Trends in the prevalence of stroke among community-dwelling individuals in the U.S.: 1999-2018
Wells Andres1, Aaron Rothstein1, Holly Elser1, Kelly Sloane1, Scott Kasner1, Rebecca Gottesman2, Andrea Schneider1
1Department of Neurology, Hospital of the University of Pennsylvania, 2Stroke Branch, National Institute of Neurologic Disorders and Stroke Intramural Research Program
Objective:
To estimate the prevalence of stroke among community-dwelling individuals in the U.S. between 1999 and 2018 using a nationally representative sample.
Background:
There is a lack of recent data on trends in stroke prevalence among community dwelling individuals in the U.S. Prior epidemiological reports indicate decreasing stroke incidence and decreasing stroke mortality. Accurate and up-to-date representative estimates of stroke prevalence are needed to inform public health interventions.
Design/Methods:
We performed a series of cross-sectional analyses of data from 2,197 participants aged 20+ years in the 1999-2018 National Health and Nutrition Examination Surveys (NHANES) with self-reported history of stroke. We calculated age-standardized stroke prevalence over four-year epochs overall, and stratified by age group, sex, and race/ethnicity. Using the American Community Survey Public Use Microdata Sample from 2017-2018, we estimated the number of persons affected by stroke.
Results:
The overall age-standardized prevalence of stroke was 3.1% (95%CI: 2.9%-3.3%) from 1999-2002 to 2015-2018, which corresponds to 7.4 million (7.0-7.9 million) affected individuals. The age-standardized prevalence of stroke was stable from 1999-2002 to 2015-2018 (p-value-for-linear-trend-across-four-year-epochs=0.332). The age-standardized prevalence of stroke from 1999-2002 to 2015-2018 was higher among older individuals (aged ≥60 years: 7.7%, 7.2%-8.2%) compared to younger individuals (aged 20-39 years: 0.4%, 0.3%-0.5%; aged 40-59 years: 2.0%, 1.8%-2.3%), among non-Hispanic Black individuals (4.7%, 4.3%-5.1%) compared to other race/ethnicities (non-Hispanic White: 2.9%, 2.7%-3.2%; Mexican American: 2.6%, 2.3%-3.0%; Other: 3.5%, 2.8%-4.2%; Asian American: 1.7%, 1.3%-2.3%), and was similar by sex (men: 2.9%, 2.7%-3.2%; women: 3.2%, 3.0%-3.5%). The prevalence of stroke in each age, sex, and race/ethnicity group was stable from 1999-2002 to 2015-2018
Conclusions:
The age-standardized prevalence of stroke in the non-institutionalized civilian adult population of the U.S. has not significantly changed between 1999 and 2018. In the context of other reports this likely reflects a combination of decreasing stroke incidence and improved stroke outcomes.