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The decline of mortality due to stroke

A competitive and deterministic perspective

Departments of Neurology, Medicine, and Community Medicine, West Virginia University School of Medicine, Morgantown, WV.

Although stroke mortality has been declining since the first part of this century, the rate of decline increased sharply during the early 1970s. The basis for the fall in stroke mortality is often attributed to effective management of risk factors, particularly hypertension. However, some investigators have questioned whether risk factor reduction alone can adequately account for the magnitude of the recent decline in stroke mortality. When viewed from the perspective of competitive and deterministic mortality dynamics, the major force decreasing stroke mortality is the decreasing deterministic competitiveness of stroke and the increasing deterministic competitiveness of various malignant neoplasms and degenerative diseases as causes of mortality. These reciprocal trends are a natural consequence of the competitive deterministic mortality dynamics which describe these diseases in an environment that is becoming more conducive to human survival. The competitive nature of human mortality makes drawing etiopathogenic conclusions based upon single disease mortality data hazardous.

Address correspondence and reprint requests to Dr. Jack E. Riggs, Department of Neurology, West Virginia University Health Sciences Center, Morgantown, WV 26506.

Received January 8, 1991. Accepted for publication in final form February 14, 1991.

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