The Burden of Cerebrovascular Disease in the United States

Xin Tong, MPH; Quanhe Yang, PhD; Matthew D. Ritchey, PT, DPT, OCS, MPH; Mary G. George, MD, MSPH; Sandra L. Jackson, PhD, MPH; Cathleen Gillespie, MS; Robert K. Merritt, MA


Prev Chronic Dis. 2019;16(4):e52 

In This Article

Abstract and Introduction


Introduction: Little is known about trends in the overall combined burden of fatal and nonfatal cerebrovascular disease events in the United States. Our objective was to describe the combined burden by age, sex, and region from 2006 through 2014.

Methods: We used data on adults aged 35 and older from 2006 through 2014 Nationwide Emergency Department Sample, National Inpatient Sample of the Healthcare Cost and Utilization Project, and the National Vital Statistics System. We calculated age-standardized cerebrovascular disease event rates by using the 2010 US Census population. Trends in rates were assessed by calculating the relative percentage change (RPC) between 2006 and 2014, and by using Joinpoint to obtain P values for overall trends.

Results: The age-standardized rate increased significantly for total cerebrovascular disease events (primary plus comorbid events) from 1,050 per 100,000 in 2006 to 1,147 per 100,000 in 2014 (P < .05 for trend). Treat-and-release emergency department visits with comorbid cerebrovascular disease events increased significantly, from 114 per 100,000 in 2006 to 213 per 100,000 in 2014 (RPC of 87%, P < .05 for trend). Significant rate increases were identified among adults aged 35 to 64 with an RPC of 19% in primary cerebrovascular disease events, 48% in comorbid cerebrovascular disease events, and 36% in total events.

Conclusion: Our findings have important implications for the increasing cerebrovascular disease burden among adults aged 35 to 64. Focused prevention strategies should be implemented, especially among young adults who may be unaware of existing modifiable risk factors.


Cerebrovascular disease often manifests in a person experiencing an acute nonfatal event (ie, emergency department [ED] visit, hospitalization) or fatal event, with stroke being the primary disease type.[1,2] Cerebrovascular disease is a leading cause of serious long-term disability, and the second leading cause of death worldwide.[3] Despite declines in cerebrovascular disease mortality rates in the United States since the early 1900s, stroke is the fourth leading cause of death among women and the fifth leading cause of death among men.[4] Approximately 795,000 new or recurrent acute strokes occur every year, with an estimated annual direct medical cost for stroke of $17.9 billion in 2012 to 2013.[4] Studies have suggested that previous declines in cerebrovascular disease mortality and hospitalization rates have stalled, and that mortality from cerebrovascular disease is increasing significantly among younger adults (35–64 y).[5,6]

Despite the large public health burden of cerebrovascular disease, no surveillance system exists to collectively track fatal and nonfatal events attributed to cerebrovascular disease or describe the potential shift in burden of these events among different demographic groups in the United States. The aim of our study was to help address this limitation in public health surveillance by estimating the US burden of fatal and nonfatal cerebrovascular disease events (a combination of the mutually exclusive estimates of treat-and-release emergency department [ED] visits, nonelective acute nonfatal hospitalizations, and deaths) by age, sex, and region, from 2006 through 2014. The findings and methodology presented in this study can be used to guide efforts to decrease the health care and mortality burden of cerebrovascular disease in the United States and to track the progress of these efforts.