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(Stroke. 1998;29:415-421.)
© 1998 American Heart Association, Inc.


Original Contributions

The Greater Cincinnati/Northern Kentucky Stroke Study

Preliminary First-Ever and Total Incidence Rates of Stroke Among Blacks

Joseph Broderick, MD; Thomas Brott, MD; Rashmi Kothari, MD; Rosie Miller, RN; Jane Khoury, MS; Arthur Pancioli, MD; James Gebel, MD; Debbie Mills, RN; Laura Minneci, BA; Rakesh Shukla, PhD

From the Departments of Neurology (J.B., T.B., R.M., J.G., D.M., L.M.), Emergency Medicine (R.K., A.P.), and Environmental Health (J.K., R.S.), University of Cincinnati Medical Center, Cincinnati, Ohio.

Correspondence to Joseph Broderick, MD, University of Cincinnati Medical Center, Department of Neurology, 231 Bethesda Ave, Room 4010, Cincinnati, OH 45267-0525. E-mail broderjp{at}ucsmtp.edu

Background and Purpose—The Greater Cincinnati/Northern Kentucky Stroke Study was designed to be the first large, population-based metropolitan study of temporal trends in stroke incidence rates and outcome within a biracial population.

Methods—We are identifying all hospitalized and autopsied cases of stroke and transient ischemic attack (TIA) among the 1.3 million inhabitants of a five-county region of Greater Cincinnati/Northern Kentucky for the period 7/1/93–6/30/94. We have already prospectively monitored for out-of-hospital stroke and TIAs for this same time period at 128 screening sites, including a random sample of all primary care physicians and nursing homes in the region. We have already identified all hospitalized and autopsied cases of stroke and TIA among blacks for 1/1/93–6/30/93 and report preliminary incidence rates for this 6-month period.

Results—The overall incidence rate for all first-ever hospitalized or autopsied stroke (excluding TIAs) among blacks in the Greater Cincinnati region was 288 per 100 000 (95% CI, 250 to 325, age- and sex-adjusted to 1990 US population). The overall incidence rate for first-ever and recurrent stroke (excluding TIAs) was 411 per 100 000 (95% CI, 366 to 456). By comparison, the overall incidence rate of first-ever stroke among whites in Rochester, Minn, during the period 1985–1989 was 179 per 100 000 (95% CI, 164 to 194, age- and-sex adjusted to 1990 US population). The incidence rates among blacks in Greater Cincinnati were substantially greater than the rates among whites in Rochester, Minn, for all age categories except ages 75 and older, for which the rates were similar.

Conclusions—We conservatively estimate that 731 100 first-ever or recurrent strokes occurred in the United States during 1996. Studies of first-ever as well as total stroke among biracial and representative populations are critical for understanding temporal trends in the incidence rate and the burden of stroke in the US population.


Key Words: cerebral infarction • epidemiology • intracerebral hemorrhage • racial differences • subarachnoid hemorrhage




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Diabetes CareHome page
B. M. Kissela, J. Khoury, D. Kleindorfer, D. Woo, A. Schneider, K. Alwell, R. Miller, I. Ewing, C. J. Moomaw, J. P. Szaflarski, et al.
Epidemiology of Ischemic Stroke in Patients With Diabetes: The Greater Cincinnati/Northern Kentucky Stroke Study
Diabetes Care, February 1, 2005; 28(2): 355 - 359.
[Abstract] [Full Text] [PDF]


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StrokeHome page
J. P. Stansbury, H. Jia, L. S. Williams, W. B. Vogel, and P. W. Duncan
Ethnic Disparities in Stroke: Epidemiology, Acute Care, and Postacute Outcomes
Stroke, February 1, 2005; 36(2): 374 - 386.
[Abstract] [Full Text] [PDF]


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BloodHome page
H. J. Fullerton, R. J. Adams, S. Zhao, and S. C. Johnston
Declining stroke rates in Californian children with sickle cell disease
Blood, July 15, 2004; 104(2): 336 - 339.
[Abstract] [Full Text] [PDF]


