Five-Decade Mortality Trends in Ischemic Stroke in the United States: A CDC WONDER Analysis

Ischemic stroke, comprising nearly 85% of all strokes, remains a leading cause of death and disability worldwide. Annually, about 795,000 individuals in the United States (US) experience a new or recurrent stroke. Despite advancements in diagnosis, treatment, and prevention, significant disparities and geographic variability persist, highlighting the need for targeted strategies to address these ongoing challenges.

We analyzed US death certificate data from Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (1968-2023) for ischemic stroke mortality using International Classification of Diseases (ICD-8, ICD-9, and ICD-10) codes. Demographics included age, sex, and race/ethnicity. Crude and age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percent changes (AAPC) were calculated using joinpoint regression, and a p-value less than 0.05 defined significance.

From 1968 to 2023, ischemic stroke mortality declined substantially, with 1,363,668 total deaths and the AAMR decreasing from 76.2 to 10.0 per 100,000 (AAPC: -3.59%). Early steep declines occurred from 1968 to 1982 and continued through 2014, followed by pronounced increases between 2014-2017 (APC 38.69) and 2017-2023 (APC 7.48). Men consistently exhibited higher AAMRs than women, with long-term declines, yet both experienced recent upward trends. Racial disparities persisted, with Black adults declining from 85.9 to 14.2 (AAPC: -3.30%) and White from 75.5 to 9.8 (AAPC: -3.63%), but both showed reversals after 2014. Older adults (≥65 years) bore the greatest burden (AAPC: -3.91%), while younger age groups exhibited smaller reductions.

Despite long-term declines in mortality, recent increases and persistent disparities by age, sex, and race underscore the need for targeted prevention and equitable healthcare interventions in particularly high-risk populations.