Abstract HUP9: Divergent Temporal Trends in Ischemic and Hemorrhagic Stroke Mortality in the United States: A CDC WONDER Database Analysis

Introduction: Declining stroke mortality is a public health success story, yet disparities persist. This study investigates the divergent temporal trends in age-adjusted mortality rates for ischemic stroke (IS) and hemorrhagic stroke (HS) across different demographic and geographic strata in the United States. Methods: We analyzed the underlying cause of death data from 1999 to 2020 using the CDC’s WONDER database. Age-adjusted death rates for IS (ICD-10 code I63.0, I64.0) and HS (I60.0, I61.0, I62.0) were extracted and stratified by urbanization, sex, and race/ethnicity. We calculated the percent change in mortality rates for both stroke types and compared these trends across the specified strata. Results: Overall, mortality rates for both IS (-54.93%) and HS (-33.56%) stroke types showed a significant decline. The decline in IS mortality was similar in both urban (-54.00%) and rural areas (-52.99%). However, for HS, the decline was more pronounced in urban areas (-35.57%) compared to rural areas (-28.87%). Regarding sex, female mortality rates declined more significantly for both stroke types compared to males. For IS, the decline was -56.11% for females vs. -53.62% for males. For HS, the decline was -36.51% for females vs. -30.88% for males. Regarding race/ethnicity, the most significant decline in IS mortality was observed in the American Indian or Alaska Native group (-60.87%), followed closely by Asian or Pacific Islander (-54.86%). In contrast, the most significant decline in HS mortality was among the Asian or Pacific Islander group (-45.64%), whereas the White population experienced the least decline (-22.99%). Notably, the decline in both IS and HS mortality was less pronounced in the Black or African American population (-50.26% and -29.23%, respectively) compared to other groups, except for White Americans for IS. Conclusion: Our analysis reveals significant and divergent temporal trends in IS and HS mortality. Although the overall decline was predominant in IS mortality, this decline is not uniform across all demographics. The less pronounced decline in HS mortality, particularly in rural areas and among males and the White population, underscores persistent disparities. These findings suggest that future public health interventions and stroke prevention strategies should be tailored to address the unique risk factors and healthcare access issues affecting these specific populations.