How Do We Know If We Are Making Progress in Reducing the Public Health Burden of Stroke?

Abstract

See related article, p, 2207. Much of the description of the differential burden of specific diseases and temporal changes in these burdens is based on mortality data. Stroke mortality rates have declined dramatically in the 20th century and into the new millennium. This has been acclaimed as one of the top 10 public health achievements of these eras.1,2 In 1999, the age-adjusted stroke death rate was 61.6 per 100 000, but it decreased by 37% in only 11 years to 38.9 per 100 000 in 2009 (most recent year available).3 Stroke has been stable as the third leading cause of death throughout most of the 20th century but in 2008, it declined to the fourth leading cause of death in the United States.4–6 Preliminary mortality data for 2009 and 2010 show that although stroke remains the fourth leading cause of death, the age-adjusted death rates for stroke continue to decrease, specifically by 4.3% between 2008 and 2009 and by 1.5% between 2009 and 2010.7,8 This dramatic and sustained decline in stroke mortality is indeed remarkable and raises questions regarding the underlying causes of the decline, including the possibility that it could be an artifact of the classification system for causes of death. What define disease-specific causes of death are codes on death certificates related to “underlying cause of death” (UCOD). In this issue of Stroke , Burke and colleagues9 report on their examination of 2000 to 2008 death certificate data of both UCOD and “any mention cause of death” to investigate …