The end of the long-term decline in stroke mortality in the United States?

Abstract

Stroke is the third leading cause of death in the United States.1 2 3 4 A decline in the age-adjusted death rate for nonwhite women began in 1924, for nonwhite men in 1930, and for whites by 1918.5 The rate of decline accelerated in the 1970s, probably because of improved hypertension control, but slowed in the 1980s for reasons that remain unclear.6 Recently published statistics suggest that the long-term decline in stroke mortality rates in the United States may have ceased. There is unmistakable evidence for a marked slowdown in the decline in stroke mortality.6 The age-adjusted US stroke mortality rate increased between 1992 and 1993; a recent report documented another rise in the preliminary rate for 1995 (percent change from 1994 to 1995, +0.8).7 Age-adjusted rates per 100 000 for 1991 to 1995 were 26.8, 26.2, 26.5, 26.5, and 26.7, respectively (Table 1⇓). It is important to view these increases in proper perspective while in no way diminishing the serious impact of the slowdown in the decline of stroke mortality in the United States since 1978.6 To this end, we tested the hypotheses (1) that the rate of decline of age-adjusted mortality rates in 1987 to 1994, the period since the previous report,6 has returned to that seen in the 1960s before the widespread availability of antihypertensive therapy, and (2) that this occurred in each sex/race group. In 1987 to 1994, the mean annual absolute and percent decline in age-adjusted death rates for stroke was less than observed in 1979 to 1986 for each sex/race group (Table 2⇓).6 It was comparable to that observed in the 1960s, before the rapid decline of the 1970s that was commonly attributed to marked improvements in hypertension detection and treatment.2 This …