Trends In Stroke Mortality Research Articles

Abstract 4124966: Trends and Gender Differences in Stroke Mortality Rates Among Patients with Atrial Fibrillation/Flutter from 1999 to 2020

Background: Atrial fibrillation (AFib) and atrial flutter (AFL) are common arrhythmias associated with increased stroke risk. This study examines stroke mortality trends and gender differences among AFib/AFL patients in the United States over a 22-year period. Research Question: Do stroke mortality rates among patients with AFib/AFL show significant trends and gender differences from 1999 to 2020? Aims: The primary aim is to analyze trends in crude and age-adjusted stroke mortality rates and determine gender-specific differences over the 22-year period. Methods: We conducted a retrospective analysis using CDC multiple causes of death files from 1999 to 2020. Stroke deaths (ICD-10 codes I60-I69) with AFib/AFL (ICD-10 code I48) as contributory factors were identified. Crude and age-adjusted mortality rates were calculated annually. Joinpoint regression calculated annual percentage change (APC) and assessed trend significance (p < 0.05). Poisson regression was used for rate comparisons. Gender-specific trends highlighted differences between males and females. Results: The analysis included 204,127 stroke deaths with AFib/AFL. Both crude and age-adjusted mortality rates increased. The crude mortality rate rose from 3.3 per 100,000 in 1999 to 4.9 per 100,000 in 2020, APC 1.8% (p < 0.01). The age-adjusted rate increased from 3.4 to 4.0 per 100,000, APC 1.2% (p < 0.01). Females had higher crude mortality rates, increasing from 4.3 to 5.5 per 100,000, APC 1.3% (p < 0.01), while males rose from 2.3 to 4.2 per 100,000, APC 2.2% (p < 0.01). Age-adjusted rates: females increased from 3.4 to 3.9 per 100,000, APC 0.8% (p < 0.01), and males from 3.3 to 4.2 per 100,000, APC 1.6% (p < 0.01). Poisson regression indicated these differences were significant (p < 0.05). Age adjustment narrowed gender disparity. Conclusion: Increasing stroke mortality rates among AFib/AFL patients highlight a growing public health concern in the United States. Females have higher crude stroke mortality rates than males, but age adjustment reveals a more balanced trend. More work is needed to understand influencing factors, including anticoagulation rates, healthcare access, and AFib/AFL management strategies.

Global, regional, and national temporal trends in metabolism-related ischemic stroke mortality and disability from 1990 to 2021

BackgroundStroke ranks as the second leading cause of mortality and the third leading cause of disability worldwide. Nonetheless, the evolving burden of ischemic stroke attributable to various metabolic risk factors remains inadequately elucidated. A thorough grasp of these trends is crucial for a nuanced comprehension of stroke epidemiology and the formulation of effective preventive and interventional measures. MethodBased on the Global Burden of Disease, Injury, and Risk Factors Study 2021 (GBD), we analyzed national temporal trends in the burden of metabolism-associated ischemic stroke in 204 countries and territories globally from 1990-2021, as measured by the average annual percentage change (AAPC), using join-point regression models. The burden of disease was assessed using age-standardized (ASR) mortality rates and disability-adjusted life years (DALY) per 100 000 population. Cross-country inequalities in ischemic stroke burden were quantified using standard health equity methods and changes in ischemic stroke burden were projected to 2045. ResultsGlobally, the ASR for ischemic stroke mortality linked to overall dietary metabolic risk declined by an average of 1.6% annually, while the ASR for disability-adjusted life years saw an average annual decrease of 1.3%. High systolic blood pressure remained a primary contributor to metabolism-related ischemic stroke, accounting for 57.9% of deaths and 58.0% of disability in 2021. Disparities associated with the sociodemographic index (SDI) diminished, with the gap in DALYs between countries with the highest and lowest SDIs narrowing from 592.2 (95% CI: 440.2-744.4) to 480.4 (95% CI: 309.7-651.2) in 2021. Projections indicate a continued decline in overall metabolism-related ischemic stroke deaths, mortality rates, and ASRs through 2045, although an increase in DALYs and ASRs is anticipated within the male population. ConclusionThe global burden of metabolic risk-associated ischemic stroke has generally been decreasing from 2019 to 2021. This study highlights significant challenges in controlling and managing metabolic risk-associated ischemic stroke, including an increase in the number of cases in certain countries and regions, as well as an uneven distribution worldwide. These findings may provide valuable insights for the development of improved public health policies and the rational allocation of healthcare resources.

