Abstract TP180: Trends and Disparities in Hemorrhagic Stroke-associated Mortality Among Adults in the United States: A Centers for Disease Control and Prevention (CDC) WONDER Analysis (1999-2023)

Background: Hemorrhagic stroke remains a major contributor to stroke-related mortality in the United States despite advances in prevention, acute care, and rehabilitation. The demographic and geographic distribution of hemorrhagic stroke-related mortality remains incompletely described. This study characterizes recent trends by sex, race/ethnicity, region, urbanization, age group, and state. Hypothesis: We hypothesized that hemorrhagic stroke-related mortality declined in the United States from 1999 to 2023, with persistent disparities by sex, race/ethnicity, and geography. Methods: We analyzed the Centers for Disease Control and Prevention (CDC) WONDER Multiple Cause-of-Death dataset for 1999 to 2023. Hemorrhagic stroke deaths were identified using ICD-10 codes (I60–I62). Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the U.S. 2000 standard population and stratified by sex, race/ethnicity, region, metropolitan status, age group, and state. Joinpoint regression estimated the average annual percent change (AAPC) with 95% confidence intervals. Statistical significance was defined as p < 0.05. Results: From 1999 to 2023, 830,251 deaths were recorded. The national AAMR declined from 17.96 in 1999 to 12.39 in 2023, with an overall AAPC of −1.64 (95% CI: −1.78 to −1.51). Males had higher mortality than females (16.30 vs 14.50). Black or African American individuals had the highest mortality (20.98), followed by American Indian or Alaska Native (17.62), Asian or Pacific Islander (15.41), and White individuals (15.32). Regionally, the South showed the highest mortality (16.41), while the Northeast had the lowest (14.14). Nonmetropolitan areas (16.51) exceeded metropolitan areas (15.44). Mortality increased sharply with age, peaking in adults aged 75–84 years (28.79%). State-level rates were highest in Alabama (21.22) and lowest in Utah (10.88). Conclusion: From 1999 to 2023, hemorrhagic stroke mortality in the United States declined significantly overall. However, males, Black populations, residents of the South, and individuals in nonmetropolitan areas continue to bear disproportionate burdens. These findings emphasize the importance of regionally tailored prevention strategies, improved access to timely stroke care, and efforts to reduce persistent demographic and geographic disparities.