Risk factors for stroke among persons age 18 and older

Data for the first seven risk factors are taken from the Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional telephone survey that generates United States and state-specific information about health risk behaviors, clinical preventive services, disease prevalence, health care access and other health-related issues. BRFSS data are collected through random-digit-dialed telephone interviews with non-institutionalized, civilian adults (18 years of age and older) using standardized protocols and interviewing techniques. BRFSS is the world's largest, on-going telephone health survey system that is conducted annually by all 50 state health departments as well as those in the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands with support and technical assistance from CDC. For more information on the BRFSS, see http://www.health.mo.gov/data/BRFSS/index.php. Data for the other eight risk factors are taken from the 2011 County-Level Study (CLS), which is a large sample survey of Missouri adults (18 years and older) and provides county-specific rates. For more information on the CLS, please visit http://www.health.mo.gov/data/cls/index.php. For definitions of risk factors or statistics, click on the row or column headings in the profile.

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Angina or coronary heart disease

Answered “yes” to “Has a doctor, nurse, or other health professional ever told you that you had angina or coronary heart disease?”

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Prior heart attack

Answered “yes” to “Has a doctor, nurse, or other health professional ever told you that you had a heart attack, also called a myocardial infarction?”

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No cholesterol screening

Answered “no” to “Have you ever had your blood cholesterol checked?”

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Binge drinking

Adult males having five or more drinks and adult females having four or more drinks on at least one occasion in the past 30 days.

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Heavy drinking

Adult males having more than two drinks per day and adult females having more than one drink per day on each day of the past 30 days.

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Heavy drinking among males

Adult males having more than two drinks per day on each day of the past 30 days.

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Heavy drinking among females

Adult females having more than one drink per day on each day of the past 30 days.


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Incorrectly answered signs and symptoms of stroke

Incorrectly answered one or more of the following questions or responded “don't know” or “not sure”:

“Do you think sudden confusion or trouble speaking are symptoms of a stroke?” (Correct answer is “yes”)
“Do you think sudden numbness or weakness of face, arm, or leg, especially on one side, are symptoms of a stroke?” (Correct answer is “yes”)
“Do you think sudden trouble seeing in one or both eyes is a symptom of a stroke?” (Correct answer is “yes”)
“Do you think sudden chest pain or discomfort are symptoms of a stroke?” (Correct answer is “no”)
“Do you think sudden trouble walking, dizziness, or loss of balance are symptoms of a stroke?” (Correct answer is “yes”)
“Do you think severe headache with no known cause is a symptom of a stroke?” (Correct answer is “yes”)
Excludes respondents with refused or missing responses.

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High blood pressure

Answered “yes” to "Has a doctor, nurse or other health professional ever told you that your blood pressure was high?"

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High cholesterol

Respondents age 35 and older who answered “yes” to the two questions:

“Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked?” AND

“Have you ever been told by a doctor, nurse, or other health professional that your blood cholesterol is high?”

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Diabetes

Answered “yes” to "Have you ever been told by a doctor that you have diabetes?" Females with pregnancy (gestational) diabetes and people with pre-diabetes or borderline diabetes are not included.

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Obesity

Adults who reported weight and height (without shoes) from which the calculated body mass index (BMI) is 30 or greater. BMI equals weight in kilograms divided by height in meters squared. Weight in pounds divided by 2.2 converts weight to kilograms. Height in inches multiplied by 0.0254 converts height to meters.

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Overweight

Adults who reported weight and height (without shoes) from which the calculated body mass index (BMI) is greater than or equal to 25 but less than 30. BMI equals weight in kilograms divided by height in meters squared. Weight in pounds divided by 2.2 converts weight to kilograms. Height in inches multiplied by 0.0254 converts height to meters.

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Current smoking

Adults who reported smoking at least 100 cigarettes in their lifetime and now smoke cigarettes every day or some days.

