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The US decline in stroke mortality: what does ecological analysis tell us?
D R Jacobs1, P G McGovern, H Blackburn
1Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454.
American Journal of Public Health
|December 11, 1992
Summary
Medication for high blood pressure likely caused only a small drop in US stroke deaths. Other factors like reduced smoking and better treatments may also explain the decline in stroke mortality.
Area of Science:
- Epidemiology
- Public Health
- Cardiovascular Research
Background:
- Stroke mortality rates in the US have seen a decline.
- The role of medication in lowering high blood pressure (hypertension) in contributing to this decline is under investigation.
Purpose of the Study:
- To review and analyze the impact of antihypertensive medication use on US stroke mortality rates.
- To identify other potential contributing factors to the observed decline in stroke mortality.
Main Methods:
- Ecological association analyses were employed to examine population-level data.
- The study considered various potential confounders and alternative explanations for the decline in stroke mortality.
Main Results:
- The use of medication to lower high blood pressure was associated with at most a small decline in US stroke mortality.
- Population-wide reductions in blood pressure levels, decreased cigarette smoking, and improved treatment of stroke sequelae were identified as other significant factors.
Conclusions:
- While ecological methods are valuable for assessing population-level effects of medical interventions, they require careful application.
- The observed decline in stroke mortality is likely multifactorial, with medication playing a potentially limited role compared to broader public health improvements.