For at least the last 50 years, the rate at which Americans died from stroke has declined. But that remarkable progress has stalled of late, according to a new federal report, and may even be reversing.
While strokes have dropped from the third-leading cause of death a decade ago to the fifth in 2013, that good-news story obscures a grimmer prospect: Years of deteriorating health among Americans may be manifesting in more people falling victim to strokes.
“The risk profile in the U.S. has changed, and changed significantly,” says Quanhe Yang, senior scientist at the Centers for Disease Control and lead author of the new report. “This is a wake-up call.”
Strokes are the result of blood clots or hemorrhages that lead to brain damage within minutes. Almost 800,000 Americans suffer a stroke each year, and about one-sixth of stroke victims die. Many survive only with serious disability. Risk factors for stroke include high blood pressure, smoking, obesity, and diabetes.
Obesity and diabetes have increased significantly since the 1980s, with more than one-third of U.S. adults classified as obese. As people develop these conditions at younger ages and live with them for longer periods, the risk that they will have strokes increases.
A big chunk of the southeastern U.S. has long been considered the “stroke belt,” with rates of stroke deaths far higher than the rest of the country. The CDC’s latest analysis shows troubling trends are spreading through a far wider area, to the west and northeastern U.S. In 16 states, stroke mortality improvement has slowed — meaning improvements haven’t kept up with historical trends. In another 21 states and the District of Columbia, the improvements have stalled entirely or reversed in some cases.
Yang and his colleagues at the CDC analyzed death certificate data with statistical software to discern recent patterns in stroke trends. The big picture story looks positive: Among Americans 35 and older, the death rate from stroke declined to 73 per 100,000 residents in 2015 from 118 at the start of the century. (The rates are age-adjusted, meaning they account for the changing age distribution of the population.)
But, like overall mortality rates, long-term reductions in stroke deaths have flattened out. Rates actually increased by 2.5 percent annually between 2013 and 2015, though the change wasn’t statistically significant, the CDC reports. There were significant increases in the south and among Hispanics nationally.
Stroke deaths wouldn’t be expected to decline forever, of course. But Wang notes that 80 percent of strokes are preventable with modifications to lifestyle or other risk factors.