Since the early twentieth century, there has been a decline in stroke mortality in the United States, and recently this decline has become even stronger. As a result, strokes have fallen from the third to the fourth leading cause of death in the United States, and this decline has been identified as one of the top 10 medical successes from 2001 through 2010. A recent review by the American Heart Association and the American Stroke Association looks at the factors that led to this decline and the implications for future public health interventions.
The decrease is due to both a lower number of overall strokes, as well as fewer strokes being fatal. The decline in stroke deaths has been seen in both sexes and across all racial/ethnic groups. However, while there was a 26 percent decrease for whites and a 23 percent decline for African Americans over the period from 1996 to 2005, strokes remained a much more common cause of death for African Americans. While for whites and the US population, overall strokes have moved from the third to fourth leading cause of death, for African Americans they remain the second leading cause of death. Similarly, while there were declines for both genders, stroke remained a much more common cause of death for women than for men. For women, stroke was the number two cause of death, for men stroke dropped from the third to the fifth leading cause of death.
When the authors examined the factor that most significantly contributed to the decline in stroke mortality, they concluded that the biggest influence appeared to be public health efforts aimed at reducing high blood pressure that began in the 1970s. From 1900 to 1968, stoke deaths decreased from more than 150 per 100,000 deaths to 50 per 100,000, a steady decline of 0.5 percent per year. However, in the 1970s, this decline drastically accelerated to approximately 5 percent per year. In addition to the impact of addressing high blood pressure, greater attention to the treatment of high cholesterol and diabetes also contributed to the observed decline in stroke mortality, as did smoking cessation programs. Although they are too new to have contributed to the observed decline, the authors also point to evidence that suggests that telemedicine (the wireless and electronic transmission of medical information) and stroke systems of care that enable quick and appropriate stroke treatment can have a strong impact on stroke fatalities.
Not only has stroke mortality decreased, but so has the risk of recurrent strokes, which account for 23 percent of all strokes annually. A review of available studies on reoccurring strokes suggests that the five-year risk from stroke recurrence has declined from 32 percent to 16 percent.
This review also described the efforts of the National High Blood Pressure Education Program (NHBPEP), which coordinates with all 50 state health departments, 2,000 community groups, seven federal agencies, and voluntary health and professional organizations. NHBPEP and other organizations conducted mass media and patient education campaigns that led to higher percentages of people’s awareness of their high blood pressure, which also led to a doubling of treatment rates for high blood pressure. These NHBPEP efforts also seem to have contributed to increased interest and research from scientists into high blood pressure and strokes. While a search for “hypertension” and “clinical trials” in a major medical database yielded less than 50 results in 1972, 1,200 results were obtained when searching results from the year 2002. These campaigns by NHBPEP and others were also associated with a reduction of racial/ethnic and geographic disparities in risk.
The authors conclude by suggesting that the trends observed in stroke mortality reduction should continue through ongoing research and education efforts similar to those that have led to the past 40 years’ decline.