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
Summary
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.
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