Abstract HUP5: Twenty-Five Years Of Widening Rural-Urban Divide In Cerebrovascular Mortality Among Middle-Aged Americans

Introduction: Increase in cerebrovascular mortality among middle-aged rural residents have been described between 2013 and 2018. Aim: We aimed to obtain a broader understanding of the rural-urban cerebrovascular mortality gaps in the past 2 decades among middle-aged female and male US residents. Methods: Age-adjusted cerebrovascular mortality rates (ICD tenth revision codes I60-I69) in middle-aged adults (age 25-64) stratified by urbanization and sex from 1999 to 2023 were obtained from the Underlying Cause of Death database of the National Center for Health Statistics. Joinpoint regression was used to estimate the annual percentage change (APC) for mortality rates and the linear slope for mortality rate ratios between urbanization strata. Confidence intervals at 95% probability are indicated in brackets. Results: Between 1999 and 2012, cerebrovascular mortality rates decreased among middle-aged rural and urban residents, with APC ranging from -1.4% (-1.9% to -0.9%) among male residents of small and medium metropolitan counties to -3.2% (-3.6% to -2.8%) among female residents of large metropolitan counties. Since 2013, cerebrovascular mortality rates increased among rural and urban residents, with APC ranging from +0.8% (+0.2% to +1.4%) among female residents of large metropolitan counties to +2.2% (+1.5% to +2.9%) among male residents of rural counties (Figures 1 and 2). The mortality rate ratio of rural-to-large-metropolitan counties linearly increased throughout the 25 years studied, at an annual slope +0.0174 (+0.0154 to +0.0193) among female and +0.0124 (+0.0115 to +0.0133) among male residents (Figure 3). The small-and-medium-to-large-metropolitan mortality ratio increased at a smaller slope (Figure 3). Conclusion: The linear trend of widening rural-urban divide in cerebrovascular mortality among middle-aged males and females has been present for at least 25 years. Cerebrovascular mortality increased among all middle-aged persons from 2013 to 2023 with a larger increase among rural residents. Further efforts are needed to address the rural health crisis.