Abstract Number: Esoc2026a2292 Mortality in Stroke Survivors During a Global Health Crisis: A Population-Based Study

Background and aims Individuals with comorbidities may have experienced excess mortality during the COVID-19 pandemic. We investigated whether stroke survivors had higher mortality during the pandemic years (2020–2021) compared with post-pandemic years (2022–2024), using a population-based cohort. Methods We analyzed all first-ever strokes occurring in 2018–2019 among residents of a defined regional area in Europe. Mortality over 5 years was assessed in 1123 patients (1000 ischemic stroke [IS], 123 intracerebral hemorrhage [ICH]). Deaths were identified using official state records. Predictors of mortality were analyzed using Cox proportional hazards models. Mortality among stroke survivors (alive ≥90 days post-stroke) was compared with the general population by age group and calendar year using standardized mortality ratios (SMRs). Results Five-year mortality was 40.3% after IS and 56.1% after ICH. In IS, mortality was independently associated with age (HR 1.06), premorbid modified Rankin score (HR 1.28), stroke severity (NIHSS; HR 1.09), and atrial fibrillation (HR 1.12; all p<0.001). In ICH, mortality was associated with age (HR 1.07) and stroke severity (NIHSS; HR 1.10; both p<0.001). Throughout follow-up, stroke survivors had significantly higher mortality than the general population in all calendar years, particularly during the first post-stroke year (SMR 2.58 [1.99–3.29] in 2018-2019). However, mortality among stroke survivors did not differ between pandemic (2020-2021) and post-pandemic periods (2022-2024) (SMR 1.88 [1.56–2.25] vs 1.94 [1.62–2.30]; p=0.82). Conclusions Stroke survivors had persistently higher mortality than the general population, but no excess mortality was observed during the COVID-19 pandemic compared with post-pandemic years. Conflict of interest Siddhartha Pandit: nothing to disclose; Elisabeth Dirren: nothing to disclose; Emmanuel Carrera: : nothing to disclose