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StrokeHome page
A. T. Schneider, B. Kissela, D. Woo, D. Kleindorfer, K. Alwell, R. Miller, J. Szaflarski, J. Gebel, J. Khoury, R. Shukla, et al.
Ischemic Stroke Subtypes: A Population-Based Study of Incidence Rates Among Blacks and Whites
Stroke, July 1, 2004; 35(7): 1552 - 1556.
[Abstract] [Full Text] [PDF]


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StrokeHome page
H. J. Fullerton, J. S. Elkins, and S. C. Johnston
Pediatric Stroke Belt: Geographic Variation in Stroke Mortality in US Children
Stroke, July 1, 2004; 35(7): 1570 - 1573.
[Abstract] [Full Text] [PDF]


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StrokeHome page
H. F. McGruder, A. M. Malarcher, T. L. Antoine, K. J. Greenlund, and J. B. Croft
Racial and Ethnic Disparities in Cardiovascular Risk Factors Among Stroke Survivors: United States 1999 to 2001
Stroke, July 1, 2004; 35(7): 1557 - 1561.
[Abstract] [Full Text] [PDF]


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StrokeHome page
D. O.C. Corbin, V. Poddar, A. Hennis, A. Gaskin, C. Rambarat, R. Wilks, C. D.A. Wolfe, and H. S. Fraser
Incidence and Case Fatality Rates of First-Ever Stroke in a Black Caribbean Population: The Barbados Register of Strokes
Stroke, June 1, 2004; 35(6): 1254 - 1258.
[Abstract] [Full Text] [PDF]


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StrokeHome page
C. S. Ivan, S. Seshadri, A. Beiser, R. Au, C. S. Kase, M. Kelly-Hayes, and P. A. Wolf
Dementia After Stroke: The Framingham Study
Stroke, June 1, 2004; 35(6): 1264 - 1268.
[Abstract] [Full Text] [PDF]


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StrokeHome page
T. Rundek, K. Nielsen, S. Phillips, K. C. Johnston, M. Hux, D. Watson, and for the GAIN Americas Investigators
Health Care Resource Use After Acute Stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas Trial
Stroke, June 1, 2004; 35(6): 1368 - 1374.
[Abstract] [Full Text] [PDF]


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StrokeHome page
B. Kissela, A. Schneider, D. Kleindorfer, J. Khoury, R. Miller, K. Alwell, D. Woo, J. Szaflarski, J. Gebel, C. Moomaw, et al.
Stroke in a Biracial Population: The Excess Burden of Stroke Among Blacks
Stroke, February 1, 2004; 35(2): 426 - 431.
[Abstract] [Full Text] [PDF]


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StrokeHome page
D. Kleindorfer, B. Kissela, A. Schneider, D. Woo, J. Khoury, R. Miller, K. Alwell, J. Gebel, J. Szaflarski, A. Pancioli, et al.
Eligibility for Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke: A Population-Based Study
Stroke, February 1, 2004; 35 (2): e27 - e29.
[Abstract] [Full Text] [PDF]


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StrokeHome page
M. J. Alberts, D. L. Bergman, E. Molner, B. D. Jovanovic, I. Ushiwata, and J. Teruya
Antiplatelet Effect of Aspirin in Patients With Cerebrovascular Disease
Stroke, January 1, 2004; 35(1): 175 - 178.
[Abstract] [Full Text] [PDF]


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StrokeHome page
J. P. Broderick
William M. Feinberg Lecture: Stroke Therapy in the Year 2025: Burden, Breakthroughs, and Barriers to Progress
Stroke, January 1, 2004; 35(1): 205 - 211.
[Abstract] [Full Text] [PDF]


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Arch Intern MedHome page
L. B. Morgenstern, L. K. Bartholomew, J. C. Grotta, L. Staub, M. King, and W. Chan
Sustained Benefit of a Community and Professional Intervention to Increase Acute Stroke Therapy
Arch Intern Med, October 13, 2003; 163(18): 2198 - 2202.
[Abstract] [Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
S. L. Seliger, D. L. Gillen, D. Tirschwell, H. Wasse, B. R. Kestenbaum, and C. O. Stehman-Breen
Risk Factors for Incident Stroke among Patients with End-Stage Renal Disease
J. Am. Soc. Nephrol., October 1, 2003; 14(10): 2623 - 2631.
[Abstract] [Full Text] [PDF]