Temporal Mortality Trends Attributable to Stroke in South Asia: An Age-Period-Cohort Analysis.

South Asia contributes the most to stroke mortality worldwide. This study aimed to determine the long-term trends in stroke mortality across four South Asian countries and its associations with age, period, and birth cohort. In 2019, nearly one million stroke deaths occurred across South Asia, and the associated age-standardized mortality rate (ASMR) was 80.2 per 100,000. Between 1990 and 2019, India had the largest decrease in the ASMR (-35.8%) across the four South Asian countries. While Pakistan had the smallest decrease in the ASMR (-7.6%), an increase was detected among males aged 15 to 34 years and females aged 15 to 19 years. Despite a 22.8% decrease in the ASMR, Bangladesh had the highest ASMR across the four South Asian countries. Nepal reported a witness increase in the stroke ASMR after 2006. Improved period and cohort effects on stroke mortality were generally indicated across the analyzed countries, except for recent-period effects in males from Nepal and cohort effects from those born after the 1970s in Pakistan. Stroke mortality has decreased in the four South Asian countries over the past 30 years, but potentially unfavorable period and cohort effects have emerged in males in Nepal and both sexes in Pakistan. Governmental and societal efforts are needed to maintain decreasing trends in stroke mortality.

Trends in Mortality Due to Stroke in South America between 1990 and 2019.

Stroke is the second leading cause of death and disability in Latin America; however, few epidemiological studies have been conducted in South America. An observational study was conducted to analyze trends in stroke mortality in South American (SA) countries. Age-standardized mortality rates and proportional mortality due to stroke in the populations of SA countries between 1990 and 2019 were assessed by extracting data from the Global Burden of Disease 2019 study. Joinpoint regression models were employed to identify trends in the annual percentage change in mortality rates for each segment. Considering the data collected over the 30 years that were studied, the age-standardized stroke mortality trend decreased in Argentina (-1.6%), Uruguay (-0.6%), Brazil (-0.5%), Guyana (-0.5%), and Bolivia (-0.4%), while Venezuela (+1.6%) and Suriname (+1.0%) showed an increasing trend. The proportional stroke mortality trend decreased in Argentina (-1.7%), Paraguay (-0.9%), Uruguay (-0.7%), Guyana (-0.7%), Brazil (-0.5%), and Chile (-0.5%), whereas Bolivia (+1.0%), Suriname (+0.6%), and Peru (+0.4%) exhibited an increasing trend. The trends in stroke mortality between 1990 and 2019 demonstrated considerable variability. While most SA countries experienced significant decreases in stroke mortality trends, Venezuela and Suriname showed increases in age-standardized mortality rates, and Bolivia, Suriname, and Peru exhibited increases in proportional mortality rates. No decreasing stroke mortality trend was observed in the segment after the last joinpoint, highlighting the need for improvement in prevention and treatment.

Stroke care in sub-Saharan Africa: Evaluating the present landscape and proposing strategies for improving outcomes

