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State of Alaska

Health Indicator Report of Stroke (Cerebrovascular Disease) Mortality Rate

Stroke, the death of brain tissue due to interruption of blood flow, was the 6th leading cause of death in Alaska in 2017 and the 5th leading cause of death in the US, the most recent year data is available.^1,2^ Stroke is a major cause of adult disability and economic losses as a result of impairment.^3^ 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.^4^ About 795,000 new or recurrent strokes occur in the U.S. each year.^3^ 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.^3^ Two major mechanisms are responsible for strokes: ischemia and hemorrhage. The most common mechanism, ischemia, is responsible for 87% of all strokes.^3^ 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.^5^[[br]] [[br]] ---- {{class .SmallerFont 1. 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 December 6, 2018. 2. 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. 3. 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. 4. 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. 5. Moskowitz MA, Lo EH, Iadecola C. The science of stroke: mechanisms in search of treatments. Neuron 2010;67:181-98. }}
** = Data not available.

Notes

Data are age adjusted to U.S. 2000 standard population. ICD-10 codes I60-I69 (equivalent to NCHS 113 Leading Causes of Death #61: Cerebrovascular Diseases).

Data Sources

  • [http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services
  • National Vital Statistics System, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention

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].

Definition

Age 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.

Numerator

Number of deaths due to stroke in the resident population for a specific time period.

Denominator

Total midyear resident population for a specific time period.

Healthy People Objective: Reduce stroke deaths

U.S. Target: 34.8 deaths per 100,000 population

How Are We Doing?

Cerebrovascular disease, or stroke, was the sixth leading cause of death in Alaska in 2017, claiming the lives of 187 Alaskans. Among the leading causes of death in Alaska, cerebrovascular disease ranked eleventh in years of potential life lost with 729 years lost. On average, 3.9 years of life were lost prematurely for each stroke death.^1^ Death rates for stroke in Alaska have declined from an age adjusted rate of 65.6 per 100,000 in 2000 to 34.8 per 100,000 in 2017. There are major regional differences, with highest rates in the Northern region (57.7 per 100,000) and the lowest rate in the Southeast region (31.2 per 100,000) for the 5-year average from 2013-2017. Stroke mortality is generally higher among Alaska Native people, being 59.8 per 100,000 compared to 34.8 per 100,000 for all Alaskans in 2017. From 2007 to 2016 in the U.S., the age adjusted rate of stroke death fell by 14.2.1%.^2^ These trends 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.^6^[[br]] [[br]] ---- {{class .SmallerFont 1. 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. 2. 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. 6. Lackland DT, Roccella EJ, Deutsch A, Fornage M, et. al. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 2014;45(1):315-53. }}

How Do We Compare With the U.S.?

Stroke was the 5th leading cause of death in the U.S. and Alaska in 2016. In 2016, Alaska had an age-adjusted mortality rate for cerebrovascular disease (stroke) of 38.2 deaths per 100,000 population as compared to the 2016 U.S. mortality rate for stroke of 37.3 deaths per 100,000 population. The decline in stroke mortality rates in the U.S. has been mirrored in Alaska, although Alaska generally has a higher rate. Stroke mortality was lower among females (36.5 per 100,000) than males (37.5 per 100,000) in the U.S. in 2016. There are also major national differences in stroke mortality rates per 100,000 between races: Black- 51.9, White - 36.1, Asian/Pacific Islanders - 31.0, and American Indian/Alaska Native people - 30.7.^7^[[br]] [[br]] ---- {{class .SmallerFont 7. Xu JQ, Murphy SL, Kochanek KD, Bastian B, Arias E. Deaths: Final data for 2016. National Vital Statistics Reports; vol 67 no 5. [https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf]. Accessed January 2, 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.

Available Services

Information about stroke can be found at the Alaska Heart Disease and Stroke Prevention Program (HDSPP) website: [http://dhss.alaska.gov/dph/Chronic/Pages/Cardiovascular/default.aspx]
Page Content Updated On 02/15/2019, Published on 02/15/2019
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Thu, 21 March 2019 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Wed, 20 Feb 2019 14:57:53 AKST
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Thu, 21 March 2019 12:20:22 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Wed, 20 Feb 2019 14:57:53 AKST