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Neurorehabil Neural RepairHome page
C. J. Winstein, J. P. Miller, S. Blanton, E. Taub, G. Uswatte, D. Morris, D. Nichols, and S. Wolf
Methods for a Multisite Randomized Trial to Investigate the Effect of Constraint-Induced Movement Therapy in Improving Upper Extremity Function among Adults Recovering from a Cerebrovascular Stroke
Neurorehabil Neural Repair, September 1, 2003; 17(3): 137 - 152.
[Abstract] [PDF]


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PediatricsHome page
A. Kirton, J. H. Wong, J. Mah, B. C. Ross, J. Kennedy, K. Bell, and M. D. Hill
Successful Endovascular Therapy for Acute Basilar Thrombosis in an Adolescent
Pediatrics, September 1, 2003; 112(3): e248 - 251.
[Abstract] [Full Text] [PDF]


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NeurologyHome page
H. J. Fullerton, Y. W. Wu, S. Zhao, and S. C. Johnston
Risk of stroke in children: Ethnic and gender disparities
Neurology, July 22, 2003; 61(2): 189 - 194.
[Abstract] [Full Text] [PDF]


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StrokeHome page
S. Olindo, P. Cabre, R. Deschamps, C. Chatot-Henry, P. Rene-Corail, P. Fournerie, M. Saint-Vil, F. May, and D. Smadja
Acute Stroke in the Very Elderly: Epidemiological Features, Stroke Subtypes, Management, and Outcome in Martinique, French West Indies
Stroke, July 1, 2003; 34(7): 1593 - 1597.
[Abstract] [Full Text] [PDF]


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JAMAHome page
P. B. Gorelick, D. Richardson, M. Kelly, S. Ruland, E. Hung, Y. Harris, S. Kittner, and S. Leurgans
Aspirin and Ticlopidine for Prevention of Recurrent Stroke in Black Patients: A Randomized Trial
JAMA, June 11, 2003; 289(22): 2947 - 2957.
[Abstract] [Full Text] [PDF]


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JAMAHome page
R. L. Sacco
Preventing Stroke Among Blacks: The Challenges Continue
JAMA, June 11, 2003; 289(22): 3005 - 3007.
[Full Text] [PDF]


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StrokeHome page
R. D. Horner, J. W. Swanson, H. B. Bosworth, and D. B. Matchar
Effects of Race and Poverty on the Process and Outcome of Inpatient Rehabilitation Services Among Stroke Patients
Stroke, April 1, 2003; 34(4): 1027 - 1031.
[Abstract] [Full Text] [PDF]


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StrokeHome page
D. M. Bravata, S.-Y. Ho, L. M. Brass, J. Concato, J. Scinto, and T. P. Meehan
Long-Term Mortality in Cerebrovascular Disease
Stroke, March 1, 2003; 34(3): 699 - 704.
[Abstract] [Full Text] [PDF]


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PsychosomaticsHome page
J. Huffman and T. A. Stern
Acute Psychiatric Manifestations of Stroke: A Clinical Case Conference
Psychosomatics, February 1, 2003; 44(1): 65 - 75.
[Full Text] [PDF]


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NeurologyHome page
J. Bian, E.Z. Oddone, G.P. Samsa, J. Lipscomb, and D.B. Matchar
Racial differences in survival post cerebral infarction among the elderly
Neurology, January 28, 2003; 60(2): 285 - 290.
[Abstract] [Full Text] [PDF]


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JAMAHome page
A. T. Schneider, A. M. Pancioli, J. C. Khoury, E. Rademacher, A. Tuchfarber, R. Miller, D. Woo, B. Kissela, and J. P. Broderick
Trends in Community Knowledge of the Warning Signs and Risk Factors for Stroke
JAMA, January 15, 2003; 289(3): 343 - 346.
[Abstract] [Full Text] [PDF]


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CirculationHome page
B. Meier and J. E. Lock
Contemporary Management of Patent Foramen Ovale
Circulation, January 7, 2003; 107(1): 5 - 9.
[Full Text] [PDF]


