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Vital signs : Recent trends in stroke death rates -- United States, 2000–2015
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    Introduction: The prominent decline in U.S. stroke death rates observed for more than 4 decades has slowed in recent years. CDC examined trends and patterns in recent stroke death rates among U.S. adults aged ≥35 years by age, sex, race/ethnicity, state, and census region.

    Methods: Trends in the rates of stroke as the underlying cause of death during 2000–2015 were analyzed using data from the National Vital Statistics System. Joinpoint software was used to identify trends in stroke death rates, and the excess number of stroke deaths resulting from unfavorable changes in trends was estimated.

    Results: Among adults aged ≥35 years, age-standardized stroke death rates declined 38%, from 118.4 per 100,000 persons in 2000 to 73.3 per 100,000 persons in 2015. The annual percent change (APC) in stroke death rates changed from 2000 to 2015, from a 3.4% decrease per year during 2000–2003, to a 6.6% decrease per year during 2003–2006, a 3.1% decrease per year during 2006–2013, and a 2.5% (nonsignificant) increase per year during 2013–2015. The last trend segment indicated a reversal from a decrease to a statistically significant increase among Hispanics (APC = 5.8%) and among persons in the South Census Region (APC = 4.2%). Declines in stroke death rates failed to continue in 38 states, and during 2013–2015, an estimated 32,593 excess stroke deaths might not have occurred if the previous rate of decline could have been sustained.

    Conclusions and Implications for Public Health Practice: Prior declines in stroke death rates have not continued in recent years, and substantial variations exist in timing and magnitude of change by demographic and geographic characteristics. These findings suggest the importance of strategically identifying opportunities for prevention and intervening in vulnerable populations, especially because effective and underused interventions to prevent stroke incidence and death are known to exist.

    Key Points:

    • After more than 4 decades of decline, stroke death rates in the United States have declined more slowly, stalled, or reversed among some subpopulations in recent years.

    • Trends in stroke death rates reversed in 2013 among Hispanics and in the South Census Region, where significant declines from year to year changed to significant increases during 2013–2015.

    • Thirty-eight states had an unfavorable change in the rate of decline in stroke death rates during 2000–2015.

    • An estimated 30,000 excess stroke deaths might have occurred because of the unfavorable changes in the rate of decline in stroke mortality during 2013–2015.

    • The findings emphasize the importance of continuing surveillance of stroke and strategically identifying disparities in specific risk factors, incidence, and geography that might be driving the unfavorable changes in the rate of decline so that targeted interventions can be implemented to prevent strokes in vulnerable populations.

    • Additional information is available at https://www.cdc.gov/vitalsigns/.

    Suggested citation for this article: Yang Q, Tong X, Schieb L, et al. Vital Signs: Recent Trends in Stroke Death Rates — United States, 2000–2015. MMWR Morb Mortal Wkly Rep. ePub: 6 September 2017. DOI: http://dx.doi.org/10.15585/mmwr.mm6635e1.

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