ENCSN Stroke Background Information

Data Sources:
June 2009 Burden of Cardiovascular Disease in North Carolina (The NC Heart Disease and Stroke Prevention Program); ECU Center for Health Services Research & Development; Behavioral Risk Factor Surveillance System; Department of Health and Human Services; State Center for Health Statistics; Cecil G. Sheps Center for Health Services Research (UNC); The NC Office of EMS (OEMS).

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See ENCSN county rankings for heart disease mortality (2005-2009)

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See top 5 ENCSN county heart disease mortality data rankings (2005-2009)

Stroke is a leading cause of death, premature death, and years of life lost in N.C.

• Stroke is the 3rd leading cause of death in N.C.1 In 2007, stroke caused 4,335 deaths among North Carolinians--that's one stroke death in the state every two hours and nearly 6% of all deaths in the state each year.
• Stroke is the 6th leading cause of years of life lost in N.C., causing an estimated 19,383 years of life lost during 2007.

Stroke morbidity and mortality can be prevented.

• North Carolinians can reduce their risk of stroke by being physically active, eating healthfully, maintaining a healthy weight, not using tobacco, and working with their health care providers to treat and control high blood pressure, high cholesterol, diabetes, and atrial fibrillation (a type of irregular heartbeat).
• Prompt, good quality emergency care for an acute stroke can reduce death and disability. Rehabilitation after stroke can also reduce disability and improve the quality of life for stroke survivors. N.C. has one of the highest stroke death rates in the nation.
• N.C.'s 2005 age-adjusted stroke death rate is the 6th highest among the 50 states and Washington, D.C.3
• N.C. is part of the Stroke Belt, an 8- to 12-state region that historically has had substantially higher stroke death rates than the rest of the nation.4
• The eastern counties of N.C. are also part of the "Buckle of the Stroke Belt" (the coastal plains region of Ga., S.C., and N.C.), which has had the very highest stroke death rates in the nation for at least the past 30 years.5

While N.C.'s stroke death rate is on the decline, it remains substantially higher than the U.S. rate and the Healthy People 2010 target.

• After declining very little during the 1990's (average annual decline less than 1%), stroke death rates in N.C. have been declining much more rapidly between 2000 and 2005 (average annual decline of 6%). Since 2000, stroke death rates have actually been declining more rapidly in N.C. than for the U.S. overall (Figure 1, see below).

• In 2006, there were 27,838 hospitalizations in N.C. for stroke; that's one hospitalization due to stroke every 20 minutes.
• More than 195,000 North Carolinians (3% of N.C. adults) have a history of stroke. Because this estimate excludes people living in long-term care facilities, it is probably an underestimate of the true prevalence of stroke in the state.
• After rising during the mid-1990's, N.C.'s stroke hospital discharge rates have been declining since 1997, dropping from 389.9 per 100,000 in 1997 to 316.4 per 100,000 in 2006. The mortality, morbidity and disability caused by stroke have a large economic impact in N.C.
• The average lifetime cost of a stroke in the U.S. is estimated at $103,576 per stroke event,6 and in N.C. an economic analysis estimated conservatively that stroke costs the state $1.05 billion each year.7
• Total annual hospital charges for stroke in N.C. have climbed from $271 million per year to more than $588 million per year between 1995 and 2006. That's currently more than $1.6 million in charges for stroke each day in the state.
• In N.C., Medicaid costs due to stroke currently exceed $279 million annually, more than $7,400 per N.C. Medicaid beneficiary with a history of stroke.8

Significant racial and geographic disparities in stroke exist in N.C.

• American Indian and African-American North Carolinians have higher stroke death rates than do white North Carolinians (Figure 2, please see below).

• African-American North Carolinians are also more likely to die of stroke at relatively young ages than are their white counterparts. Among African-American men, 35% of stroke deaths occur before age 65, compared with 15% among white men; 20% of stroke deaths among African-American women occur before age 65, compared with 7% among white women.
• Counties in the coastal plains region of N.C. tend to have both the highest stroke death rates and the highest stroke hospitalization rates. Counties along the Virginia border also tend to have higher stroke death rates than the rest of the state (Figures 3 and 4, please see below).1

• Most North Carolinians do not know the symptoms of stroke, even though they say they would call 911 for stroke.
• Although 87% of N.C. adults say they would call 911 if they thought someone was having a stroke, only 19% actually knew all the stroke symptoms, which means that they may not be able to identify a stroke when it occurs.
• Only 18% of N.C. adults knew all stroke symptoms and said they would call 911 for stroke.