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Am J EpidemiolHome page
P. Piriyawat, M. Smajsova, M. A. Smith, S. Pallegar, A. Al-Wabil, N. M. Garcia, J. M. Risser, L. A. Moye, and L. B. Morgenstern
Comparison of Active and Passive Surveillance for Cerebrovascular Disease: The Brain Attack Surveillance in Corpus Christi (BASIC) Project
Am. J. Epidemiol., December 1, 2002; 156(11): 1062 - 1069.
[Abstract] [Full Text] [PDF]


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StrokeHome page
A. I. Qureshi, M. F. K. Suri, Y. Mohammad, L. R. Guterman, and L. N. Hopkins
Isolated and Borderline Isolated Systolic Hypertension Relative to Long-Term Risk and Type of Stroke: A 20-Year Follow-Up of the National Health and Nutrition Survey
Stroke, December 1, 2002; 33(12): 2781 - 2788.
[Abstract] [Full Text] [PDF]


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StrokeHome page
B. S. Jacobs, B. Boden-Albala, I-F. Lin, and R. L. Sacco
Stroke in the Young in the Northern Manhattan Stroke Study
Stroke, December 1, 2002; 33(12): 2789 - 2793.
[Abstract] [Full Text] [PDF]


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StrokeHome page
E. Z. Oddone, R. D. Horner, D. C.C. Johnston, K. Stechuchak, L. McIntyre, A. Ward, L. G. Alley, J. Whittle, L. Kroupa, and J. Taylor
Carotid Endarterectomy and Race: Do Clinical Indications and Patient Preferences Account for Differences?
Stroke, December 1, 2002; 33(12): 2936 - 2943.
[Abstract] [Full Text] [PDF]


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StrokeHome page
S. S. Rathore, A. R. Hinn, L. S. Cooper, H. A. Tyroler, and W. D. Rosamond
Characterization of Incident Stroke Signs and Symptoms: Findings From the Atherosclerosis Risk in Communities Study
Stroke, November 1, 2002; 33(11): 2718 - 2721.
[Abstract] [Full Text] [PDF]


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Arch NeurolHome page
J. S. Elkins, S. Sidney, D. R. Gress, A. S. Go, A. L. Bernstein, and S. C. Johnston
Electrocardiographic Findings Predict Short-term Cardiac Morbidity After Transient Ischemic Attack
Arch Neurol, September 1, 2002; 59(9): 1437 - 1441.
[Abstract] [Full Text] [PDF]


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NeurologyHome page
H.J. Fullerton, D.M. Chetkovich, Y.W. Wu, W.S. Smith, and S.C. Johnston
Deaths from stroke in US children, 1979 to 1998
Neurology, July 9, 2002; 59(1): 34 - 39.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
C. J. Rodriguez, R. L. Sacco, R. R. Sciacca, B. Boden-Albala, S. Homma, and M. R. Di Tullio
Physical activity attenuates the effect of increased left ventricular mass on the risk of ischemic stroke: The Northern Manhattan Stroke Study
J. Am. Coll. Cardiol., May 1, 2002; 39(9): 1482 - 1488.
[Abstract] [Full Text] [PDF]


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StrokeHome page
S. Ruland, P. B. Gorelick, M. Schneck, D. Kim, C. G. Moore, S. Leurgans, and A. Bhardwaj
Acute Stroke Care in Illinois: A Statewide Assessment of Diagnostic and Treatment Capabilities * Editorial Comment: A Statewide Assessment of Diagnostic and Treatment Capabilities
Stroke, May 1, 2002; 33(5): 1334 - 1340.
[Abstract] [Full Text] [PDF]


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QJMHome page
K. Stavem and O.M. Ronning
Survival of unselected stroke patients in a stroke unit compared with conventional care
QJM, March 1, 2002; 95(3): 143 - 152.
[Abstract] [Full Text] [PDF]


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J. Neurol. Neurosurg. PsychiatryHome page
C D A Wolfe, A G Rudd, R Howard, C Coshall, J Stewart, E Lawrence, C Hajat, and T Hillen
Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register
J. Neurol. Neurosurg. Psychiatry, February 1, 2002; 72(2): 211 - 216.
[Abstract] [Full Text] [PDF]