By Omoye E. Imoisili, Alina Chung, Xin Tong, Donald K. Hayes and Fleetwood Loustalot, CDC Division for Heart Disease and Stroke Prevention. Morbidity and Mortality Weekly Report (MMWR).
In brief
- Known: stroke was the fifth leading cause of death in the U.S. in 2021 and a leading cause of long-term disability, costing about $56.2 billion in 2019–2020. From 2006 to 2010, the share of adults who had had a stroke fell 3.7%.
- New: from 2011–2013 to 2020–2022, it rose 7.8%, from 2.7% to 2.9% of adults.
- So what: teaching the signs of stroke and targeting the groups most affected could improve prevention and treatment.
How the study worked
The Behavioral Risk Factor Surveillance System (BRFSS) phones about 400,000 adults a year. This analysis used 5,225,987 respondents in all 50 states and DC from 2011 to 2022, who answered: "Has a doctor or other health professional ever told you that you had a stroke?" Results were age-standardized and pooled into four 3-year periods.
Who has had a stroke (2020–2022)
| Group | Share who had had a stroke |
|---|---|
| Age 65 and older | 7.7% |
| Age 18–44 | 0.9% |
| American Indian or Alaska Native | 5.3% |
| Native Hawaiian or Pacific Islander | 4.4% |
| Black | 4.3% |
| Asian | 1.6% |
Adults without a high school diploma had about three times the rate of college graduates.
Where it rose
From 2011–2013 to 2020–2022:
- Ages 18–44: up 14.6%; ages 45–64: up 15.7%. Rates among those 65 and older held steady.
- Women up 9.3%, men up 6.2%.
- Black adults up 7.8%, White 7.2%, Hispanic 16.1%.
- Less than high school: up 18.2%, the largest rise.
- States: significant increases in 10 — California, Colorado, Minnesota, Mississippi, North Carolina, North Dakota, Ohio, Oklahoma, Tennessee and West Virginia — led by Ohio (20.9%) and Tennessee (20.7%). DC fell 19.2%. The highest rates were mostly in the South, the "stroke belt."
- COVID-19: no significant change during the pandemic.
Stroke prevalence by state, 2011–2013 and 2020–2022, and the change between them. Maps: CDC.
Why it might be rising
- Risk factors in younger adults: obesity among men rose from 27.5% to 43% and among women from 33.4% to 41.9% between 1999–2000 and 2017–2018; high blood pressure among adults 45–64 rose from 40.3% to 46.8%.
- Opioids: rising stroke hospitalizations among adults under 45 during 2006–2015 were tied to opioid use and infective endocarditis.
- Inequities: higher rates of other conditions, lower income and unequal access to care may explain the gaps between groups, within larger forces such as discrimination.
- More survivors: clot-busting thrombolytic treatment for ischemic stroke rose from 10%–15% (2003–2009) to 43%–46% (2021), so more people live after a stroke — and count in surveys.
Limitations
Answers are self-reported; BRFSS response rates were under 50% (though stable); and better treatment means more survivors, which raises prevalence.
For public health
Programs such as Million Hearts 2027 and CDC's Paul Coverdell National Acute Stroke Program have improved stroke care across communities; tackling social determinants of health may also be needed. And everyone should know F.A.S.T.:
- Face: does one side droop when smiling?
- Arms: does one arm drift down when both are raised?
- Speech: is it slurred or strange?
- Time: if you see any of these signs, call 9-1-1 right away.
Sources
Based on "Prevalence of Stroke — Behavioral Risk Factor Surveillance System, United States, 2011–2022," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; MMWR material is in the public domain. Full tables by group and state are in the article PDF.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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