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

## TL;DR

This study examines 50 years of ischemic stroke mortality in the U.S., revealing significant long-term declines but recent increases and ongoing disparities by age, sex, and race.

## Contribution

The study provides a comprehensive analysis of ischemic stroke mortality trends from 1968 to 2023 using CDC WONDER data, highlighting recent reversals and disparities.

## Key findings

- Ischemic stroke mortality rates in the U.S. declined from 76.2 to 10.0 per 100,000 between 1968 and 2023.
- Recent increases in mortality were observed between 2014–2017 and 2017–2023, reversing earlier declines.
- Persistent disparities were found, with higher mortality rates among men, Black individuals, and older adults.

## Abstract

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.

This graphical abstract depicts long‐term trends in ischemic stroke mortality in the United States using CDC WONDER data. Over five decades, age‐adjusted mortality rates declined substantially, with the highest burden observed among older adults. Persistent disparities were evident by sex and race, with higher mortality among males and Black or African American individuals compared with other groups.