Abstract TP136: Trends in Mortality due to Stroke among Adult Smokers in the US from 2005-2023: Insights from CDC WONDER

Introduction: Smoking is a preventable risk factor for stroke. Compared to non smokers, current smokers have a 1.7 to 1.9 times higher risk of stroke and stroke related death, due to mechanisms like accelerated atherosclerosis, hypercoagulability, vascular inflammation, and impaired cerebral perfusion. In the United States, nearly one in five adults (approximately 49.2 million people) smoke cigarettes. Smoking even one cigarette per day is associated with a 25% to 30% increased stroke risk. This study analyzed mortality trends associated with stroke among smokers to understand the burden of stroke-related deaths and guide preventive strategies. Methods: We analyzed mortality due to stroke (ICD-10 code: I60-I69) in patients addicted to nicotine smoke (ICD-10 code: F17) using publicly available death certificates from the CDC-WONDER database from 2005 to 2023. Age-Adjusted Mortality Rates (AAMR) per 100,000 were calculated and categorized by demographics and region. Joinpoint regression was used to estimate Annual Percent Change (APC) and Average Annual Percent Change (AAPC) in AAMR. Results: A total of 148,911 deaths were attributed to stroke among adult smokers between 2005 and 2023. The AAMR first increased from 2.28 in 2005 to 3.89 in 2019 (APC: 4.05; 95% CI: 3.76 to 4.34; p<0.000001) and then plateaued until 2023 (APC: -0.99; 95% CI: -2.53 to 0.58; p=0.19). Men demonstrated a higher AAMR than women (4.77 vs. 3.03). Non-Hispanic (NH) Black Americans had the highest AAMR (3.75), followed by NH American Natives (3.48), NH Whites (3.28), Hispanics (1.56), and NH Asians (1.03). Non-metropolitan areas had almost double the burden of mortality than metropolitan areas (AAMR: 4.66 vs. 2.86). Among the census regions, the Midwest demonstrated the highest AAMR (4.47). Conclusion: Stroke-related mortality among smokers in the U.S. increased significantly from 2005 to 2019 and has since plateaued, with disproportionately higher burdens in men, non-Hispanic Black individuals, non-metropolitan areas, and the Midwest region. Despite recent stabilization, mortality rates remain high, emphasizing the critical need for tobacco cessation, equitable prevention strategies, and focused public health interventions to reduce stroke mortality in high-risk populations in India. Integrated stroke prevention programs that combine awareness of smoking cessation with improved access to cardiovascular care can help reduce mortality rates and mitigate these disparities.