Stroke Incidence and Prevalence

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Stroke is a major public health problem, ranking among the top three causes of death in most countries. It affects the brains of almost a half million people every year, causing 150,000 deaths, and there are now approximately 3 million stroke survivors in the United States. Overall, ageadjusted incidence rates range between 100 and 300 per 100,000 population per year. Stroke is the major cause of serious disability in adults and is responsible for $20 billion in annual costs per year in lost wages in the United States. Stroke incidence rates declined during the 1950s and 1960s but increased during the 1980s. This increase may be due to increased recognition related to advances in neuroimaging technology, increased survival of patients with ischemic heart disease, better detection of milder cases of stroke, and other undefined factors during the past 10 years. y , y

Stroke accounts for about 10 percent of all deaths in most industrialized countries, and the great majority of deaths are among persons over age 65. The average age-adjusted mortality rate is 50 to 100 per 100,000 population

Figure 45-2 Differential diagnosis of stroke.

per year in the United States. Stroke mortality rises exponentially with age, virtually doubling every 5 years. Stroke death rates are higher among blacks. The stroke mortality rate has steadily declined in the United States since 1915; the decline in black mortality rates has exceeded that of whites and spans all age groups. Improved survival after stroke contributes to this trend most significantly.

Ischemic stroke accounts for more than 80 percent of all strokes. ICH usually accounts for 10 to 30 percent of cases depending on the origin of the patient, with greater relative frequencies reported in Asians and blacks. Frequency of SAH is usually a third to a half of that of ICH. Among patients with brain ischemia, cardioembolism accounts for 20 to 30 percent of cases, atherothrombotic infarction accounts for 14 to 40 percent, and small deep infarcts due to penetrating artery disease (lacunes) account for 15 to 30 percent of cases. y

There are major sex and racial differences in the distribution of occlusive cerebrovascular lesions. Extracranial occlusive diseases usually affect white men, are located at the origins of the internal carotid and vertebral arteries in the neck, occur twice as often in men, and are strongly associated with coronary and peripheral vascular occlusive disease, systolic hypertension, and hyperlipidemia. Compared with white men, blacks, persons of Asian origin, and women have more severe diseases of the intracranial arteries and their perforating branches. Intracranial stenosis is usually less frequently associated with coronary and peripheral vascular disease. Figure...45-2 shows the major differential diagnostic stroke categories.

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