Abstract WP161: Comparative Trends in Mortality from Ischemic and Hemorrhagic Stroke in the United States, 1999–2020

Introduction: Stroke remains a leading cause of mortality in the U.S., with ischemic (IS) and hemorrhagic stroke (HS) representing the most common subtypes. Recent shifts in stroke mortality necessitate updated evaluation, particularly across demographics and geographic regions. Methods: We analyzed national mortality data for adults aged ≥25 years from 1999 to 2020 using the CDC WONDER database. Stroke deaths were identified via ICD-10 codes (I60, I61, I63). Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, and region. Temporal trends were evaluated using Joinpoint regression to determine annual percent changes (APCs). Results: A total of 435,402 ischemic and 681,756 hemorrhagic stroke deaths were recorded. Males exhibited higher age-adjusted mortality rates (AAMRs) for both stroke types. Ischemic stroke (IS) mortality declined steadily from 1999 to 2014, followed by a sharp increase through 2020, particularly among younger and middle-aged adults. Hemorrhagic stroke (HS) mortality declined until 2012 but plateaued or slightly increased thereafter. Racial disparities persisted: Non-Hispanic Blacks had the highest age-adjusted mortality rates (AAMRs) for both ischemic stroke (IS) (12.0 per 10,000) and hemorrhagic stroke (HS) (20.0 per 10,000), followed by Whites and Asians. Hispanic and Asian populations showed lower ischemic stroke (IS) mortality but experienced increasing trends after 2014. Regionally, the South consistently had the highest mortality for both stroke types, with age-adjusted mortality rates (AAMRs) nearly double those of the lowest-performing states. State-level analysis showed Washington and the District of Columbia among the highest age-adjusted mortality rates (AAMRs), while Rhode Island and Nevada had the lowest for ischemic stroke (IS) and hemorrhagic stroke (HS), respectively. Geographic disparities have widened over time, emphasizing the influence of local health infrastructure and socioeconomic conditions. Conclusions: Stroke mortality trends in the U.S. reveal growing concerns, particularly in ischemic stroke-related deaths and among vulnerable populations. Addressing modifiable risk factors and improving healthcare equity must be central to future public health strategies.