CDC: Stroke drops to fourth leading cause of death in U.S.
CT images in a patient with left hemiparesis. Image source: Michael H. Lev, MD, and Angelos Konstas, MD, Massachusetts General Hospital, Boston.
Chronic lower respiratory diseases (CLRDs) have replaced stroke as the third leading cause of death, moving stroke to fourth on the list, according to new data published by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS).

Arialdi M. Miniño, MPH, and colleagues used U.S. death records occurring during the 2008 calendar year to outline data on death rates, life expectancies and causes of death, which were categorized by age, sex and race.

“The change in the ranks of these two causes of death [CLRD and stroke] is mostly driven by a decreasing trend in the numbers of deaths from stroke (from 167,661 deaths in 2000 to 133,750 in 2008),” the CDC found.

During a video commentary, President of the American Heart Association (AHA), Ralph Sacco, MD, said, “The latest statistics show that stroke has dropped to the fourth leading cause of death in the United States.” In addition, Sacco said that the AHA and the American Stroke Association (ASA) has reached its 2010 goal early, which was to reduce stroke mortality by 25 percent.

“We believe a lot of this reduction in stroke deaths is due to the increased number of acute stroke hospitals, the increase in evidence-based hospitals using Get With The Guidelines programs, the increased utilization of tPA and, of course, the increased prevention in stroke.”

However, Sacco urged that “stroke is still the number one leading cause  of adult disability and more than 795,000 Americans have a stroke each year.

“We still need to do so much more in terms of stroke prevention and that’s why our new 2020 goal is focused on improving the cardiovascular health of all Americans.”

However, the CDC said that the increase in the number of CLRD deaths could very well be due to the fact that coding for CLRDs changed in 2008. During that year, death records that independently mentioned pneumonia in conjunction with chronic lower respiratory problems were changed and classified as chronic obstructive pulmonary disease (COPD) with acute lower respiratory infection instead.

Therefore, the CDC offered that the increase in CLRD deaths between 2007 and 2008 should be interpreted with caution.

Additionally, the CDC data showed that heart disease-related death decreased by 2.2 percent, while deaths linked to diabetes and hypertension and hypertensive renal disease decreased 3.1 percent and 4.1 percent, respectively.

Between 2007 and 2008, the age-adjusted death rates decreased for six of the leading 15 causes of death: heart diseases, malignant neoplasms, cerebrovascular diseases, accidents, diabetes mellitus and assault.

Over that same time period, the age-adjusted death rates increased for: chronic lower respiratory disease, Alzheimer’s, influenza and pneumonia, nephritis, nephritic syndrome and nephrosis, suicide and hypertension and hypertensive renal disease.

The life expectancy rates decreased by 0.1 year from 77.9 years in 2007 to 77.8 in 2008, according to the CDC statistics.

In 2008, the number of deaths in the U.S. was reported at 2,473,018 and the crude rate of death was 813.3 per 100,000 population, which was 1.2 percent larger than the rate of 803.6 per 100,000 in 2007.

The rates of age-adjusted death increased 0.4 percent for white females, 0.2 percent for non-Hispanic white males and 0.5 for non-Hispanic white females. The rates for black males, black females, non-Hispanic black males, non-Hispanic black females and Hispanic males decreased by 2.8, 1.9, 2.7, 1.8 and 3 percent, respectively.

“It is important to keep in mind, however, that mortality for races other than white and black may be seriously understated in some cases due to under-reporting for some race groups and Hispanic origin on death certificates,” the CDC acknowledged.

Sacco said that becoming familiar with Life's Simple 7, a free, easy tool that provides an assessment of stroke risk, can help prevent and reduce incidence of stroke.