For more information and downloadable slides, please visit "The Burden of Cardiovascular Disease in N.C."

1. North Carolina Center for Health Statistics. North Carolina Vital Statistics, Volume 2: Leading Causes of Death, 2007. Raleigh, N.C.: North Carolina Department of Health and Human Services;2008.
2. Jones-Vessey K, Buescher P, Farmer AH, Avery M, Duval A. Health Profile of North Carolinians: 2009 Update. Raleigh, NC: State Center for Health Statistics, North Carolina Department of Health and Human Services;2009.
3. Compressed Mortality File 1999-2005, CDC Wonder On-line Database [Compressed Mortality File 1999-2005, Series 20, No. 2K, 2008]. Centers for Disease Control and Prevention, National Center for Health Statistics; 2008.
4. Lanska D. Geographic distribution of stroke mortality in the United States: 1939-1941 to 1979-1981. Neurology. 1993;43:1839-1851.
5. Howard G, Howard VJ, Katholi C, Oli MK, Huston S. Decline in US stroke mortality: an analysis of temporal patterns by sex, race, and geographic region. Stroke. 2001;32:2213-2220.
6. Taylor TN, Davis PH, Tomer JC, Homes J, Meyer JW, Jacobson MF. Lifetime cost of stroke in the United States. Stroke. 1996;27(9):1459-1466.
7. Datta SK, Matchar DB. Economic burden of stroke in the Tri-State area. In: Huston SL, Lengerich EJ, Pratap SA, Puckett EM, eds. Unexplained Stroke Disparity: Report and Recommendations from Three Southeastern States. Raleigh, NC: NC Heart Disease and Stroke Prevention Task Force; 2000.
8. Centers for Disease Control and Prevention. Chronic Disease Cost Calculator: Version 1, November 2008. 2008; http://www.cdc.gov/nccdphp/resources/calculator.htm.

Other Background Information Resources

National Stroke Death Rate

Regional Convergence of Social Issues

North Carolina Percent Population African-American by Census Block

Health Professional Shortage Areas

County EMS Training Levels

County EMS Systems with EMD Programs

Stroke Quality Improvement Programs in NC

NC Disparities in Cerebrovascular Disease (Stroke)

CVD Mortality in Eastern NC

NC Hypertension Prevalence

Eastern NC Hypertension Prevalence

NC Hypertension Prevalence by Race

Eastern NC Cholesterol Prevalence

NC Cholesterol Prevalence

Cholesterol Prevalence by Race

Lloyd-Jones D.; Adams R.J. et al. Heart Disease and Stroke Statistics—2010 Update. A Report From the American Heart Association. Circulation. 2009 Published online before print December 17, 2009, doi: 10.1161/ CIRCULATIONAHA.109.192667. Download article

Regional Implementation of the Stroke Systems of Care Model Recommendations of the Northeast Cerebrovascular Consortium

Gropen T., Magdon-Ismail Z., Day D., Melluzzo S., Schwamm L.H. Regional Implementation of the Stroke Systems of Care Model Recommendations of the Northeast Cerebrovascular Consortium. Stroke 2009;40;1793-1802. Download article

Below is a downloadable word document with hypertext links to many CDC Division of Heart Disease & Stroke Prevention online guides, documents, and websites that could be useful to those needing national or statewide data on stroke and heart disease.

CDC DHDSP Products/Documents:

All Causes of Death, All Causes of Premature Mortality, and Ten Leading Causes of Death by County

Mortality Trends in Beaufort and Hyde Counties, 1979-2001

Mortality Trends in Carteret County, 1979-2001

Mortality Trends in Craven County, 1979-2001

Mortality Trends in Dare County, 1979-2003

Mortality Trends in Halifax County, 1979-2001

Mortality Trends in Hyde County, 1979-2001

Mortality Trends in Onslow County, 1979-2001

Mortality Trends in Pitt County, 1979-2004