title: The unchanging incidence and case-fatality of stroke in the 1990s: a population-based study.
abstract: OBJECTIVE
  Many advances were made in stroke prevention strategies during the 1990s, and yet temporal trends in stroke incidence and case-fatality have not been reported in the United States. Blacks have a 2-fold higher risk of stroke; however, there are no data over time showing if any progress has been made in reducing racial disparity in stroke incidence. The objective of this study was to examine temporal trends in stroke incidence and case-fatality within a large, biracial population during the 1990s.
  
  
  METHODS
  Within a biracial population of 1.3 million, all strokes were ascertained at all local hospitals using International Classification of Diseases, 9th Revision codes during July 1993 to June 1994 and again in 1999. A sampling scheme was used to ascertain cases in the out-of-hospital setting. Race-specific incidence and case-fatality rates were calculated and standardized to the 2000 US Census population. A population-based telephone survey regarding stroke risk factor prevalence and medication use was performed in 1995 and 2000.
  
  
  RESULTS
  There were 1954 first-ever strokes in 1993-1994 and 2063 first-ever strokes in 1999. The annual incidence of first-ever hospitalized stroke did not significantly change between study periods: 158 per 100,000 in both 1993-1994 and 1999 (P=0.97). Blacks continue to have higher stroke incidence than whites, especially in the young; however, case-fatality rates continue to be similar between races and are not changing over time. Medication use for treatment of stroke risk factors significantly increased in the general population between study periods.
  
  
  CONCLUSIONS
  Despite advances in stroke prevention treatments during the 1990s, the incidence of hospitalized stroke did not decrease within our population. Case-fatality also did not change between study periods. Excess stroke mortality rates seen in blacks nationally are likely the result of excess stroke incidence and not case-fatality, and the racial disparity in stroke incidence did not change over time.
authors.affiliation: University of Cincinnati, 231 Albert Sabin Way ML 0525, Cincinnati, OH 45267-0525, USA. Dawn.kleindorfer@uc.edu
authors.forename: Dawn
authors.initials: D
authors.lastname: Kleindorfer
authors.forename: Joseph
authors.initials: J
authors.lastname: Broderick
authors.forename: Jane
authors.initials: J
authors.lastname: Khoury
authors.forename: Matthew
authors.initials: M
authors.lastname: Flaherty
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
authors.forename: Kathleen
authors.initials: K
authors.lastname: Alwell
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Moomaw
authors.forename: Alexander
authors.initials: A
authors.lastname: Schneider
authors.forename: Rosie
authors.initials: R
authors.lastname: Miller
authors.forename: Rakesh
authors.initials: R
authors.lastname: Shukla
authors.forename: Brett
authors.initials: B
authors.lastname: Kissela
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004363:Drug Utilization; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients / Q000706:statistics & numerical data; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009026:Mortality / Q000639:trends; D009820:Ohio / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D013689:Telephone; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data