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Concomitant trends in stroke and COPD-related mortality in the U.S.: a 25-year retrospective analysis of the CDC
Areej Javeid1, Rayyan Nabi2, Muhammad Affan3
1Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
Background:
Chronic obstructive pulmonary disease (COPD) and stroke are leading contributors to mortality and disability. We analyzed national trends in deaths attributed to co-occurring stroke and COPD in US adults from 1999-2023.
Methods:
Using CDC WONDER multiple cause-of-death data for adults aged ≥25 years, we identified decedents with co-existent stroke (ICD-10 I60.x, I61.x, I63.x, I64, I69.0, I69.1, I69.3, I69.4) and COPD (J40-J44). Crude and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 US standard population. Joinpoint regression estimated annual percent changes (APCs) and identified trend inflection points. Analyses were stratified by sex, race/ethnicity, metropolitan status, and state.
Results:
From 1999 to 2023, 311,375 deaths involved concurrent stroke and COPD. Overall AAMRs declined from 8.04 per 100,000 in 1999 to 5.17 in 2009 (APC -4.40%), with continued decline to 2018 (APC -1.34%). Rates then increased through 2020-2021 (APC +7.33%) before a modest decline toward 2023. Males consistently exhibited higher AAMRs than females. Non-Hispanic White adults had the highest AAMRs, whereas Hispanic and Asian/Pacific Islander groups had lower rates. Non-metropolitan areas experienced consistently higher AAMRs than metropolitan areas. State-level analyses identified the highest burdens in Appalachian and Deep South regions.
Conclusion:
Mortality from coexisting stroke and COPD declined for two decades but rose around the COVID-19 period, revealing significant sex, racial/ethnic, and geographic disparities. These findings highlight the need for targeted prevention, improved access to care for high-risk populations, and further research into mechanisms driving recent inflection points. Data and methods are detailed in the manuscript.
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