Death from acute stroke has dropped by as much as 55 percent, shows a population study published in BMJ.
The decline, according to the authors who were led by Olena Seminog, University of Oxford, United Kingdom, is probably driven by improvements in stroke care. Even though there appears to be fewer deaths from stroke, stroke event rates increased among 35 to 54 year old men and women.
“The increase in stroke event rates in young adults is a concern. This suggests that stroke prevention needs to be strengthened to reduce the occurrence of stroke in people younger than 55 years,” the authors wrote.
The British study is based on a review of trends in stroke events and mortality from a national database of 759,869 adults who were admitted for or died from stroke during the period from 2000 to 2010.
Several important trends emerged: Death from acute stroke declined across all age groups, which included substantial reductions in mortality during the first 30 days following the event. And, more than half of all patients over age 85 who presented with stroke in 2001 died within the first 30 days, which decreased to 34 percent among men and 38 percent among women by 2010.
Although women in the cohort had higher rates of stroke events (55.1 percent) and stroke deaths (61.5 percent), total reductions in mortality were also moderately greater in women compared to men (reduced from 128/100,000 in 2001 to 72/100,000 in 2010 and 140/100,000 in 2001 to 74/100,000 in 2010, respectively).
The greatest reduction by age group was among those aged 35 to 54. Improvements in both event rates and survival from stroke were equally important in reducing death from stroke in people over age 85, while reduction of stroke mortality was the more significant factor in younger people, as stroke events rates increased by 2 percent each year from the age of 34.
The increase in the occurrence of stroke, observed in both men and women from ages 34 to 55 was of particular concern to the investigators. “This suggests that stroke prevention needs to be strengthened to reduce the occurrence of stroke in people younger than 55 years,” they wrote.
The authors concluded that improvements in stroke care are the major contributing factors to greater survival following acute stroke, but also noted that, “acute and long term management of such patients is expensive, and the NHS is already spending about 5 percent of its budget on stroke care. By focusing on prevention and reduci¬¬ng the occurrence of stroke, major resources can be conserved.”
Seminog OO, Scarborough P, Wright FL, Rayner M, Goldacre MJ. “Determinants of the decline in mortality from acute stroke in England: linked national database study of 795 869 adults.” BMJ. May 2019. 2019;365:l1778.