Advances in Population Studies 2007

Concerns regarding the impact of population shifts were heightened this year with the reports describing several disturbing trends that were independent of the demographic population shift. Data from the National Hospital Discharge Study suggested that stroke hospitalization rates for the population aged 45 to 54 increased between 1980 and 2000 from 164.8/100 000 to 172.9/100 000, private insurance cov- erage decreased from 73% to 50%, and the proportion of stroke patients discharged home decreased from 72% to 62%. 1 While national data on incident stroke are lacking, the few available data suggests that at there are at most very modest declines (perhaps there are increases).2,3 Finally, between 1990 to 1991 and 2000 to 2001, the inflation- adjusted costs for stroke increased 54% for infarctions, 57% for intracerebral hemorrhage, and 76% for subarachnoid hemorrhage.4 Collectively, when coupled with the demo- graphic shifts in age, these trends portend an explosion in the public health impact of stroke. Racial disparities in stroke have not been substantially reduced. In 1983 stroke was the fourth largest contributor to the male black-to-white detriment in life expectancy, contrib- uting 7.0% of the 6.42-year disparity. By 2003 the contribu- tion of stroke had fallen marginally to 6.2% of the 6.33-year disparity. For women in 1983 stroke contributed 10.8% of the 5.07-year disparity, and was second largest contributor. In 2003 stroke contributed 8.2% of the 4.54-year disparity and had fallen to the third largest contributor.5 Reports suggest persistent geographic disparities in stroke. One of few reports examining geographic disparities in stroke incidence showed that compared to the northeastern United States, the hazard among "southern" male physicians was 22% higher (95% CI: 2% to 47%) for all stroke, and 30% higher (95% CI: 6% to 58%) for ischemic stroke. 6 There is also an apparent racial difference in the geographic disparities in stroke mortality, with 6% to 21% larger black-to-white mortality ratios for southern states than for nonsouthern states. 7 Finally, the prevalence of stroke was higher in the southeastern United States, with the age-adjusted estimated prevalence of stroke in the stroke belt states at or above the national average.8 Geographic variations in stroke incidence rates were also reported within the European community, ranging from 210/100 000 in Dijon, France, to 600/100 000 in Novosibirsk, Russia.9 Important reports also expanded the description of stroke epidemiology countries including China, 10 Brazil, 11 sub-Saharan Africa, 12 and Chile. 13