A58-10 Critical Trends in Stroke-Associated Mortality With Dysphagia as a Contributing Factor, United States, 1999-2020

Abstract Background Dysphagia is a common and serious sequela of stroke and contributes substantially to adverse outcomes through aspiration, malnutrition, dehydration, and respiratory complications. Although clinical studies link dysphagia to high late post-stroke mortality, national-level trendsin stroke-associated deaths with dysphagia remain unquantified. This study examines the temporal and demographic patterns of such mortality in the United States. Methods Data were obtained from the CDC WONDER Multiple Cause of Death database (1999-2020). Deaths were included if a stroke-related ICD-10 code (I60-I69) co-occurred with dysphagia (R13.*) on the death certificate. Age-adjusted mortality rates (AAMR) per 1,000,000 personswere computed using the 2000 U.S. standard population. Temporal trends were assessed via Joinpoint regression (v5.4.0) using the Weighted Bayesian Information Criterion; annual percent change (APC) was considered significant at p 0.05. Results A total of 146,726 deaths met the inclusion criteria. The leading place of death was nursing homes/long-term care (50.1%), followed by inpatient hospitals (23.2%) and decedent homes (14.9%). Mortality increased markedly with age, reaching 60.5 deaths per 100,000 among adults ≥85 years and accounting for over 80% of total deaths. Overall, the AAMR declined from 1.99 in 1999 to 1.67 in 2012 (APC -2.08 %, 95% CI -3.12 to -1.27; p 0.001), then increased to 2.78 in 2020 (APC +6.77 %, 95% CI 5.39 to 8.92; p 0.001). A single joinpoint was identified in2012 (95% CI 2011-2013). In sex-stratified analyses, both males (APC -2.21 % → +6.63 %) and females (APC -2.15 % → +6.64 %) exhibited similar inflection patterns (p 0.001 for both). The AAMR was among Black/African American individuals (2.66) compared with White (1.91) orHispanic (1.74) individuals. Rural gradients were evident: AAMR ranged from 1.83 in noncore areas to 2.33 in medium metros. State-specific rates were highest in Washington, Tennessee, Texas, and South Carolina. Conclusions After over a decade of decline, stroke-associated deaths involving dysphagia began climbing post-2012. Our population-level trends suggest a rising burden of fatal complications (e.g., aspiration pneumonia) and reflect an aging demographic, improved recognition of dysphagia, and persistent deficiencies in swallowing assessment, pulmonary monitoring, and rehabilitation. Dysphagia remains a modifiable contributor to late stroke mortality, highlighting the critical need for routine dysphagia screening, standardized swallow rehabilitation protocols, and enhanced respiratory complication surveillance across care settings. This abstract is funded by: None