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January 25, 2006

Leading Causes of Death in the United States

JAMA. 2006;295(4):383-384. doi:10.1001/jama.295.4.383-b

To the Editor: The study by Dr Jemal and colleagues1 depicts the annual death rates for stroke as declining rapidly during 1973-1982 (5.7% per year) followed by a more modest decline during 1982-1991 (3% per year) and then a very slow 1991-2002 decline (0.9% per year). However, for the authors to conclude that the decrease in mortality rates from stroke has slowed or stopped since the early 1990s is misleading. Accounting for the discontinuity of stroke mortality between the 9th and 10th revisions of the International Classification of Diseases would yield a greater percentage per year decline since 1991 than the authors demonstrated. More importantly, percentage declines have been almost as large since 1995 as they were before 1993, with only a temporary flat trend from 1992-1995; this was not clear from the percentage changes the authors reported and the scale used in Figure 1 of the article. Stroke mortality rates declined in every year since 1995, showing 2% to 3% annual declines, almost as much as in most years of declining rates except for 1973-1982.2