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Physical inactivity

Answered “no” to: “During the past 30 days, other than your regular job, did you participate in any physical activities or exercise such as running, calisthenics, golf, gardening, or walking for exercise?” (Physical inactivity is also called “no leisure-time physical activity”)

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Low fruit and vegetable intake

Adults who reported consuming less than five servings of fruits and vegetables per day. Derived by calculating number of fruits and vegetables eaten per day using the following questions:

“During the past month, how many times per day, week, or month did you drink 100% PURE fruit juices?”
“During the past month, not counting juice, how many times per day, week, or month did you eat fruit?  Count fresh, frozen, or canned fruit.”
“During the past month, how many times per day, week or month did you eat cooked or canned beans, such as refried, baked, black, garbanzo beans, beans in soup, soybeans, edamame, tofu, or lentils.  Do NOT include long green beans.”
“During the past month, how many times per day, week, or month did you eat dark green vegetables, for example broccoli or dark leafy greens including romaine, chard, collard greens or spinach?”
“During the past month, how many times per day, week, or month did you eat orange-colored vegetables such as sweet potatoes, pumpkin, winter squash, or carrots?
“Not counting what you just told me about, during the past month, about how many times per day, week, or month did you eat OTHER vegetables?”

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Stroke prevalence (non-institutional)

Answered “yes” to "Has a doctor, nurse or other health professional ever told you that you had a stroke?" Age, annual household income, educational attainment, gender and race are as reported by respondents.

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Mortality

Deaths of residents of the area (state, region, county) for which the underlying cause of death was given on the death certificate as stroke or other cerebrovascular disease, whether due to bleeding or to blockage of arteries in the brain. Deaths due to late effects of strokes are also included. 

For data through 1998, International Classification of Diseases (ICD-9) codes included are: 430-434, 436-438. For data years 1999 forward, International Classification of Diseases (ICD-10) codes included are I60-I69.

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Hospitalizations

Stroke/other cerebrovascular disease

Hospitalizations of residents of the area (state, region, county) for which the primary diagnosis was given as ICD-9 codes 430-438. Most of these are due to acute strokes. Others are hospitalizations for treatment of occlusions or aneurysms that have not yet caused strokes. A few are due to transient ischemic attacks, rarer kinds of cerebrovascular disease (e.g., Moya-moya disease), or late effects of strokes.

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Acute stroke

Hospitalizations of residents of the area (state, region, county) for which the primary diagnosis was given as ICD-9 codes 430-434 and 436. Stroke is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. Acute stroke includes ischemic stroke (ICD-9-CM codes 433-434 and 436) and hemorrhagic stroke (ICD-9-CM codes 430-432).

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Ischemic stroke

Hospitalizations of residents of the area (state, region, county) for which the primary diagnosis was given as ICD-9 codes 433-434 and 436. Ischemic stroke occurs when oxygen fails to reach the brain due to blockage of blood vessels.

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Hemorrhagic stroke

Hospitalizations of residents of the area (state, region, county) for which the primary diagnosis was given as ICD-9 codes 430-432. Hemorrhagic stroke is due to excessive bleeding from blood vessels in the brain.

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Late effects and other cerebrovascular disease

Hospitalizations of residents of the area (state, region, county) for which the primary diagnosis was given as ICD-9 codes 437-438. Late effects are classified according to the type of neurological deficit (cognitive, speech, etc.) caused by the stroke. Other and ill-defined cerebrovascular disease includes cerebral atherosclerosis, not-ruptured aneurysm and other types of cerebrovascular disease.

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Transient ischemic attack (TIA)

Hospitalizations of residents of the area (state, region, county) for which the primary diagnosis was given as ICD-9-CM code 435. TIAs usually have no lasting effects, are typically 2-15 minutes in duration and almost always resolve in 24 hours.

