Abstract DP152: Trends in Obstructive Sleep Apnea–Associated Stroke Mortality Rates Among Older Adults in the United States from 1999 to 2020: A Nationwide Analysis

Introduction: Obstructive sleep apnea (OSA) is a prevalent yet substantially underdiagnosed condition among older adults and an independent and probably modifiable risk factor for stroke. However, OSA-associated stroke mortality rates and risk factors remain poorly defined. Methods: Death certificate data from the CDC WONDER database were used to examine stroke and OSA-related mortality among U.S. adults aged 65 and older from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were standardized to the 2000 U.S. standard population. Rates were stratified by year, age group, sex, stroke etiology, and sociodemographic characteristics. Trends were analyzed using Joinpoint regression to estimate annual percent changes (APC) with 95% confidence intervals (CI). Results: A total of 7,759 stroke deaths among older adults with OSA diagnosis were recorded in the United States from 1999 to 2020. The overall mean (SD) age was 77.8 (± 7.8) years. Most deaths were coded as unspecified stroke (69.8%), with hemorrhagic (16.1%) slightly exceeding ischemic (14.1%). The overall AAMR increased from 0.3 to 1.8 (AAPC: 9.32%, 95% CI 6.95%-11.75%, P < 0.000001). Both females and males experienced marked rises, with the AAMR in males increasing from 0.6 to 2.6, and in females from 0.1 to 1.2. Although the AAMR was consistently higher in males, the relative increase over time was slightly greater in females (AAPC: 11.4% for females vs. 7.6% for males, P < 0.000001 for both). All racial groups showed significant increases, with non-Hispanic White individuals exhibiting the most rapid rise (AAPC 9.02%, P < 0.000001). Census-level burden increased across the country, ranging from highest in the West (AAPC 9.48%, P < 0.000001) to lowest in the South (AAPC 7.79%, P < 0.000001). Rural areas had the greater rise, though substantial upward trends were seen across all urbanization strata (AAPC 9.1% for rural vs. 8.34% for urban). Conclusion: Over the past two decades, Death amongst stroke patients with OSA diagnosis has risen substantially, with consistent increases across both sexes, all racial and ethnic groups. These trends underscore an urgent need for improved screening, diagnosis, and management of OSA as part of stroke risk reduction strategies in aging populations.