Key result
Ischemic stroke and COPD mortality rates rise, with females seeing a ~2% annual increase.
Why the study?
Smoking is a shared etiology for ischemic stroke and COPD death, and both conditions interact to worsen physical activity, pulmonary dysfunction, and recurrent cerebrovascular risk.
Mortality from concurrent ischemic stroke and COPD in the U.S. has significantly increased from 1999 to 2023, with notable geographic and demographic disparities.
Increasing concurrent ischemic stroke-COPD mortality may prompt comorbidity vigilance; extends prior observations on female and southern U.S. disparities.
Introduction: Patients with ischemic stroke and COPD death have smoking as the most common etiology—whether current or past. Smoking causes vascular inflammation leading to atherosclerosis, chronic hypoxia, endothelial dysfunction, and impaired pulmonary function. Both COPD and stroke contribute to reduced physical activity, which in turn exacerbates pulmonary dysfunction and increases the risk of recurrent cerebrovascular events. Methods: We performed a retrospective analysis using CDC WONDER data to identify ischemic stroke and COPD deaths (ICD-10: I63, J43, J44) from 1999 to 2023. Age-adjusted mortality rates (AAMRs) were examined by year and stratified by sex, region, and urban–rural status. Joinpoint regression estimated Annual and Average Annual Percent Change (APC, AAPC); p < 0.05 was considered significant. Ethical review was not required. Results: A total of 33,808 ischemic stroke and COPD deaths occurred from 1999 to 2023. Overall, AAMRs increased from 0.7 in 1999 to 0.9 in 2023 (AAPC = 1.55*; 95% CI: 0.28 to 2.86). Males had a higher AAMR (AAPC = 0.52; 95% CI: -0.84 to 1.90) compared to females (AAPC = 2.27*; 95% CI: 1.53 to 3.06). Region-wise analysis indicates that the South has the highest AAMR (AAPC = 1.69*; 95% CI: 0.17 to 3.22), followed by the Midwest (AAPC = 1.28*; 95% CI: 0.41 to 2.21), followed by the West (AAPC = 0.78; 95% CI: -0.75 to 2.34), and lastly the Northeast (AAPC = -0.07; 95% CI: -1.21 to 1.05). According to the urbanization analysis, rural areas have a higher AAMR (AAPC = 2.12*; 95% CI: 0.73 to 4.02) than urban areas (AAPC = 0.03; 95% CI: -1.23 to 1.30). Discussion: Since 2014, stroke cases have risen significantly alongside the spread of e-cigarettes that cause atherosclerosis and lung injury and raise the risk of TIA and stroke—similar to traditional smoking. Additional factors increasing mortality include obesity-related inactivity, diabetes, and hyperlipidemia. The southern U.S., known as the “Stroke Belt,” has the highest mortality, driven by rural, low-income populations with high smoking rates and poor diet and exercise. Smoking cessation and regular physical activity could greatly reduce stroke and COPD rates.
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Alappat et al. (2026) studied this question. From 1999 to 2023, age-adjusted mortality rates for ischemic stroke and COPD increased, with males at 0.52% and females at 2.27% annual percent change, respectively.
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