Vital Signs: Recent Trends in Stroke Death Rates - United States, 2000-2015

Abstract

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.

FIGURE 1

Stroke deaths and age-standardized stroke death rate among adults aged ≥35 years — United States, 2000–2015

FIGURE 2

Trends in age-standardized stroke death rates among adults aged ≥35 years, by state and census region — United States, 2000–2015 * Continued: significant decrease in stroke death rate continued over the period. ^† Slowed: significant decrease in stroke death rate followed by a less negative decreasing (significant or nonsignificant) trend segment. ^§ Stalled/reversed: significant decrease in stroke death rate followed by a nonsignificant (stalled) or significant (reversed) increasing trend segment (final Joinpoint trend segment Annual Percent Change >0).