More Strokes in U.S. Than in Europe
Obesity, Diabetes, and Smoking Drive Trend
Feb. 22, 2008 (New Orleans) -- Stroke
is more prevalent in the United States than in Europe -- and higher rates of obesity, diabetes, and lifetime smoking in the U.S. play a major role, researchers
Barriers to care in the U.S. -- chiefly a lack of universal health care
coverage and minimal focus on prevention -- also contribute to its higher
prevalence of stroke, says study head Mauricio Avendano, PhD, a research fellow
in public health at the Erasmus Medical Center in Rotterdam, Netherlands.
The researchers looked at what is known as stroke prevalence -- the number
of people who have a disease at any given point in time.
Compared with European men, American men had a 61% higher chance of having
had a stroke in their lifetime, Avendano says. U.S. women had almost twice the
odds of having had a stroke as European women.
"Most of this gap is among relatively poor Americans who were, in our
data, much more likely to have a stroke than poor Europeans, whereas the gap in
stroke prevalence is less marked between rich Americans and rich
Europeans," Avendano says.
The study was presented at the American Stroke Association's (ASA)
International Stroke Conference 2008.
Stroke Deaths Down in U.S.
ASA spokesman Larry Goldstein, MD, a stroke expert at Duke University in
Durham, N.C., says looking at stroke prevalence may give a blurred snapshot of
what's going on the U.S.
That's because prevalence goes up as the chance of dying of a disease goes
down. "If everyone has a disease and everyone survives, then prevalence is
100%," he tells WebMD.
The fact that the U.S. has made great strides in reducing deaths due to
stroke -- there's been a 25% drop in recent years -- may play a role in its
higher prevalence, Goldstein says.
That said, "there are a lot of data linking lower socioeconomic status
and lack of access of care to a variety of ill health effects, including
stroke," he says.
African-Americans Have Highest Stroke Odds
The researchers analyzed 2004 data from the U.S. Health and Retirement
Survey (HRS); the Survey of Health, Aging and Retirement in Europe (SHARE); and
the English Longitudinal Study of Aging (ELSA). These surveys include
twice-yearly interviews among people age 50 and older.
Altogether, there were data on 13,667 people in the U.S. and 30,120
individuals in 11 European countries.
Among the findings:
- Overall, women were about 25% less likely to have had a stroke, on average,
- When age was taken into account, stroke was most prevalent in the U.S. and
least prevalent in the southern Mediterranean European countries of Spain,
Italy and Greece, as well as Switzerland.
- African-Americans had the highest odds of having a stroke of any group
studied -- they were nearly three times more likely to have had a stroke in
their lifetime than "other Americans," the dubious winner of the
- In the U.S., stroke prevalence is higher in the southern and western
Within Europe, "there was a north-south gradient, with the northern
countries, especially Denmark and Sweden, having the highest prevalence of
stroke," Avendano says.
Avendano says that while rates of lifetime smoking are higher in the U.S.
than in Europe, "the proportion of current smokers is lower in the U.S. So
going forward we could see a positive effect of that trend."