Analysis

As shown in Table 1 below, the death rate due to stroke has declined since 2003, and it is now the sixth-leading cause of death in Minnesota. As recently as 2010, it was the third-leading cause of death in the state, but has fallen below Accidental Injury, Chronic Obstructive Pulmonary Disease, and Alzheimer’s Disease, all of which have rising death rates. The age-adjusted death rate for stroke for men and women is similar. More women die of stroke than men, but usually at an older age, which explains the similar death rate. Total stroke deaths were lowest in 2009 and have risen slightly in the years since. Chart 1 shows the pattern in total number of deaths and for women (green) and men (blue) since 2009. Even though the number of deaths has increased slightly, death rates have remained relatively stable. This can be explained by our aging population, with the number of older people who are at a risk of dying from stroke also increasing each year.

Table 1: Total Deaths and Death Rate due to Stroke for all Minnesotans and by sex, 2003-2017

Year	Total Number of Deaths	Total Age-Adjusted Death Rate (per 100,000)	Number of Deaths, Females	Age-Adjusted Death Rate (per 100,000 Females)	Number of Deaths, Males	Age-Adjusted Death Rate (per 100,000 Males)
2003	2,549	47.1	1,540	44.4	1,009	50.4
2004	2,540	46.2	1,540	44.1	1,009	50.4
2005	2,372	42.1	1,472	41.2	900	42.3
2006	2,215	39.3	1,356	38.2	859	40.1
2007	2,081	36.2	1,258	34.5	823	37.7
2008	2,087	35.7	1,326	35.9	761	34.6
2009	2,023	34.1	1,244	33.3	779	34.7
2010	2,154	35.8	1,313	35.1	841	36.0
2011	2,145	34.8	1,304	34.4	841	34.6
2012	2,064	32.7	1,223	31.2	841	33.7
2013	2,051	31.7	1,194	29.9	857	33.2
2014	2,172	33.5	1,307	33.3	865	33.1
2015	2,228	33.4	1,291	32.1	937	34.8
2016	2,197	32.5	1,299	31.7	898	32.7
2017	2,248	32.6	1,348	32.7	900	31.9

Chart 1: Total Deaths due to Stroke for all Minnesotans and by sex, 2003-2017

Despite Minnesota’s overall lower stroke death rate compared to the United States (15% lower in 2017), there are large disparities in the state. As shown in Chart 2 and Table 2, the death rate due to stroke is highest in African-American/African and Asian/Pacific Islander communities in Minnesota and lowest in Hispanic communities. The last column of Table 2 shows a rate ratio, which compares two rates to describe how much one group is impacted compared to another. Any number larger than 1 means that the group of interest is higher than the comparison group. Any number smaller than 1 means the group of interest is lower than the comparison group. African-American/Africans and Asians/Pacific Islanders die from stroke at a rate 1.41 times higher than Whites, while stroke death rates for American Indians are 1.19 times higher than Whites. Stroke death rates for Hispanic Minnesotans are 25% lower than for Whites.

Chart 2: Death Rate due to Stroke by Race and Ethnicity, 2013-2017

Table 2: Total Deaths and Death Rate due to Stroke by Race and Ethnicity, 2013-2017

Race/Ethnicity	Total Deaths, 2012-2016	Annual Age-Adjusted Death Rate (per 100,000), 2012-2016	Rate Ratio, compared to White
White	10,176	31.7	-
African-American/African	314	44.7	1.41
American Indian	87	37.7	1.19
Asian/Pacific Islander	283	44.8	1.41
Hispanic	94	23.7	0.75

The number of deaths due to stroke increases in older age groups. Table 3 shows the number of deaths and death rate due to stroke over the three most recent five-year time periods. Over that 15 year period, the largest declines in death rates have been for Minnesotans aged 35-44 and 65-84, as shown in Chart 3. For Minnesotans aged 45-64 and 85 and older, the declines have only been about half as large.

Table 3: Total Deaths and Death Rate due to Stroke by Age Group, 2003-2017

Age Group (years)	Number of Deaths 2003-2007	Crude Death Rate (per 100,000), 2003-2007	Number of Deaths, 2008-2012	Crude Death Rate (per 100,000), 2008-2012	Number of Deaths, 2013-2017	Crude Death Rate (per 100,000), 2013-2017	Change over 15 years
35-44	137	3.5	98	2.9	89	2.6	-26%
45-54	375	9.7	354	8.8	307	8.3	-14%
55-64	554	21.6	585	18.6	673	18.6	-14%
65-74	1,243	81.5	1,160	64.6	1,304	57.7	-29%
75-84	3,559	328.5	2,795	253.2	2,814	238.0	-28%
85 and Over	5,814	1,155.7	5,412	996.8	5,651	957.8	-17%

Chart 3: Percent change in Death Rate due to Stroke by Age Group, from 2003-2007 to 2013-2017

There are two main types of stroke. About 80% of stroke events are ischemic strokes which occur when a clot blocks a blood vessel in the brain. A hemorrhagic stroke occurs when a blood vessel ruptures in the brain. Table 4 shows that death rates due to ischemic strokes have dropped by approximately 40% in the last 15 years, largely due to improvements in treatments. The number of hemorrhagic stroke deaths has remained relatively stable over the last 15 years, with a smaller decline in the death rate (down 26%). Chart 4 shows that all of the decline in stroke deaths over the last 15 years occurred due to a reduction in ischemic stroke deaths that happened through about 2006. Since then, deaths have remained fairly steady.

Table 4: Total Deaths and Death Rate due to Types of Stroke, 2003-2017

Year	Number of Ischemic Stroke Deaths	Annual Age-Adjusted Ischemic Stroke Death Rate (per 100,000)	Number of Hemorrhagic Stroke Deaths	Annual Age-Adjusted Hemorrhagic Stroke Death Rate (per 100,000)
2003	1,479	27.5	530	10.4
2004	1,476	27.1	527	10.2
2005	1,295	23.5	580	11.0
2006	1,247	22.1	541	10.0
2007	1,240	21.4	549	9.9
2008	1,316	22.2	527	9.4
2009	1,225	20.5	462	8.2
2010	1,290	21.3	514	8.9
2011	1,250	20.0	558	9.4
2012	1,235	19.3	495	8.2
2013	1,202	18.4	488	7.8
2014	1,199	18.2	540	8.7
2015	1,207	17.9	551	8.6
2016	1,161	16.8	557	8.6
2017	1,157	16.6	516	7.7

Chart 4: Number of Deaths due to Hemorrhagic and Ischemic Stroke, 2003-2017

Other Resources

• Minnesota Vital Statistics Interactive Queries
  These data are population based and include all deaths in Minnesota regardless of where the event occurred. Users can group data by cause of death, age, sex, race, ethnicity, county, and year.


• CDC Wonder Online Mortality Database
  These data are population based and include all deaths and allows users to look at multiple causes of death. Users can group data by cause of death, age, sex, race, ethnicity, county, year, and some additional characteristics. Minnesota can be compared against other states.


• Interactive Atlas of Heart Disease & Stroke
  Online mapping tool from CDC with health indicators (including mortality and hospitalizations), risk factors, social and economic data, health care delivery, insurance, and health care costs data for states and counties. Some census tract data is also available.

Data Source

Annual death records from 2003 to the present were obtained from the Minnesota Department of Health Center for Health Statistics.

Measure Definition

Since 1999, stroke deaths are identified as the underlying cause of death on death certificates as ICD-10: I60-I69. This includes ischemic stroke, hemorrhagic stroke, and other cerebrovascular diseases.