Advances in Stroke Population Studies 2013 George Howard, DrPH; Armin Grau, MD, PhD

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he population burden of stroke mortality continues to plummet in developed countries. For example, in the United States, among the 30 leading causes of death the 37% decline in age-adjusted stroke deaths between 1990 and 2010 was only exceeded by a 68% decline from HIV/AIDS, a 44% decline from ischemic heart disease, and a 39% decline from lower respiratory tract infections.1 However, data from the US Greater Cincinnati/Northern Kentucky Study suggest that between 1993/1994 and 2005 stroke rates are falling only for those aged ≥55 years, and there has been a 55% (83/100 000→128/100 000) increase for blacks aged 20 to 54 years, and a 92% (26/100 00→48/100 000) increase for whites of the same age.2 Although declines in stroke mortality and incidence in the United States are encouraging, disparities exist for Hispanics3 (perhaps because of a higher stroke risk in native born than first-generation Hispanics)4 and blacks.5

Individual Stroke Risk and Trigger Factors Traditional Risk Factors (Defined by the Framingham Stroke Risk Function) Advances have been made to further understand the impact of the well-established risk factors. Not only the presence of diabetes mellitus, but also its duration may be an important factor. Compared with those free from diabetes mellitus, the risk of stroke was 1.7× greater for persons with diabetes mellitus of duration 300 mg/g is associated with a 2.70× (95% CI, 1.58–4.61) increase in stroke risk in blacks but only a 1.25× (95% CI, 0.62–2.51) risk in whites (relative to a albumin-to-creatinine ratio of

Advances in stroke: Population studies 2013.

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