Abstract WP138: Trends In Stroke-Related Mortality Among Patients With Atherosclerosis Aged 25 Or Older In The US From 1999-2023: A 24-year CDC WONDER Database Analysis

Introduction: Atherosclerosis remains a major contributor to stroke, especially ischemic stroke, accounting for 20-30% of all cases and significantly increasing the risk of recurrence and mortality. Smoking has also been identified as a risk factor for hemorrhagic strokes, with smokers having 2-3 times higher risk of subarachnoid hemorrhage than non-smokers. Patients with concomitant atherosclerosis experience worse outcomes due to mechanisms such as plaque rupture, embolism, and impaired cerebral blood flow. Understanding long-term trends in stroke-related mortality among patients with atherosclerosis is essential for identifying disparities and informing targeted prevention strategies. Methods: We analyzed mortality due to stroke (ICD 10 codes: I60-I69) in patients with atherosclerosis (ICD 10 codes: I70) using the CDC-WONDER database from 1999 to 2023. Age-Adjusted Mortality Rates (AAMR) per 100,000 were calculated and categorized by demographics and region. Joinpoint regression was used to estimate the Annual Percent Change (APC) and Average Annual Percent Change (AAPC). Results: A total of 169,475 deaths were attributed to stroke in patients with atherosclerosis between 1999 and 2023. The overall AAMR decreased from 4.77 in 1999 to 1.09 in 2023 (AAPC: -6.62; 95% CI: -7.58 to -5.65). Males exhibited a slightly higher AAMR than females throughout the study period (Males: 3.33, Females: 3.25). Racially, non-Hispanic (NH) Black Americans had the highest AAMR (3.38), followed by NH White (3.36), Hispanic (2.75), and NH Asians or Pacific Islanders (2.17). Older adults aged ≥65 years experienced the highest mortality burden among all age groups, with 159,730 deaths and an average AAMR of 16.14 per 100,000 population. Non-metropolitan areas had a higher AAMR (4.27) than metropolitan areas (3.15). Regionally, the West recorded the highest overall AAMR (4.32), followed by the Midwest (3.62), South (3.23), and Northeast (2.15). Among the states, Arizona, Tennessee, Ohio, Vermont, and Iowa were among the top 90th percentile of deaths due to stroke in patients with atherosclerosis. Conclusion: Stroke mortality among patients with atherosclerosis has declined significantly over the past two decades, reflecting advances in cardiovascular care, yet the persistent disparities by age, race, sex, and geography highlight the need for targeted prevention and management strategies.