwide are due to stroke; the majority occur in poorer countries.¹ From the limited data on national cause of death (available for only about one quarter of the world's population), it is clear that there are striking variations among countries in both stroke death rates and their direction and rate of change. Age-standardized death rates in central and eastern European countries are four to five times greater than the rates in the United States and are increasing.² Stroke death rates have been declining in the United States at least since the 1950s, with an increase in the rate of decline since the early 1970s. This decline, which has also occurred in many other industrialized countries, is real and has contributed to the increasing life expectancy of middle-aged and older people. Stroke is also a leading cause of disability, with poor countries carrying much of the global burden of stroke disability.³ With the aging of all populations, the global burden of stroke will inevitably increase.

Well-designed studies, which prospectively measure the incidence and case fatality of stroke in large, well-defined populations, are required to understand the reasons for these trends. The change in death rates could be due to a decline (or an increase) in incidence as a consequence of the success (or the failure) of primary preventive efforts, to an improvement (or a deterioration) in case fatality as a consequence of treatment, or to a change in the natural history of the disease. . . . [Full Text of this Article]

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