1035 Trends and Disparities in the Location of Death for Ischemic Stroke Decedents in the United States: A Two-Decade Analysis From 1999-2020

INTRODUCTION: Stroke is the fifth leading cause of death in the US, predominantly caused by ischemic strokes. Substantial research has documented rural-urban disparities in stroke outcomes in the United States, stemming from differences in healthcare infrastructure and access. This nationawide retrospective study examines trends in death locations among ischemic stroke victims across geographic and racial differences from 1999 to 2020. METHODS: A retrospective review of ischemic stroke mortality data from CDC WONDER was performed, categorizing by urbanization (metropolitan vs. non-metropolitan) and race (White, Black/African American, Asian/Pacific Islander, American Indian/Alaska Native). Age-adjusted mortality rates were calculated based on the 2000 US standard population. RESULTS: Total death recorded in the 20-year period was 238,129. Age-adjusted mortality rates have risen among all urbanization levels since 2009, following an initial period of decline. The proportion of deaths occurring at home increased from 8.44% in 1999 to 29.31% in 2020, while inpatient deaths decreased from 46.41% to 29.56%. The fraction of the rural population with at-home deaths and hospice utilization was less than the fraction of their urban counterparts. Black/African American individuals had the highest age-adjusted mortality rates. CONCLUSIONS: Targeted efforts are needed to address access gaps in end-of-life stroke care, particularly for rural and minority populations. Policymakers should prioritize initiatives that enhance rural healthcare infrastructure, promote care coordination, and address social determinants of health. Further research is necessary to develop innovative care delivery models that ensure equitable access to comprehensive, high-quality stroke care, from prevention to end-of-life support, regardless of geographic location or socioeconomic status.