Abstract TP177: Disparities in Stroke-Related Mortality among U.S. Adults with Chronic Obstructive Pulmonary Disease (COPD) 1999–2023: A CDC WONDER Database Analysis

Background: Chronic obstructive pulmonary disease (COPD) and stroke remain major contributors to U.S. mortality. Although age-adjusted mortality rates (AAMRs) have declined, disparities across sex, race/ethnicity, region, and urbanization persist. Methods: We used CDC WONDER data (1999–2023) to identify deaths among adults ≥35 years with COPD (ICD-10 J40–J47) and stroke (I60.x, I61.x, I63.x, I64, I69.0, I69.1, I69.3, I69.4). A total of 324,642 deaths were included. AAMRs per 100,000 ( 2000 U.S. standard population) were calculated. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC) by demographic and geographic factors Results: The overall AAMR was 7.52 (95% CI: 7.39–7.65). Mortality decreased from 1999–2009 (APC −4.5%, p<0.01), stabilized from 2009–2018, and increased after 2018 (APC +7.6%, p=0.03). Males experienced steeper early declines (APC −5.5%, p = 0.002) but sharper increases after 2018 (APC +6.1%, p = 0.006) compared with females (APC +7.9%, p = 0.03). Non-Hispanic Asian/Pacific Islanders showed the largest decline (APC −6.0%, p=0.002), while non-Hispanic Whites demonstrated significant increases post-2018 (APC +7.8%, p=0.017). Regionally, the Midwest and South exhibited post-2017 increases (APC +6.7% and +9.0%, respectively). Metropolitan areas declined until 2009 (APC −4.7%, p < 0.001), then plateaued, whereas non-metropolitan areas showed a persistent burden, with a rise after 2014 (APC +3.2%, p = 0.002). Conclusions: COPD- and stroke-related mortality declined overall since 1999 but has risen since 2018, disproportionately affecting males, non-Hispanic Whites, residents of the South and Midwest, and non-metropolitan populations. These findings highlight widening disparities and the need for targeted prevention and healthcare strategies.