The burden of stroke is alarmingly high in sub-Saharan Africa (SSA), characterized by increasing trends in stroke incidence, prevalence, and mortality. This review details the landscape of stroke care in SSA, encompassing epidemiology, risk factors, care availability, and challenges in advancing stroke care, along with a proposed strategic framework for improvement. Epidemiological studies in SSA indicate a rising trend in stroke incidence and prevalence, with significant variability attributable to differences in study methodologies. Crude incidence rates have risen from an average of 53 (range: 26 – 101) cases/100,000 population between 1973 and 1991 to 88 (range: 25 – 149) cases/100,000 population between 2003 and 2011. Similarly, prevalence rates have shown an upward trend. Stroke mortality in SSA remains high, with variability across studies. Key predictors of mortality include hemorrhagic stroke, gender, National Institute of Stroke Scale score at presentation, and comorbidities such as anemia and human immunodeficiency virus infection. However, the interpretation of mortality rates warrants caution due to methodological limitations. Both modifiable and non-modifiable risk factors significantly contribute to stroke risk in SSA. Notably, stroke occurs at a younger age in SSA compared to Western countries. Hypertension, diabetes, dyslipidemia, and lifestyle factors are among the major modifiable risk factors. The availability of organized stroke care varies significantly across SSA, with more advanced care typically found in higher-level health-care centers. However, efforts to improve access and quality of care are ongoing. The challenges in advancing stroke care in SSA include cultural beliefs, limited access to care, and prohibitive costs. A “5 Ps” framework involving collaboration among policymakers, payers, partners in health care, providers, and patients is proposed to improve stroke care. This review underscores the urgent need for enhanced public health strategies, medical interventions, and collaborative efforts to address the escalating stroke burden in SSA.

Global, regional, and national temporal trends of diet-related ischemic stroke mortality and disability from 1990 to 2019.

Stroke is the second leading cause of death and the third leading cause of disability in the general population worldwide. However, the changing trend of ischemic stroke burden attributable to various dietary risk factors has not been fully revealed and may contribute to a better understanding of stroke epidemiology. Our article aimed to evaluate the temporal trend of diet-related ischemic stroke burden to inform future research and policy-making. This analysis was based on the data from the Global Burden of Disease (GBD) Study 2019 (spanning years 1990 to 2019), and we used the joinpoint regression to model temporal trends in diet-related ischemic stroke burden across countries and regions of the world during the study period. Six specific dietary factors known to influence stroke risk, including sodium, red meat, fiber, vegetables, whole grains, and fruits, were evaluated in the GBD study to determine their individual and joint impact on ischemic stroke. The changing trend was primarily measured by the average annual percent change (AAPC). Age-standardized rates (ASRs) of mortality and years lived with disability (YLD) per 100,000 population were used to evaluate disease burden. Finally, the socioeconomic background, which was quantified as sociodemographic index (SDI), and its association with diet-related ischemic stroke burden were also explored with the Pearson correlation coefficient. During the study period, the ischemic stroke ASR of mortality attributable to overall dietary risk decreased by an average of 1.6% per year, while the ASR of YLD decreased by an average of 0.2% per year. High sodium diet was still a key driver of diet-related ischemic stroke, accounting for 8.4% and 11.0% of deaths and disabilities, respectively, in 2019. In addition, we found a negative association between temporal evolution of stroke burden and socioeconomic background (r = -0.6603 for mortality and r = -0.4224 for disability, P < 0.001), which suggested that the developing countries with weak social and economic foundation faced greater challenges from the ongoing burden of diet-related strokes compared with developed countries. Our study found declining trends and revealed the current status of diet-related ischemic stroke mortality and disability. Interdisciplinary countermeasures involving the development of effective food policies, evidence-based guidelines, and public education are needed in the future to combat this global epidemic. The data used for analysis were open-access and can be obtained from https://vizhub.healthdata.org/gbd-results/.

Trends in Demographic and Geographic Disparities in Stroke Mortality Among Older Adults in the United States

Stroke is a leading cause of morbidity and mortality in the United States (US) among older adults. However, the impact of demographic and geographic risk factors remains ambiguous. A clear understanding of these associations and updated trends in stroke mortality can influence health policies and interventions. This study characterizes stroke mortality among older adults (age ≥ 55) in the US from January 1999 to December 2020, sourcing data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. Segmented regression was used to analyze trends in crude mortality rate (CMR) and age-adjusted mortality rate (AAMR) per 100,000 individuals stratified by stroke subcategory, sex, ethnicity, urbanization, and state. 3,691,305 stroke deaths occurred in older adults in the US between 1999 and 2020 (AAMR = 233.3), with an overall decrease in AAMR during these years. The highest mortality rates were seen in non-specified stroke (AAMR = 173.5), those 85 or older (CMR = 1276.7), men (AAMR = 239.2), non-Hispanic African American adults (AAMR = 319.0), and noncore populations (AAMR = 276.1). Stroke mortality decreased in all states from 1999 to 2019 with the greatest and least decreases seen in California (-61.9%) and Mississippi (-35.0%), respectively. The COVID-19 pandemic saw increased stroke deaths in most groups. While there's a decline in stroke-related deaths among US older adults, outcome disparities remain across demographic and geographic sectors. The surge in stroke deaths during COVID-19 reaffirms the need for policies that address these disparities.

