DefinitionAge adjusted rate of stroke (cerebrovascular disease) mortality is the number of stroke deaths (ICD-9 codes 430-438 and ICD-10 codes I60-I69) per 100,000 population.
NumeratorNumber of deaths due to stroke in the resident population for a specific time period.
DenominatorTotal midyear resident population for a specific time period.
Data Interpretation Issues[http://live.laborstats.alaska.gov/pop/index.cfm Alaska population estimates] provided by the State Demographer in the [http://laborstats.alaska.gov/ Research and Analysis Section] of the [http://labor.alaska.gov/ Alaska Department of Labor and Workforce Development].
Why Is This Important?Stroke is a major cause of adult disability and economic losses as a result of impairment.^1^ Stroke damage in the brain can affect the entire body - resulting in mild to severe disabilities. These include paralysis, problems with thinking, problems with speaking, and emotional problems.^2^ About 795,000 new or recurrent strokes occur in the U.S. each year.^1^ Approximately 610,000 of these are first events and 185,000 are recurrent stroke events. In 2011, stroke caused about 1 of every 20 deaths in the United States. On average, every 40 seconds, someone in the United States has a stroke, and someone dies of stroke approximately every 4 minutes.^1^
Two major mechanisms are responsible for strokes: ischemia and hemorrhage. The most common mechanism, ischemia, is responsible for 87% of all strokes.^1^ Ischemia can be caused by thrombosis (blood clot formation in an artery or vein), embolism (anything that travels through the blood vessels until it lodges in a vessel), or systemic hypoperfusion (shock). About 13% of strokes are caused by hemorrhage (vessel rupture and bleeding) or cardiac arrest.^3^[[br]]
1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, et al. Heart disease and stroke statistics-2015 update: a report from the American Heart Association. Circulation 2015;131:e29-e322.
2. NINDS | What you need to know about stroke. National Institute of Neurological Disorders and Stroke. [http://www.ninds.nih.gov/disorders/stroke/stroke_needtoknow.htm}. Accessed November 29, 2016.
3. Moskowitz MA, Lo EH, Iadecola C. The science of stroke: mechanisms in search of treatments. Neuron 2010;67:181-98.
Healthy People Objective: Reduce stroke deathsU.S. Target: 34.8 deaths per 100,000 population
How Are We Doing?Cerebrovascular disease, or stroke, was the fifth leading cause of death in Alaska in 2018, claiming the lives of 210 Alaskans. Among the leading causes of death in Alaska, cerebrovascular disease ranked eleventh in years of potential life lost with 729 years lost in 2017. On average, 3.9 years of life were lost prematurely for each stroke death.^4^
There are major regional differences, with highest rates in the Northern (54.7 per 100,000) and Southwest (54.9 per 100,000) region for the 5-year average from 2014-2018. Stroke mortality is generally higher among Alaska Native people, being 63.5 per 100,000 compared to 39.9 per 100,000 for all Alaskans in 2018.
Death rates for stroke in Alaska have declined from an age adjusted rate of 65.6 per 100,000 in 2000 to 39.9 per 100,000 in 2018. The downward trend could be related to access to acute stroke care and in the result of improved detection and treatment of hypertension. Hypertension control efforts initiated in the 1970s appear to have had the most influence on the decline in stroke mortality. Control of diabetes and dyslipidemia, as well as smoking cessation programs, in combination with hypertension treatment, also appear to have contributed to the decline in stroke mortality.^5^[[br]]
4. Alaska Department of Health and Social Services, Division of Public Health, Health Analytics and Vital Records Section. Alaska Vital Statistics 2017 Annual Report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2017.pdf]. Accessed June 11, 2018.
5. Xu JQ, Murphy SL, Kochanek KD, Bastian B, Arias E. Deaths: Final data for 2016. National Vital Statistics Reports. 67(5) July 26, 2018. [https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf]. Accessed December 6, 2018.
How Do We Compare With the U.S.?Stroke was the 5th leading cause of death in the U.S. and the 6th leading cause of death in Alaska in 2017. In 2017, Alaska had an age-adjusted mortality rate for cerebrovascular disease (stroke) of 34.8 deaths per 100,000 population as compared to the 2017 U.S. mortality rate for stroke of 37.6 deaths per 100,000 population. The decline in stroke mortality rates in the U.S. has been mirrored in Alaska.
Stroke mortality was lower among females (36.6 per 100,000) than males (38.0 per 100,000) in the U.S. in 2017. There are also major national differences in stroke mortality rates per 100,000 between races: Black- 52.7, White - 36.4, American Indian/Alaska Native people - 34.1, and Asian/Pacific Islanders
6. Kochanek KD, Murphy SL, Xu JQ, Arias E.
Deaths: Final data for 2017. National Vital
Statistics Reports; vol 68 no 9. Hyattsville, MD:
National Center for Health Statistics. 2019.[https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf]. Accessed October 4, 2019.
What Is Being Done?Three Alaska hospitals are Joint-Commission certified as a Primary Stroke Centers and also participate in the American Heart Association's [http://www.heart.org/HEARTORG/HealthcareProfessional/GetWithTheGuidelinesHFStroke/GetWithTheGuidelinesStrokeHomePage/Get-With-The-Guidelines-Stroke-Home-Page_UCM_305098_SubHomePage.jsp Get with the Guidelines-Stroke] program to enhance stroke quality of care. In addition to these three primary stroke centers, 5 hospitals are "spoke" hospitals connected to the Primary Spoke Center "hub" through a telestroke network. Alaska EMS agencies are standardizing evidenced-based stroke care protocols throughout the state.
The Alaska Heart Disease and Stroke Prevention Program (HDSPP) educates and encourages partner organizations to utilize information from the American Heart Association (AHA) "[http://www.heart.org/HEARTORG/Conditions/My-Life-Check---Lifes-Simple-7_UCM_471453_Article.jsp#W1YY8jaWyHt 7 simple steps]", and the Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) "[https://millionhearts.hhs.gov/about-million-hearts/index.html Million Hearts]" initiative in program activities.
The AHA defines and promotes 7 simple steps to a healthier heart to help individuals improve health behaviors. These steps include managing blood pressure, controlling blood cholesterol, reducing blood sugar, getting active, eating better, losing weight and smoking cessation.
In 2012, CMS and CDC launched the Million Hearts initiative to prevent 1 million heart attacks and strokes by 2017. To meet this goal, the many Million Hearts public and private partners focus, coordinate, and enhance cardiovascular disease prevention activities. Significant progress was made towards the goal, however challenges faced include an aging population and increasing rates of obesity and diabetes. Million Hearts has developed a year 2020 framework based on optimizing health care and an evidence-based process to improve ABCS (Aspirin when appropriate, Blood pressure control, Cholesterol management and Smoking cessation), keeping people healthy and improving outcomes for priority populations (reducing heart disease disparity in racial/ethnic groups).
In Alaska, the Southeast Alaska Regional Health Consortium (SEARHC) and Southcentral Foundation (SCF) operate the [https://www.cdc.gov/wisewoman/about.htm WISEWOMAN] program to help Alaska Native women understand and reduce their risk for heart disease and stroke and promote lasting heart-healthy lifestyles. The program serves low-income uninsured and underinsured women aged 40 to 64 years with free screenings and counseling about their risk for heart disease and stroke as they participate in evidenced-based lifestyle programs, individual health coaching or are referred to other community resources.