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Emergency room visits

Stroke/other cerebrovascular disease

Emergency room visits of residents of the area (state, region, county) for which the primary diagnosis was given as ICD-9 codes 430-438. Most of these are due to acute strokes. Others are emergency room visits for treatment of occlusions or aneurysms that have not yet caused strokes. A few are due to transient ischemic attacks, rarer kinds of cerebrovascular disease (e.g., Moya-moya disease), or late effects of strokes. Persons who are admitted to the hospital through the emergency room are not included in these counts and rates; they are counted among the inpatient hospitalizations.

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Transient ischemic attack (TIA)

Emergency room visits of residents of the area (state, region, county) for which the primary diagnosis was given as ICD-9-CM code 435. TIAs usually have no lasting effects, are typically 2-15 minutes in duration and almost always resolve in 24 hours. Persons who are admitted to the hospital through the emergency room are not included in these counts and rates; they are counted among the inpatient hospitalizations.

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Hospital Utilization Indicators

Stroke/other cerebrovascular disease

Total charges

The amount that the hospital charges for inpatient hospitalizations for residents of the area (state, region, county) admitted for stroke or other cerebrovascular disease (ICD-9-CM codes 430-438). The charges do not necessarily represent the cost to the hospital of providing the care nor do they represent the amount actually collected by the hospital for providing the care.

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Total days of care

The days of care (length of stay) in the hospital for residents of the area (state, region, county) admitted for stroke or other cerebrovascular disease (ICD-9-CM codes 430-438).

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Ischemic stroke

Total charges

The total amount that the hospital charges for inpatient hospitalizations for residents of the area (state, region, county) admitted for ischemic stroke (ICD-9-CM codes 433-434, 436). The charges do not necessarily represent the cost to the hospital of providing the care nor do they represent the amount actually collected by the hospital for providing the care.

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Total days of care

The total days of care (length of stay) in the hospital for residents of the area (state, region, county) admitted for ischemic stroke (ICD-9-CM codes 433-434, 436).

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Discharge status

Hospital discharge disposition for residents of the area (state, region, county) admitted for ischemic stroke (ICD-9 codes 433-434, 436):
            Home: patient was discharged to home.
            Rehabilitation: patient was discharged to a rehabilitation facility. Not all hospitals record this disposition so it is likely underreported.
            Other LTC facility: patient was discharged to an intermediate, long-term or skilled nursing facility.
            Died: patient died while in the hospital.

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Thrombolytic agent given

Hospitalizations of residents of the area (state, region, county) for which the primary procedure code was ICD-9-CM code 99.10, injection or infusion of thrombolytic agent. This can include tissue plasminogen activator (tPA). There is no procedure code specific to tPA. ICD-9-CM code 99.10 can also include streptokinase and urokinase. For hospitalizations due to stroke, the thrombolytic agent can probably be assumed to have been tPA.

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Hemorrhagic stroke

Total charges

The total amount that the hospital charges for inpatient hospitalizations for residents of the area (state, region, county) admitted for hemorrhagic stroke (ICD-9-CM codes 430-432). The charges do not necessarily represent the cost to the hospital of providing the care nor do they represent the amount actually collected by the hospital for providing the care.

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Total days of care

The total days of care (length of stay) in the hospital for residents of the area (state, region, county) admitted for hemorrhagic stroke (ICD-9-CM codes 430-432).

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Discharge status

Hospital discharge disposition for residents of the area (state, region, county) admitted for hemorrhagic stroke:

Home: patient was discharged to home.
Rehabilitation: patient was discharged to a rehabilitation facility. Not all hospitals record this disposition so it is likely underreported.
Other LTC facility: patient was discharged to an intermediate, long-term or skilled nursing facility.
Died: patient died while in the hospital.

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TIA hospitalization admitted through the emergency room

Admission through the emergency room of  residents of the area (state, region, county) for transient ischemic attacks, ICD-9-CM code 435. TIAs usually have no lasting effects, are typically 2-15 minutes in duration and almost always resolve in 24 hours.

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