Stroke Kills Fewer in America

But hospitalizations due to brain attacks rising

FRIDAY, Oct. 5, 2001 (HealthDayNews) -- In the last decade, stroke has put more Americans in hospitals than ever before, says a new study. But there's a silver lining to this cloud -- the number of deaths due to stroke has fallen steadily.

Authors of the study, which appears in the October issue of Stroke: Journal of the American Heart Association, say while the drop in deaths is encouraging, the fact that so many are hospitalized may call for a new approach to stroke prevention programs.

About 750,000 Americans have strokes every year, and about 160,000 are fatal. That ranks stroke third behind heart disease and cancer among the nation's leading causes of death.

Stroke is most common among elderly and minority populations, including blacks and Hispanics.

Using data from the National Hospital Discharge Survey, researchers at the Albert Einstein College of Medicine, in the Bronx, N.Y., found that between 1988 and 1997 the number of deaths from stroke, even when adjusted to rule out the effect of age, fell 13.4 percent, from 29.9 to 25.9 deaths per 100,000 people. The rates of in-hospital stroke deaths also fell from 12.7 percent to 7.6 percent.

But overall, the number of national hospital admissions for stroke increased 38.6 percent. Even when they ruled out the effect of increasing age on stroke, the rate still increased 18.6 percent.

Although more sensitive diagnostic techniques that pick up smaller strokes could account for some of the effect, lead study author Dr. Jing Fang says, "When we looked at hospitalization, which to some degree can be used as the incidence of stroke, it increased a lot."

The researchers suspect that both prevention programs and the increasing number of acute-care stroke units in hospitals may play a role in these trends.

Fang, an associate professor of epidemiology and social medicine, says prevention programs may not be reducing the overall number of strokes. But by reducing the incidence of stroke risk factors, including high blood pressure, obesity and coronary heart disease, they at least may be making the strokes that do occur less severe.

Senior study author Dr. Michael Alderman, professor of medicine and epidemiology, says, "Another possibility is that our acute treatment of people with stroke has improved."

"There's reason to believe that has happened because of things like the development of stroke units in hospitals [and a] willingness to introduce therapies right away. That means that if we rescue or salvage more people with stroke, they survive to go on perhaps to have another one," he says.

The national survey doesn't say if the hospitalizations for stroke are re-hospitalizations, a point the researchers say could have influenced their findings.

The study also found that hospitalization periods after stroke have dropped from an average of 11.1 days to 6.2 days, although Fang says hospital stays have decreased for most procedures.

Alderman says the facts that hospital stays for stroke were nearly halved and that mortality rates continued to fall "suggest that shorter hospital stays, at the very least, have not hurt anybody."

Dr. Bruce Psaty, professor of medicine and epidemiology at Seattle's University of Washington, says unlike cancer, no national registries monitor the incidence of heart disease and stroke. "That's why this paper is important. This is an attempt to provide estimates of [stroke incidence]."

Psaty says, "While the age-adjusted mortality is going down, the hospitalizations rates are actually going up. From the point of view of public health, what that means is we have more strokes occurring, and we have people surviving them."

Psaty says while some strokes are mild, others can leave people with severe physical and speech disabilities. "Stroke can be a devastating clinical condition."

Alderman says, "We can expect that hospital resources committed to the care of people with stroke is bound to expand. As our population pattern includes more older people, there's going to be more strokes and more hospitalizations."

He says the leading risk factor for stroke in America is uncontrolled high blood pressure. "Only about 25 percent of all Americans with high blood pressure currently get their blood pressure controlled. That means that the real ticket is more vigorous prevention, and the key to that appears to be better treatment of high blood pressure, particularly in older people," Alderman says.

What To Do:

The American Stroke Association explains what happens during a stroke. You can also check the National Institute of Neurological Disorders and Stroke for more about stroke.

Learn about the most common stroke symptoms from the National Stroke Association.

SOURCES: Interviews with Jing Fang, M.D., assistant professor, departments of epidemiology and social medicine, and Michael H. Alderman, M.D., professor, departments of medicine and epidemiology, Albert Einstein College of Medicine, Bronx, N.Y., and Bruce M. Psaty, M.D., Ph.D., professor, departments of medicine and epidemiology, cardiovascular health research unit, University of Washington, Seattle, Wash.; October 2001 Stroke: Journal of the American Heart Association
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