Stroke mortality in the United States from 1968 to 2023: A CDC WONDER analysis

Background: Stroke remains a leading cause of mortality in the United States, with evolving epidemiologic patterns over five decades. This study analyzes stroke mortality trends from 1968 to 2023, focusing on disparities across age, sex, race, and geographic regions. Methods: This population-based descriptive study used national mortality data from CDC WONDER. Stroke deaths among individuals aged ⩾ 25 years were identified using International Classification of Diseases (ICD) codes from 1968 to 2023. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated using US Census data. Temporal trends were analyzed using the Joinpoint regression. Results: From 1968 to 2023, 8,933,826 stroke deaths occurred. AAMRs declined from 250.6 (95% CI = 249.5 to 251.8) in 1968 to 60.0 (95% CI = 59.7 to 60.3) in 2023, with rapid declines from 1973 to 1981, slower reductions until 2000, and modest rise post-2011. Males consistently had higher AAMRs than females. Among males, AAMR fell from 268.4 (95% CI = 266.5 to 270.3) to 60.5 (95% CI = 60.1 to 61.0), while in females, it declined from 236.8 (95% CI = 235.4 to 238.2) to 58.7 (95% CI = 58.3 to 59.1). Racial disparities persisted, with Black individuals having higher AAMRs than White individuals in 2023 (83.2 vs 58.6). The Southern United States had the highest AAMRs, with recent increases post-2011. In 2022–2023, stroke mortality ranged from 37.3 (95% CI = 36.6 to 37.9) in New York to 92.9 (95% CI = 88.4 to 97.4) in Delaware. Ischemic stroke AAMR declined from 59.9 (95% CI = 59.3 to 60.4) to 12.4 (95% CI = 12.3 to 12.5), with increases observed post-2014. Hemorrhagic stroke AAMR fell from 79.4 (95% CI = 78.7 to 80.0) to 10.0 (95% CI = 9.9 to 10.1), with continued decline from 1997 onward. Conclusion: Despite long-term declines, stroke mortality has recently increased, particularly among younger adults, racial minorities, and the Southern United States. These findings underscore the need for targeted public health interventions to address disparities.