Age-Period-Cohort Analysis of Long-Term Trends in Ischemic Stroke Mortality in China Caused by Specific Risk Factors from 1990 to 2019

Objective: The objective of this study was to study the primary risk factors for the long-term trends of mortality rates in ischemic stroke (IS) in China. Methods: Using the Global Burden of Disease Study 2019 (GBD 2019) database, research was conducted on the 11 primary risk factors for the mortality rates of IS in China from 1990 to 2019. This study employed joinpoint regression software and the age-period-cohort method to evaluate the trends of mortality rates divided by age, period, and cohort over time. Results: From 1990 to 2019, the age-standardized mortality rate (ASMR) caused by a diet high in red meat and high body mass index in China showed an upward trend. ASMR increased first and then decreased due to smoking, diet high in sodium, particulate matter pollution, high fasting plasma glucose, and high systolic blood pressure. Low-density lipoprotein cholesterol (LDL-C), kidney dysfunction, low temperature, and lead exposure remained relatively stable during this period. In the 35–45 age group, the mortality rate of IS due to high LDL-C was up to about 60%, and smoking affected men more than women. Overall, high LDL-C, high systolic blood pressure, and particulate matter pollution were the most common risk factors in patients with IS. The risk of death rose with age. The period and cohort relative risks showed that metabolic risk factors had the greatest impact on the mortality of IS. Conclusion: Metabolic risk factors have become the primary risk factors for the ASMR of IS in China. Relevant authorities should pay attention to their long-term effects on IS. Effective public health policies and interventions should be implemented to reduce the burden of IS.

Trends in hemorrhagic stroke incidence and mortality in a National Stroke Registry of a multi-ethnic Asian population.

High-quality epidemiological data on hemorrhagic stroke (HS) and its subtypes, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), remains limited in Asian ethnicities. We investigated the trends in HS incidence and 30-day mortality from 2005 to 2019 in a multi-ethnic Asian population from a national registry. Data on all stroke cases from the Singapore Stroke Registry from 2005 to 2019 were collected. Cases were defined using centrally adjudicated review of diagnosis codes. Death outcomes were obtained by linkage with the national death registry. Incidence (per 100,000 people) and 30-day mortality (per 100 people) were measured as crude and age-standardized rates. Trends were analyzed using linear regression. We analyzed 19,017 cases of HS (83.9% ICH; 16.1% SAH). From 2005 to 2019, age-standardized incidence rates (ASIR) for HS remained stable from 34.4 to 34.5. However, age-standardized mortality rates (ASMR) decreased significantly from 29.5 to 21.4 (p < 0.001). For ICH, ASIR remained stable while ASMR decreased from 30.4 to 21.3 (p < 0.001); for SAH, ASIR increased from 2.7 to 6.0 (p = 0.006) while ASMR remained stable. In subgroup analyses, HS incidence increased significantly in persons <65 years (from 18.1 to 19.6) and Malays (from 39.5 to 49.7). From 2005 to 2019, ASIR of HS remained stable while ASMR decreased. Decreasing ASMR reflects improvements in the overall management of HS, consistent with global trends. Population health efforts to address modifiable risk factors for HS in specific demographic subgroups may be warranted to reduce incidence and mortality of HS.

