Our stroke associations should be appalled at the 75% reduction in stroke deaths. It should be much greater but they aren't even keeping track of why people are still dying in droves in the first 30 days. If you don't know what the problem is, you will NEVER be able to solve anything. Damn are stroke associations useless.
http://www.medscape.com/viewarticle/853347
Age-standardized mortality for all causes of death in the United
States fell during a recent 44-year period, according to a nationwide
population-based study published in the October 27 issue of JAMA.
Rates declined for five of the six leading causes of death as well,
likely reflecting better control of hypertension, hyperlipidemia, and
smoking, as well as advances in medical therapy and motor vehicle
safety.
In the study, Jiemin Ma, PhD, MHS, from the Surveillance
and Health Services Research Program, Intramural Research Department,
American Cancer Society, Atlanta, Georgia, and colleagues analyzed US
national vital statistics data from 1969 through 2013 to assess temporal
trends in mortality. They calculated the total change and annual
percentage change in age-standardized death rates and in years of
potential life lost before the age of 75 years for all causes combined
and for the six leading causes: heart disease, cancer, chronic
obstructive pulmonary disease (COPD), stroke, unintentional injuries,
and diabetes.
Results showed that age-standardized mortality for
all causes of death combined fell by 42.9% (95% confidence interval
[CI], 42.8% - 43.0%), going from 1278.8 to 729.8 per 100,000,
corresponding to an average annual decrease of 1.3%. This was driven by a
77.0% (95% CI, 76.9% - 77.2%) reduction for stroke, 67.5% for heart
disease (95% CI, 67.4% - 67.6%), 39.8% for unintentional injuries (95%
CI, 39.3% - 40.3%), 17.9% for cancer (95% CI, 17.5% - 18.2%), and 16.5%
for diabetes (95% CI, 15.4% - 17.5%).
In contrast, the death rate for COPD increased by 100.6% (95% CI, 98.2% - 103.1%).
In
addition, joinpoint regression analysis suggested the declines in rates
for heart disease, stroke, and diabetes slowed toward the end of the
study period; for example, the annual decline for heart disease fell
from 3.9% (95% CI, 3.5% - 4.2%) during 2000 to 2010 to −1.4% (95% CI,
−3.4% to 0.6%) during 2010 to 2013. The death rate for COPD in men began
to decrease slightly in the 2000 to 2010 period but continued to
increase in women.
Results further showed that the
age-standardized years of potential life lost, reflecting premature
deaths, fell by 52.4% for all causes of death combined (95% CI, 52.2% -
52.6%), going from 134.7 to 64.1 per 1000, corresponding to an average
annual decrease of 1.7% (95% CI, 1.5% - 2.0%). This was driven by a
reduction in rates of 14.5% for diabetes (95% CI, 12.6% - 16.4%), 40.6%
for cancer (95% CI, 40.2% - 41.1%), 47.5% for unintentional injuries
(95% CI, 47.0% - 48.0%), 68.3% for heart disease (95% CI, 68.1% -
68.5%), and 74.8% for stroke (95% CI, 74.4% - 75.3%). There was no
reduction in this measure for COPD.
The new data provide an
encouraging update to a similar previous study spanning 1970 through
2002, the investigators say. That study also found reductions in
age-standardized death rates for all causes combined and for heart
disease, stroke, cancer, and injuries individually; however, it found
increases in the rates for COPD and diabetes.
"We are making
progress in reducing death rates from all causes and from most leading
causes of death," coinvestigator Ahmedin Jemal, DVM, PhD, also from the
Surveillance and Health Services Research Program, commented in an
accompanying audio statement. "However, rates during the most recent
time period have slowed for heart disease, stroke, and diabetes, which
is likely due to the obesity epidemic that has unfolded over the past 3
decades. We as health providers can do more to prevent and manage
obesity through exercise, diet, and therapy for weight loss."
"The
next step would be to find out why death rates for heart disease,
stroke, and diabetes are slowing," Dr Jemal said. "One in five US adults
are smokers; one in three are obese. And obesity, smoking, unhealthy
diet, and physical inactivity account for almost half of the deaths in
the US. We also need to invest more in research to discover new
prevention, early detection, and treatment in order to accelerate the
reduction in mortality."
J. Michael McGinnis, MD, MPP, from the
National Academy of Medicine, Washington DC, commends the study and the
new insights it provides in an accompanying editorial.
However, he notes, the available data did not permit similar analysis
of trends in "rapidly emerging challenges," such as Alzheimer disease
and suicide, nor did they enable assessment of the substantial effects
of healthcare disparities.
"Death
rate may have at one time served as a sufficient measure of health
system performance, but assessment now requires more textured insights,
including those that reflect the improving capacity to measure health
status, risk prevalence, and service access, effectiveness, and
affordability," he writes.
"[W]hat is needed is a set of national
vital health indicators that is broader than mortality, but still a
limited number, tightly constructed, standardized, and reliably
available at all levels from local to national," he says, pointing to a
set of 15 core measures recently endorsed by the Institute of Medicine.
"Whether through adoption of this or some other expanded notion of what
should constitute the nation's truly vital signs, the time has arrived
to match the capacity with the potential and the need," Dr McGinnis
says.
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