Abstract TP198: Stroke and Aspiration Pneumonia Trends and Disparities in the U.S. Population Aged over 25 Years (1999–2023): Insights from the CDC Wonder Database.

Introduction: Stroke affecting the brainstem or cortical swallowing centers can cause dysphagia, predisposing patients to aspiration pneumonia. Using U.S. mortality data from 1999–2023, this study examines deaths from stroke complicated by aspiration pneumonia to identify high-risk populations and guide targeted post-stroke prevention strategies. Methods: We conducted a retrospective analysis of CDC WONDER data (1999–2023) identifying stroke (ischemic and hemorrhagic; ICD-10: I60–I63) and aspiration pneumonia deaths (J69). Age-adjusted mortality rates were stratified by sex, race/ethnicity, region, and urban–rural status. Joinpoint regression estimated APC and AAPC (Average Annual Percent Change), with significance set at p<0.05. Ethical review was not required. Results: A total of 36,852 deaths occurred due to stroke and aspiration pneumonia from 1999 to 2023. Overall, AAMRs decreased from 1 in 1999 to 0.7 in 2023 (AAPC = -1.88*; 95% CI: -2.85 to -0.89). Men had a higher AAMR (AAPC = -1.81*; 95% CI: -2.83 to -0.76) compared to women (AAPC = -2.20*; 95% CI: -3.53 to -0.82). Race analysis shows that African Americans (AAPC = -0.77; 95% CI: -1.80 to 0.62) have the highest AAMR, followed by Asian/Pacific Islanders (AAPC = 3.14*; 95% CI: -4.56 to -1.71), followed by Whites (AAPC = -1.91*; 95% CI: -2.70 to -1.09), and lastly Hispanics/Latinos (AAPC = -0.47; 95% CI: -1.84 to 0.98). Region-wise analysis indicates that the South has the highest AAMR (AAPC = -1.63*; 95% CI: -2.70 to -0.47), followed by the West (AAPC = -1.14; 95% CI: -2.10 to 0.05), followed by the Midwest (AAPC = -1.73; 95% CI: -3.30 to 0.10) and the Northeast (AAPC = -3.44*; 95% CI: -5.27 to -1.56). According to the urbanization analysis, rural areas have a higher AAMR (AAPC = -2.88*; 95% CI: -3.79 to -1.91) than urban areas (AAPC = -3.23*; 95% CI: -4.53 to -1.93). Discussion: Since 2010, mortality from stroke complicated by aspiration pneumonia has increased, with greater risk observed among males, African Americans, and rural populations. Contributing factors include socioeconomic disparities, limited access to specialists, and a shift from nursing homes with continuous 24/7 skilled care to home health services that provide only intermittent scheduled visits. Addressing these gaps through equitable public health policies, workforce expansion, and targeted resource allocation is essential to improving outcomes.