Trends in stroke mortality in La Rioja (Spain) from 1999 to 2022

Stroke mortality has declined in recent decades, but there appears to be a slowdown in the decline in recent years. We analyze the trends in stroke mortality in La Rioja (Spain) for the period 1999-2022. We evaluated stroke mortality using statistical data from the mortality registry of La Rioja (Spain). We adjusted the rates by age and sex and analyzed both overall strokes and subtypes: hemorrhagic and ischemic. To analyze the trend in mortality rates we constructed joinpoint regression models, with associated annual percentage change (APC) RESULTS: Age-standardized stroke mortality declined between 1999 and 2022: females from 98.0 to 29.2 per 100 000; males, from 131.6 to 44.8 per 100 000. We found a decrease in overall stroke mortality in all age groups, except those under 65 years old. Ischemic stroke mortality showed declines in the first decade (APC: 7.3%, CI95%: 4.1-19.1%) and increases in the second decade (APC: 1.6%, CI95%: -1.6-11.7%) among men. In women, the rates declined between 2018 and 2022(APC: -6.6%, CI95%: -5.1-30.6%) after an increase between 2015 and 2017 (APC: 23.5%, CI95%: -20.2-38.3%). For hemorrhagic stroke, we found a consistent rate of decline throughout the entire time period in men (APC: 2.4%, CI95%: 0.9 a 4.0%). In women, rates increased during the period 1999-2009(APC: 1.9%, CI95%: -2.1-22.8%) and decreased 2010-2022 (APC: 6.5%, CI95%: 4.0-25.6%). Stroke mortality rates have decreased, more so for haemorrhagic than ischaemic strokes.

Revisiting recent trends in stroke death rates, United States, 1999–2020

BackgroundPrior studies have reported a reversal or stalling of stroke mortality trends in the United States, but the literature has not been updated using recent data. A comprehensive examination of contemporary trends is crucial to informing public health intervention efforts, setting health priorities, and allocating limited health resources. This study assessed the temporal trends in stroke death rates in the United States from 1999 through 2020. MethodsWe used national mortality data from the Underlying Cause of Death files in the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (WONDER). Stroke decedents were identified using the International Classification of Diseases Codes, 10th Revision- I60-I69. Crude/age-adjusted mortality rates (AAMR) were abstracted overall and by age, sex, race/ethnicity, and US census region. Joinpoint analysis and five-year simple moving averages assessed mortality trends from 1999 through 2020. Results were expressed as annual percentage changes (APC), average annual percentage changes (AAPC), and 95% confidence interval (CI). ResultsStroke mortality trends declined from 1999 to 2012 but increased by 0.5% annually from 2012 through 2020. Rates increased by 1.3% per year among Non-Hispanic Blacks from 2012 to 2020, 1.7% per year among Hispanics from 2012 to 2020, and stalled among Non-Hispanic Whites (2012−2020), Asians/Pacific Islanders (2014–2020), and American Indians/Alaska Natives (2013−2020). Recent rates have stalled among females from 2012 to 2020 and increased among males at an annual rate of 0.7% during the same period. Based on age, trends have stabilized among older adults since 2012 and grew at an annual rate of 7.1% among persons <35 years and 5.2% among persons 35 to 64 years since 2018. Declining trends were sustained in the Northeastern region only, with rates stalling in the Midwest and increasing in the South and West. ConclusionsThe decline in US stroke mortality trends recorded during previous decades has not been sustained in recent years. While the reasons are unclear, findings might be attributed to changes in stroke risk factors in the US population. Further research should identify social, regional, and behavioral drivers to guide medical and public health intervention efforts.

Twenty-Year Disparity Trends in United States Stroke Death Rate by Age, Race/Ethnicity, Geography, and Socioeconomic Status.

