Trends and Projections in Hemorrhagic Stroke-Related Mortality in the United States: A 1968-2030 CDC WONDER Analysis

Hemorrhagic stroke is a devastating cerebrovascular event with high fatality rates and major economic burden, with hypertension as the primary modifiable risk factor. This study analyzes long-term US hemorrhagic stroke mortality trends from 1968 to 2023, identifies disparities, and projects rates through 2030.

CDC WONDER data for individuals aged ≥25 years were used, identifying hemorrhagic stroke deaths via ICD codes. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Temporal trends were evaluated using Joinpoint regression, and projections generated with Autoregressive Integrated Moving Average (ARIMA) models.

From 1968 to 2023, 1,845,841 hemorrhagic stroke deaths occurred. Overall AAMRs declined from 59.86 in 1968 to 12.39 in 2023 (AAPC: -2.8%), largely reflecting improved hypertension control, though a plateau emerged from 2018 to 2021. Males consistently showed higher AAMRs than females, and Black individuals (average 32.73) had higher rates than White individuals (20.18), despite a narrowing gap. Adults ≥65 years bore the highest burden. Regionally, the South had the highest AAMRs (22.76) and slowest decline. Projections to 2030 indicate continued decline to 11.2, with persistent disparities: higher AAMRs for Black individuals (13.96) than White individuals (10.45), males (12.17) than females (10.31), and sustained elevated burden in the Midwest (11.64) and South (11.73).

While hemorrhagic stroke mortality has fallen due to hypertension control, substantial disparities by sex, race, and geography persist and are projected to continue. Current interventions may be reaching diminishing returns, emphasizing the need for targeted, equity-focused strategies addressing structural drivers of inequity and the rising impact of an aging population.