Abstract TP161: Rising Stroke Mortality in Adults with Metabolic Syndrome: National Trends and Disparities, 1999 to 2020

Introduction: Stroke remains a leading cause of death and disability, with metabolic syndrome (MetS), a combination of obesity, dyslipidemia, hypertension, and impaired glucose tolerance, substantially increasing cerebrovascular risk. Despite progress in controlling traditional risk factors, national mortality trends linked to MetS are underexamined. This study evaluates long term patterns and disparities in stroke related mortality among U.S. adults with MetS. Methods: We analyzed CDC WONDER data for adults aged 25 to 85 years and older with stroke (ICD 10 I63, I64) and MetS related conditions (E10 to E14, E66, E78, E88) from 1999 to 2020. Age adjusted mortality rates (AAMRs) per 100,000 and temporal trends were assessed using Joinpoint regression, stratified by sex, race, region, and urbanization. Results: From 1999 to 2020, 558,157 stroke related deaths occurred in individuals with MetS. AAMR declined from 1999 to 2009 with an annual percent change of 3.9 percent decrease and from 2010 to 2018 with a 1.6 percent decrease but rose sharply from 2018 to 2020 with a 13.3 percent increase. Males had higher mortality than females (10.5 versus 9.0), with both showing late period increases (15.1 percent and 12.3 percent). The South had the highest regional AAMR (10.4), and non metropolitan areas exceeded metropolitan ones (11.9 versus 9.2). Black (18.1) and American Indian or Alaska Native (12.3) adults had the highest mortality, with sharp rises after 2018 (20.6 percent and 21.5 percent). Conclusion: Stroke related mortality associated with metabolic syndrome declined significantly from 1999 to 2018 but reversed sharply in the last two years of the study, disproportionately affecting males, racial minorities, the South, and non metropolitan populations. These findings underscore the urgent need for targeted public health initiatives, including enhanced MetS screening, equitable access to stroke prevention and acute care, and resource allocation to underserved regions, to curb this rising burden.