In 2017, the Centers for Disease Control and Prevention (CDC) issued an alert that, after decades of consistent decline, the stroke death rate levelled off in 2013, particularly in younger individuals and without clear origin. The objective of this analysis was to understand whether social determinants of health have influenced trends in stroke mortality. We performed a longitudinal analysis of county-level ischemic and hemorrhagic stroke death rate per 100,000 adults from 1999 to 2018 using a Bayesian spatiotemporally smoothed CDC dataset stratified by age (35-64 years [younger] and 65 years or older [older]) and then by county-level social determinants of health. We reported stroke death rate by county and the percentage change in stroke death rate during 2014-2018 compared with that during 2009-2013. We included data from 3,082 counties for younger individuals and 3,019 counties for older individuals. The stroke death rate began to increase for younger individuals in 2013 (p < 0.001), and the slope of the decrease in stroke death rate tapered for older individuals (p < 0.001). During the 20-year period of our study, counties with a high social deprivation index and ≥10% Black residents consistently had the highest rates of stroke death in both age groups. Comparing stroke death rate during 2014-2018 with that during 2009-2013, larger increases in younger individuals' stroke death rate were seen in counties with ≥90% (vs <90%) non-Hispanic White individuals (3.2% mean death rate change vs 1.7%, p < 0.001), rural (vs urban) populations (2.6% vs 2.0%, p = 0.019), low (vs high) proportion of medical insurance coverage (2.9% vs 1.9%, p = 0.002), and high (vs low) substance abuse and suicide mortality (2.8 vs 1.9%, p = 0.008; 3.3% vs 1.5%, p < 0.001). In contrast to the younger individuals, in older individuals, the associations with increased death rates were with more traditional social determinants of health such as the social deprivation index, urban location, unemployment rate, and proportion of Black race and Hispanic ethnicity residents. Improvements in the stroke death rate in the United States are slowing and even reversing in younger individuals and many US counties. County-level increases in stroke death rate were associated with distinct social determinants of health for younger vs older individuals. These findings may inform targeted public health strategies.

Effect of Age and Sex on Stroke Mortality of Young and Middle-aged Adults in China, 2002–2019, and Predictions to 2030

ObjectiveThis study aimed to examine the trends in stroke mortality among young and middle-aged adults in China. MethodsData were obtained from the China national vital registration system. Significant changes in mortality were assessed by Joinpoint regression. Age-period-cohort analysis was used to explain the reasons for the changes. Future mortality and counts were predicted by the Bayesian age-period-cohort model. ResultsBetween 2002 and 2019, a total of 6,253,951 stroke mortality in young and middle-aged adults were recorded. The age-adjusted mortality rates (AAMRs) of women showed a downward trend. The annual percent changes (APC) were –3.5% (–5.2%, –1.7%) for urban women and –2.8% (–3.7%, –1.9%) for rural women. By contrast, the AAMRs per 100,000 for rural men aged 25–44 years continued to rise from 9.40 to 15.46. The AAMRS for urban men aged 25–44 years and urban and rural men aged 45–64 years did not change significantly. Between 2020 and 2030, the projected stroke deaths are 1,423,584 in men and 401,712 in women. ConclusionSignificant sex and age disparities in the trends of stroke mortality among young and middle-aged adults were identified in China. Targeted health policy measures are needed to address the burden of stroke in the young generation, especially for rural men, with a focus on the prevention and management of high risk factors.

Different Changing Patterns for Stroke Subtype Mortality Attributable to High Sodium Intake in China During 1990 to 2019.

It is unclear whether sodium intake had similar effects on mortality of stroke subtypes. The purpose of this study is to compare the long-term trends in mortality of stroke subtypes attributable to high sodium intake in China during 1990 to 2019. Data for China in the GBD (Global Burden of Disease) 2019 study were obtained mainly from the Chinese surveillance systems and the KaiLuan Study. The trends in stroke mortality due to high sodium intake (>5 g/d) were evaluated using join-point regression and age-period-cohort methods adjusting for age, period, and cohort. The age-standardized mortality rates of stroke attributable to high sodium intake showed downward trends during 1990 to 2019 in China, with an average annual percentage change of -0.6 (95% CI, -0.8 to -0.4) for ischemic stroke, -2.5 (95% CI, -2.8 to -2.2) for intracerebral hemorrhage, and -6.1 (95% CI, -6.6 to -5.7) for subarachnoid hemorrhage. The curves of local drifts, which reflected the average annual percentage change of stroke mortality due to high sodium intake across age groups, showed a slow upward trend with age for ischemic stroke, a slow downward trend for intracerebral hemorrhage, and a sharp downward trend for subarachnoid hemorrhage. The high sodium-related mortality increased dramatically with age for ischemic stroke and intracerebral hemorrhage, while it reached a peak at 50 to 70 years old for subarachnoid hemorrhage. The period and cohort rate ratios of stroke mortality due to high sodium intake decreased in the past 3 decades, with the greatest decline for subarachnoid hemorrhage and the weakest decrease for ischemic stroke. Notably, men had higher high sodium-related mortality and risk but slighter declines for all stroke subtypes than women. Our results provided powerful evidence that high sodium-related age-standardized mortality rates and risk of stroke in China decreased in the past 3 decades, with diverse changing patterns for different stroke subtypes, highlighting that salt reduction had distinct impact on stroke subtypes.

