Stroke Death Rates Are Decreasing, But Race and Sex Disparities Remain

Stroke is a leading cause of death in the United States. This study examined 20-year stroke mortality rate disparities and trends among racial and ethnic groups (White, Black, Asian/Pacific Islander, and Hispanic) and between men and women, particularly with regard to stroke as one of multiple causes of death. Black men and Black women had the highest death rates of any of the examined groups (66.4 and 56.5 stroke deaths per 1,000 individuals, respectively). Among Black, Asian/Pacific Islander and Hispanic populations, stroke rates were lower for women than for men. White men and women had similar death rates (41.7 and 41.5 respectively). The lowest stroke mortality rates were among Hispanic and Asian/Pacific Islander women (32.9 and 34.6 per 1,000 individuals) followed by Hispanic and Asian/Pacific Islander men (37.9 and 38.7 deaths per 1,000 individuals). Overall, stroke mortality rates decreased for all groups, with the steepest decreases among women (across racial and ethnic groups) and Black people, and the slowest decline in stroke rates among Hispanic women. Understanding these trends will help better target public health interventions and assess their success.

Full abstract, to be presented at the American Neurological Association 2022 Annual Meeting, October 22-25, 2022 in Chicago, and published in Annals of Neurology:

Trends in Stroke Mortality by Race/Ethnicity and Sex in the U.S. 2000–2019

Daniel Oh, MD, University of Southern California

Co-authors: Bruce Ovbiagele, MD, MSc, MAS, MBA, FAHA, Daniela Markovic, MS, University of Southern California, Amytis Towfighi, MD, FAHA, University of Southern California

Introduction: Stroke mortality has declined over the past several decades. Yet studies have suggested race, ethnic, and sex disparities in mortality rates. Additionally, little is known about race/ethnic and sex-specific trends in mortality among individuals with cerebrovascular disease listed as a multiple cause-of-death. Identifying temporal trends in sociodemographic disparities in stroke-related mortality is critical for planning public health and health services interventions to eliminate inequities.

Methods: Using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database, mortality rates were extracted for those with cerebrovascular disease (ICD-10 code I60-I69) listed as a multiple cause-of-death from 2000-2019. Mean age-adjusted mortality rates per 100,000 persons for cerebrovascular disease as the underlying cause-of-death overall and between first (2000-2004) and last (2015-2019) 5-year intervals were compared by race/ethnicity and sex using linear regression.

Results: The overall 20-year mean age-adjusted mortality rate per 100,000 persons was significantly lower in Black (56.5 vs 66.4, p<0.0001), Asian/Pacific Islander (34.6 vs 38.7, p=0.032), and Hispanic (32.9 vs 37.9, p=0.0002) women compared to men. White women had similar rates to White men (41.5 vs 41.7, p=0.69). Race/ethnic differences by sex showed that Black individuals had higher rates compared to White individuals (women 56.5 vs 41.5, p<0.0001; men 66.4 vs 41.7, p<0.0001). Asian/Pacific Islander women had lower rates compared to White women. (women 34.6 vs 41.5, p<0.0001; men 38.7 vs 41.7, p=0.053). Hispanic individuals had lower rates compared to White individuals (women 32.9 vs 41.5, p<0.0001; men 37.9 vs 41.7, p=0.0007). Temporal analysis showed that the rates decreased across race/ethnicity or sex (p=<0.0001); however, rates of decline varied. Specifically, it declined more steeply in Black than White men (-27.3 vs -17.9, p=0.014) and women (-25.4 vs -17.8, p=0.0046). Hispanic women had a gentler decline compared to White individuals (-10.1 vs -17.8, p=0.0022).

Conclusions: Women and Black individuals saw the steepest decline in stroke mortality rates while it was relatively slower among Hispanic women. Racial/ethnical disparities persist despite the overall reduction in stroke mortality. Black individuals still have the highest overall mortality rates. To reduce inequities, it is critical to identify the driving factors behind these trends.

All abstracts from ANA2022 will be available in Annals of Neurology starting at 3:01 p.m. U.S. Eastern Time on October 14. This research is under embargo until that time. Contact Katherine Pflaumer ([email protected]) for additional highlighted abstracts, full meeting abstracts, and call-in information for the ANA2022 Media Roundtable (Oct. 25, 11 a.m. U.S. Central).