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

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.