Temporal Trends in Stroke Hospitalizations, Treatment Modalities, and Mortality

Stroke remains a leading cause of morbidity and is the second leading cause of death globally1 despite advances in treatment and prevention over the past decade. In this issue of Neurology ®, Kelly et al.2 use administrative data on acute stroke hospitalizations among adults aged 18 years or older in Germany between 2014 and 2019 to describe updated trends in stroke admissions, treatment modalities, and mortality nationally. Using population-level data from the Federal Statistics Office in Germany, study authors calculated frequencies of hospitalizations for acute stroke over a 6-year period. Study authors then evaluated demographic and clinical characteristics of stroke cases and evaluated trends in the utilization of interventions such as carotid stenting, systemic thrombolysis, and thrombectomy. They also calculated proportions of stroke cases in which in-hospital death occurred, followed by logistic regression models to investigate predictors of in-hospital mortality.

Changes in childhood stroke mortality from 1990 to 2019 in Brazil and its federative units

This research analyzed the temporal trend of stroke mortality in children aged 0–14 years, from 1990 to 2019, in Brazil and its federative units. This ecological study used data from the Global Burden of Disease, a study led by the Institute for Health Metrics and Evaluation. Stroke definition considered the International Classification of Diseases according to codes G45, G46, and I60–I69. Age-standardized mortality rates and the mean annual percentage change (APC) in mortality rates were estimated. Stroke mortality trends decreased, with an APC of − 3.9% (95% CI − 4.5; − 3.3; p < 0.001). Reducing trends were found in all but two states, where they were stationary. Maranhão (− 6.5%; 95% CI − 7.6; − 5.4; p < 0.001) had the greatest reduction and Rondônia, the smallest (− 1.2%; 95% CI − 2.3; − 0.1, p = 0.027). Decrease was more important in children < 5 (− 5.8%; 95% CI − 6.3; − 5.2; p < 0.001) compared to 5–14 years old (− 2.1%; 95% CI − 2.9; − 1.3; p < 0.001); additionally, it was greater in girls (− 4.1%; 95% CI − 4.6; − 3.5; p < 0.001) than in boys (− 3.8%; 95% IC − 4.5; − 3.1; p < 0.001). Ischemic stroke had the highest APC (− 6.1%; 95% CI − 6.8; − 5.3; p < 0.001), followed by intracranial hemorrhage (− 5.3%; 95% CI − 6.1; − 4.5; p < 0.001) and subarachnoid hemorrhage (− 2.7%; 95% CI − 3.3; − 2.1; p < 0.001). Largest reductions were seen in states with more vulnerable socioeconomic contexts. The stationary trends and lowest APCs were concentrated in the northern region, which had greater impact of diseases and less favorable outcomes.

MUDANÇAS EPIDEMIOLÓGICAS NA DOENÇA ARTERIAL CORONÁRIA NO BRASIL

Cardiovascular diseases (CVD) are the leading cause of death in Brazil. The main etiologies are ischemic heart disease (IHD) and stroke. Since 1984, we have observed a continuous and significant reduction in mortality from these diseases in men and women, but the death rate was consistently higher in men than in women. The prevalence and death rate from CVD predominated in the South and Southeast and capitals in the 1990s. In the 2000s, we observed the proximity of CVD mortality in the five regions due to the more significant reduction in mortality in the South and Southeast. The proximity of stroke mortality trends occurred earlier than those due to IHD, reflecting the population's greater awareness of hypertension control. Between 2007 and 2012, we had a short interruption in the downward trend in the IHD death rate in women and men, but not for all CVD and stroke, which continued to decline. However, from that period, the downward trend continued. Recent studies showed that mortality from all causes of cancer would exceed mortality from CVD in the population aged between 35 to 74. The intensification of primary prevention with greater access to a healthy life and control of risk factors can have an even more significant impact on reducing mortality from CVD.

