Abstract TP226: Ischemic Stroke and Sepsis Mortality Trends and Disparities in the U.S. Population Aged Over 25 Years (1999–2023): Insights from the CDC WONDER Database

Introduction: Ischemic stroke is a major complication following sepsis, mediated by endothelial injury and inflammation. Conversely, stroke-induced immunosuppression via sympathetic and HPA axis overactivation increases infection risk, with aspiration pneumonia often progressing to sepsis. Use of invasive devices in stroke care further predisposes to nosocomial infections, amplifying mortality. Analyzing mortality trends over time can highlight these patterns and guide prevention efforts. Methods: We retrospectively analyzed CDC WONDER data (1999–2023) for ischemic stroke (I63) and sepsis (A41) deaths. Age-adjusted mortality rates (AAMRs) were stratified by sex, region, ethnicity, and urban–rural status. Joinpoint regression estimated Annual Percent Change (APC) and Average Annual Percent Change (AAPC), with p<0.05 considered significant. Ethical review was not required. Results: A total of 23,962 deaths occurred due to ischemic stroke and sepsis from 1999 to 2023. Overall AAMRs rose from 0.5 in 1999 to 0.7 in 2023 (AAPC = 1.79*; 95% CI: 0.84 to 2.70). Men had higher AAMR (AAPC = 0.50; 95% CI: -0.66 to 1.71) as compared to women (AAPC = 1.47*; 95% CI: 0.08 to 2.91). Regional analysis showed that the South had the highest AAMR (AAPC = 1.87*; 95% CI: 0.84 to 2.93), followed by the West (AAPC = 3.18*; 95% CI: 1.30 to 5.08), followed by the Midwest (AAPC = 2.12; 95% CI: 0.71 to 3.52), followed by the Northeast (AAPC = -0.33; 95% CI: -1.86 to 1.34). Race analysis showed that the Blacks or African Americans had the highest AAMR (AAPC = -0.37; 95% CI: -2.03 to 1.46), followed by the Hispanics or Latinos (AAPC = 2.16*; 95% CI: 0.12 to 4.27), followed by the Whites (AAPC = 1.38; 95% CI: -0.26 to 3.07). Urbanization analysis showed that the rural areas had a higher AAMR (AAPC = 1.79*; 95% CI: 0.35 to 3.37) than the urban areas (AAPC = -0.87*; 95% CI: -1.80 to -0.02). Discussion: An aging population with comorbidities such as diabetes, hypertension, and chronic kidney disease faces elevated risk of ischemic stroke and sepsis. Since 2013, mortality has increased, driven by shifts from 24/7 nursing home care to limited home health services, greater sepsis recognition after 2016, and the healthcare disruptions of COVID-19. Socioeconomic disparities and rural workforce shortages further delay access to timely care, underscoring the need for equitable infrastructure, expanded workforce capacity, and targeted funding to reduce post-stroke aspiration pneumonia mortality.