title: Stroke rates: 1980-2000: the Minnesota Stroke Survey.
abstract: In this paper, the authors report trends in hospitalized stroke rates among Minneapolis-St. Paul, Minnesota (population 2.6 million) metropolitan area residents aged 30-74 years from 1980 to 2000. Cases were identified from lists of discharge diagnoses provided by hospitals serving the target population. Age-adjusted, sex-specific stroke attack rates were computed for each survey year by using 5 different diagnostic definitions: 2 based purely on International Classification of Diseases, Ninth Revision (ICD-9) codes and 3 including clinical and neuroimaging criteria. Stroke rates, as measured by a highly specific clinical definition, remained stable from 1980 to 2000 for women. For men, these rates declined modestly from 1980 to 1990 and leveled off during 1990-2000. In contrast, use of stroke-related ICD-9 discharge codes declined significantly from 1980 to 2000: 35% among men and 16% among women. Neuroimaging use increased significantly from 75% of cases in 1980 to 98% in 2000. Short-term (28-day) stroke survival improved significantly, by 16% for women and 12% for men, from 1980 to 2000. The decline in stroke ICD-9 code usage reflects the influence of increased neuroimaging on discharge coding. The improved short-term survival in the face of stable, clinically defined stroke rates may imply treatment advances or ascertainment of less severe strokes, possibly masking a true decline in stroke rates.
authors.affiliation: Department of Neurology, School of Medicine, University of Minnesota, Minneapolis, MN 55455, USA. laksh004@umn.edu
authors.forename: Kamakshi
authors.initials: K
authors.lastname: Lakshminarayan
authors.forename: David C
authors.initials: DC
authors.lastname: Anderson
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Barber
authors.forename: Russell V
authors.initials: RV
authors.lastname: Luepker