Cardiovascular mortality trends in Switzerland 1995-2018.

Mortality rates due to coronary heart disease (CHD) and stroke have declined in the last century in high-income countries, including Switzerland. However, these rates have plateaued in several countries. We assessed CHD and stroke mortality trends (1995-2018) in Switzerland. We estimated annual rate changes via JoinPoint regression. Rates decreased steadily in most sex and age groups; however, in those aged 60-74, stroke rates plateaued after 2012 among men and CHD rates plateaued after 2015 among women. Cardiovascular mortality continues to decrease in most of the Swiss population. Prevention efforts should be maintained, especially in individuals aged 60-74.

Epidemiology and trends in stroke mortality in the USA, 1975-2019.

Whether changes in stroke mortality are affected by age distribution and birth cohorts, and if the decline in stroke mortality exhibits heterogeneity by stroke type, remains uncertain. We undertook a sequential time series analysis to examine stroke mortality trends in the USA among people aged 18-84 years between 1975 and 2019 (n = 4 332 220). Trends were examined for overall stroke and by ischaemic and haemorrhagic subtypes. Mortality data were extracted from the US death files, and age-sex population data were extracted from US census. Age-standardized stroke mortality rates and incidence rate ratio (IRR) with 95% confidence interval [CI] were derived from Poisson regression models. Age-standardized stroke mortality declined for females from 87.5 in 1975 to 30.9 per 100 000 in 2019 (IRR 0.27, 95% CI 0.26, 0.27; average annual decline -2.78%, 95% CI -2.79, -2.78). Among males, age-standardized mortality rate declined from 112.1 in 1975 to 38.7 per 100 000 in 2019 (RR 0.26, 95% CI 0.26, 0.27; average annual decline -2.80%, 95% CI -2.81, -2.79). Stroke mortality increased sharply with advancing age. Decline in stroke mortality was steeper for ischaemic than haemorrhagic strokes. Stroke mortality rates have substantially declined, more so for ischaemic than haemorrhagic strokes.

The epidemic of stroke mortality attributed to high body mass index in mainland China: Current trends and future prediction.

High body mass index (BMI) is an important risk factor for stroke. The aim of this study was to assess the long-term trend of high BMI-attributed stroke mortality and make projections through 2030. Data were extracted from the Global Burden of Disease Study 2019 and World Population Prospects 2019. An age-period-cohort framework was used in the analysis. From 1990 to 2019, the age-standardized mortality rate (ASMR) of high BMI-attributed stroke among females decreased by 15.2%, while among males, it increased by 31.1%. All of the age groups studied showed an increasing pattern over the last 30 years in males, and in female, the age groups encompassing participants who were 25-69 years old showed a decreasing pattern. In the same birth cohort, high BMI-attributable stroke mortality rates increased exponentially with age in both sexes. For females, the period rate ratios (RR) showed a downward trend after 2000-2004, and the cohort RR also showed a downward trend after the birth cohort 1930-1934. For males, the period RR showed an upward trend, but this increase was halted in the most recent period, and the cohort RRs showed a monotonic increasing pattern. It was projected that the ASMR of high BMI-attributed stroke would decrease among females and increase among males in the near future and that the proportion of elderly individuals with death due to high BMI-attributed stroke was projected to increase. Over the last three decades, the high BMI-attributed stroke mortality rate decreased among females and increased among males, and these trends are projected to continue in the future. In addition, the proportion of elderly individuals with high BMI-attributed stroke mortality was projected to increase gradually in both men and women. More health-promoting efforts are needed, especially for elderly individuals and males.