This Article Full Text Full Text (PDF) All Versions of this Article: 34/9/2113    most recent 01.STR.0000089682.03104.F6v1 Alert me when this article is cited Alert me if a correction is posted 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 Google Scholar Google Scholar Articles by Longstreth, W.T. Articles by Tirschwell, D.L. Search for Related Content PubMed PubMed Citation Articles by Longstreth, W.T., Jr Articles by Tirschwell, D.L.

(Stroke. 2003;34:2113.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—The Next 30 Years of Stroke for Patients, Providers, Planners, and Politicians

Department of Neurology, Harborview Medical Center, University of Washington, Seattle, Washington

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Quibble with the models or puzzle over the formula, but heed the message of Figure 1. Stroke is more common in the elderly, and the proportion of elderly in the United States is rapidly growing. When questions involve comparisons, absolute numbers are shunned in favor of crude and especially adjusted rates. But here the question is what numbers we—as providers and planners of health care—should anticipate in the coming years. Figure 1 and its rising absolute numbers should alarm us. Are we prepared for this 98% projected increase over the next 30 years, from 139 000 patients dying from stroke in 2002 to 275 000 in 2033?

Considering mortality rather than morbidity underestimates the number, and many elderly are less frightened by death than by the prospect of long-term disability from stroke. Using Medicare hospital claims, the CDC estimated that during 2000 a total of 445 452 hospitalizations among Medicare enrollees were attributed to stroke.¹ Only 8.7% of these 445 452 patients died during the hospitalization. Data on death following hospitalization were not reported. Additionally, focus on fatal and nonfatal stroke ignores the even more ubiquitous vascular injury to the brain—such as with small infarcts, small bleeds, and white matter changes—that can erode function in the elderly without ever leading to signs and symptoms recognized as stroke.

The solution rests in primary prevention in people who have not had a stroke and secondary prevention in patients who have. Paradoxically, developing effective treatments for stroke may only worsen the problem by . . . [Full Text of this Article]