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American Journal of Epidemiology Advance Access originally published online on March 24, 2009
American Journal of Epidemiology 2009 169(9):1070-1078; doi:10.1093/aje/kwp029
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Stroke Rates: 1980–2000

The Minnesota Stroke Survey

Kamakshi Lakshminarayan, David C. Anderson, David R. Jacobs, Jr., Cheryl A. Barber and Russell V. Luepker

Correspondence to Dr. Kamakshi Lakshminarayan, Department of Neurology, MMC 295, 420 Delaware Street SE, Minneapolis, MN 55455 (e-mail: laksh004{at}umn.edu).

Received for publication September 20, 2008. Accepted for publication January 23, 2009.

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.

incidence; mortality; population surveillance; stroke

Abbreviations: ICD-9, International Classification of Diseases, Ninth Revision


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