Abstract HUP18: Disparities in Stroke Mortality by Educational Attainment in the U.S.

Background and Purpose: Education is associated with socioeconomic status and is associated with health outcomes. We investigated the association between the educational attainment and the age- and sex- stratified cerebrovascular mortality rates among all U.S residents. Methods: We obtained cerebrovascular mortality rates stratified by age, sex and education attainment. The number of cerebrovascular deaths from 2021 to 2023 were obtained from the Underlying Cause of Death database of the National Center for Health Statistics. The population in each stratum was obtained from the 5-year estimate from the 2023 American Community Survey. The mortality rate is shown as annual deaths per 100.000 individuals. Mortality Rate Ratios (MRR) are calculated for each age and sex group with high school graduates as the referent. Confidence intervals propagate the population size uncertainty at 95% probability and are reported in brackets. Results: There were 163,226 annual deaths among the population estimate of 258.7 million, of which 160,459 (98.3%) had an education variable available and less than 30 deaths were suppressed. The cerebrovascular mortality rates stratified by age, sex and education attainment are shown in Figure 1. A clear inverse association was observed between educational attainment and stroke mortality (Figure 1). Compared to high school graduates, the MRR for individuals with graduate or professional degree was 0.091 (0.090 - 0.092) for males and 0.122 (0.120 - 0.124) for females in the age group 35-44; 0.157 (0.155 - 0.159) for males and 0.172 (0.170 - 0.174) for females in the age group 45-64; and 0.510 (0.507 – 0.513) in males and 0.363 (0.360 – 0.366) in females older than 65 years (Figure 2). While larger relative differences were observed among younger individuals, the 65+ group contributed to 78% of the absolute difference in estimated excess annual stroke deaths associated with differences in education. Conclusions: Lower educational attainment is significantly associated with higher stroke mortality across the lifespan. Further understanding and addressing the factors driving this association are necessary.