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Determining stroke's rank as a cause of death using multicause mortality data

James F Burke1, Lynda D Lisabeth, Devin L Brown

  • 1Department of Veterans Affairs, Veterans Affairs Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, USA. jamesbur@med.umich.edu

Stroke
|July 24, 2012
PubMed

Insights

Mortality attribution methods did not cause stroke

Area of Science:

  • Public Health
  • Epidemiology
  • Mortality Statistics

Background:

  • Stroke has declined as a leading cause of death in the US.
  • This decline occurred without significant changes in stroke incidence or case fatality.
  • Investigated potential attribution methodology changes as a cause.

Purpose of the Study:

  • To determine if changes in mortality attribution methodology explain stroke's declining rank.
  • Hypothesized that stroke mortality is underestimated if attribution methods changed.
  • Specifically examined changes in underlying cause of death (UCOD) versus any mention of cause of death (AMCOD) for stroke.

Main Methods:

  • Analyzed multicause mortality files from 2000 to 2008.
  • Compared changes in stroke as UCOD versus AMCOD.
  • Calculated the UCOD/AMCOD ratio for stroke and other leading causes of death.

Main Results:

  • Both UCOD and AMCOD death rates for stroke declined by 33%.
  • The UCOD/AMCOD ratio for stroke remained stable (0.595 to 0.598).
  • Minor changes in UCOD/AMCOD ratios for other leading causes did not explain stroke's decline.

Conclusions:

  • Changes in mortality attribution methodology are unlikely to be responsible for stroke's declining rank.
  • The discrepancy between stroke incidence, case fatality, and mortality trends warrants further investigation.
  • Further research is needed to understand the factors driving these discordant trends.
Abstract

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