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Stroke mortality in Minneapolis-St Paul declined slowly from 1960 through 1972(average fall,2.4%per year),dropped sharply from 1972 through 1984 (average fall,6.5%per year),but exhibited little change thereafter(average fall,1.5%per year).The average level of cardiovascular disease risk factors fell from 1973-1974 to 1985-1987,with the exception of body mass index.In particular,hypertension diagnosis,treatment,and control levels improved substantially between 1973-1974 to 1980-1982,although there was little improvement after 1980-1982.While discharge rates for hospital- coded acute stroke declined substantially between 1970 and 1985 in both sexes,no clear trend was observed in definite stroke rates as validated using standard clinical criteria.Twenty-eight-day case fatality rates of definite stroke improved significantly from 1970 to 1985.The substantial decline in stroke mortality of more than 50%from 1960 through 1990 appears to have been attributable to both primary and secondary prevention.These data suggest that the long decline in stroke mortality and morbidity in Minneapolis-St Paul has plateaued,although improved detection of stroke with computed tomography prevents an unequivocal conclusion. |
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