Skip to main content.

A Public Death: Preventing Strokes by Improving Vital Statistics

A Public Death: Preventing Strokes by Improving Vital Statistics

Picture of William Heisel

Saying someone died of a stroke is only a little more specific than saying that they died from old age. It’s fine if you’re just updating a relative on what happened to someone in the family, but it does little good if you’re trying to manage a public health program aimed at saving lives or decide where to focus research funds to get the biggest impact.

A study in Stroke, the American Heart Association journal, published this month found:

Of 398,942 people who died from stroke in the United States between 2007 and 2009, in 209,933 (53%) cases, the medical certifier did not specify whether the stroke was hemorrhage or infarction on the death certificate. There were 44 states in which the percentage of unspecified stroke among all strokes was [greater than or equal to] 50% and 20 states in which the percentage was [greater than or equal to] 55%. The percentage was lowest in the District of Columbia (46%) and highest in Oklahoma (64%). The state variation in the proportion of unspecified stroke decreased with age of the deceased.

Let’s look at the types of strokes first, and then we can get into what the study found and why it matters. When someone has a stroke, the blood supply to their brain is cut off. The mechanisms behind the blood loss can take many different forms, but they fall under two main categories.

1. Ischemic stroke or cerebral infarction: Think of this as a dam forming in the bloodstream. A clot blocks a blood vessel that delivers blood to the brain. This is a common side effect from surgery, particularly in older patients.

You might have heard a surgeon talk about “throwing a clot,” which means a blood clot is loosened and leaves one part of the body, making its way to the blood vessels in the brain where it causes a cerebral embolism, also called an embolic stroke. If an artery is narrowed by fat, cholesterol or other factors and a clot forms, the event is called a thrombotic stroke.

2. Hemorrhagic stroke: Think of this as the bloodstream breaking the levee. For a variety of reasons, a brain blood vessel may weaken. When it finally tears open, blood runs out. Where the blood runs determines the type of hemorrhage. If it is an intracerebral hemorrhage, that means the blood has spilled into the brain tissue, killing the brain cells.

What can cause this type of stroke? High blood pressure is one of the top causes, followed by severe injury to the brain – car crash, fall, violence – veins and arteries in the brain that are misshapen in some way, and blood thinners. Then there is the subarachnoid hemorrhage. That means a blood from an artery on the outer edge of the brain has leaked into the area between the brain and the skull.

Most often, this type of stroke starts with an artery bulging out to create an aneurysm that then breaks open. It can be heralded by painful headaches, and it can be followed by vasospasms, which are just what you might guess, wild fluctuations in the blood vessels that harm the brain even further.

Getting the underlying cause of death wrong half the time has huge implications. All of these strokes combined lead to about 7% of all deaths in the United States, making it one of a small group of causes of death that have a very big impact. It’s important to understand what is behind these strokes and which types of strokes are causing the most death and injury.

I’ll write more about how the researchers for the Stroke study did their work and where it might lead in my next post.

Photo courtesy of Doyle Saylor via Flickr.

Related Content:

A Public Death: Records Reveal Endangered Patients In Three States

A Public Death: Five Tips from American-Statesman's Investigation of Veteran Deaths

A Public Death: NFL Concussion Crisis Documented with Death Certificates

A Public Death: Get to Know the People in Vital Records

A Public Death: Is the HIPAA Patient Privacy Law Being Abused to Bury Government Secrets?

Leave A Comment


Soaring out-of-pocket costs, rising premiums, and shaky insurance exchanges raise urgent questions this election season. What policies might address these problems, and how do the presidential candidates’ health plans differ? This webinar will give an overview of each candidates’ policy prescriptions and provide reporters with crucial context for covering one of the election’s most important but overlooked issues.

The 2017 California Fellowship, for California-based journalists only, will be held March 5-9, 2017 in Los Angeles. This Fellowship will focus on vulnerable populations and access to care and health care reform and innovation. We also take an in-depth look at how community conditions influence individuals' prospects for health. Each Fellow receives a $1,000 stipend to assist with the costs of reporting an ambitious Fellowship project on a California health issue, as well as six months of mentoring by a Senior Fellow. Deadline to apply is Dec. 1.  For more information, go here.


Member Activities

Alex Hepgurn has added an award to their profile

Kyla Irving's profile has been updated

Connect with Kyla Irving

Monya De has shared a blog post

Read it.

Barrett Newkirk has shared a fellowship project

Read it.

Laura Russell's profile has been updated

Connect with Laura Russell
More Member Activities

Follow Us



CHJ Icon