Premature Mortality Due to Cerebrovascular Disease - United States, 1983

Cerebrovascular disease is the third leading cause of death in the United States and the eighth leading cause of years of potential life lost before the age of 65 (YPLL) (1,2). In this report, which assesses the contribution of cerebrovascular disease to YPLL, YPLL was calculated using the National Center for Health Statistics' detailed mortality data from computerized death certificate tapes for 1983, the latest year for which data are available. Data on YPLL attributable to all forms of cerebrovascular disease (International Classification of Diseases, 9th Revision, Codes 430-438) were analyzed by sex and race of the decedents. For the purpose of comparison, YPLL rates per 100,000 persons <65 years of age were calculated.

Differences in YPLL, by sex. In 1983, men accounted for slightly over half of the total YPLL due to cerebrovascular disease (Table 1). Overall and within each racial group, the rates of YPLL were slightly higher for men than for women (rate ratio, men to women = 1.1).

Differences in YPLL, by race. Although blacks constitute only 12% of the U.S. population, they accounted for 28% of YPLL due to cerebrovascular disease (Table 1). The rate of YPLL due to cerebrovascular disease was 2.6 times higher among blacks than among whites. These racial differences were observed for both men and women.

Reported by: Epidemiology Br, Div of Nutrition, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: Analysis of YPLL data has proven useful in assessing the impact of preventable causes of death on premature mortality (1). This information is also valuable in determining priorities for prevention activities. For example, the findings reported here reemphasize the importance of identifying, treating, and controlling hypertension, especially among blacks.

Blacks accounted for a disproportionate percentage of YPLL due to cerebrovascular disease. The rate of YPLL for blacks was more than two and one-half times higher than the rate for whites. Based upon blood pressure measurements from the second National Health and Nutrition Examination Survey (NHANES II), 37.9% of blacks are hypertensive *, compared with 32.6% of whites (3). Additionally, blacks are more likely to have severe hypertension.

The major risk factor for stroke is hypertension, a condition which often remains asymptomatic for decades until it is manifested as a stroke in later life. It is, therefore, not surprising that, while cerebrovascular disease is the third leading cause of death in the United States, it ranks eighth in YPLL (2). This could change, however. Projected increases in the number of persons > 65 in coming decades + could alter the perception among health professionals and the public of what constitutes "premature mortality". If, as a result, the somewhat arbitrary definition of 65 years as the cutoff for YPLL was raised to 75 or even 85 years of age, cerebrovascular disease would increase in perceived importance as a preventable cause of premature mortality in the United States.

• Persons whose blood pressure is >= 140 mm Hg systolic/90 mm Hg diastolic or who are taking antihypertensive medication.

+ Even if age-specific mortality does not change, it has been projected that the population >= 65 years of age will increase from the estimated 23.2 million in 1980 to 41.3 million in 2080 (4).

References

1. CDC. Premature mortality in the United States: public health issues in the use of years of potential life lost. MMWR 1986;35(suppl 25)1S-11S.

2. CDC. Changes in premature mortality-United States, 1984-1985. MMWR 1987;36:55-7.

3. National Heart, Lung, and Blood Institute, National Institutes of Health. Hypertension prevalence and the status of awareness, treatment, and control in the United States. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1985.

4. Vaupel JW, Gowan AE. Passage to Methuselah: some demographic consequences of continued progress against mortality. Am J Public Health 1986;76:430-3.

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