Stagnating national declines in stroke mortality mask widespread county-level increases, 2010-2016

Background and Purpose-Recent national and state-level trends show a stalling or reversal of previously declining strokedeath rates. These national trends may mask local geographic variation and changes in stroke mortality. We assessedcounty-level trends in stroke mortality among adults aged 35 to 64 and =65 years.Methods-We used data from National Vital Statistics Systems and a Bayesian multivariate space-time conditionalautoregressive model to estimate age-standardized annual stroke death rates for 2010 through 2016 among middle-agedadults (35-64 years) and older adults (=65 years) in US counties. We used log-linear regression models to estimateaverage annual and total percent change in stroke mortality during the period.Results-Nationally, the annual percent change in stroke mortality from 2010 to 2016 was -0.7% (95% CI, -4.2% to 3.0%)among middle-aged adults and -3.5% (95% CI, -10.7% to 4.3%) among older adults, resulting in 2016 rates of 15.0 per100000 and 259.8 per 100 000, respectively. Increasing county-level stroke mortality was more prevalent among middleaged adults (56.6% of counties) compared with among older adults (26.1% of counties). About half (48.3%) of middleaged adults, representing 60.2 million individuals, lived in counties in which stroke mortality increased.Conclusions-County-level increases in stroke mortality clarify previously reported national and state-level trends,particularly among middle-aged adults. Roughly 3×as many counties experienced increases in stroke death rates formiddle-aged adults compared with older adults. This highlights a need to address stroke prevention and treatment formiddle-aged adults while continuing efforts to reduce stroke mortality among the more highly burdened older adults.Efforts to reverse these troubling local trends will likely require joint public health and clinical efforts to developinnovative and integrated approaches for stroke prevention and care, with a focus on community-level characteristics thatsupport stroke-free living for all.