Stroke is a leading cause of disability and the second leading cause of death globally. A significant increase in stroke burden was observed in North Dakota during the COVID-19 period. Little is known about which areas in North Dakota experienced a great burden. This study examined the trends in stroke prevalence by county in North Dakota before, during, and after the COVID-19 pandemic and identified changes over time. For this study, we used CDC PLACES data and focused on county-level stroke prevalence in North Dakota from 2018-2023. The stroke prevalence was regrouped into three years using the COVID period(2020-2021) as the baseline. The Average Annual Percentage Change (AAPC) was calculated with corresponding 95% confidence intervals (CI) to determine the trend of prevalence of stroke by county and by year. Across the 53 counties in North Dakota, 13.2% experienced an increase in stroke prevalence before COVID. 83% occured in the rural counties and the rest in semi-urban. Richland County, a semi-urban area (3.6%, 95%CI:0.1% to 7.1), and 5 rural counties accounted for the increase in stroke prevalence during pre-COVID. During COVID, about 45.3% counties (66.7% rural, 25% semi-urban, and 8.3% urban) had an increase in stroke prevalence. Two urban counties (Burleigh and Morton), together with 6 semi-urban counties and 16 rural counties, accounted for the increase in stroke prevalence during COVID. There were stable rates of stroke prevalence post-COVID across all counties in North Dakota. North Dakota has a significant amount of urban, semi-urban, and rural counties with an increased burden of stroke. There is a need for intensified efforts in these counties to improve outcomes and equity in stroke care across all populations in North Dakota to prevent such a rise during any pandemic.
Akomaning et al. (Wed,) studied this question.