Abstract
Introduction: Important disparities in stroke outcomes persist based on sex, race, and ethnicity. The aim of this study was to examine trends in stroke (ischemic and hemorrhagic) related deaths among young adults in the United States from 1999 to 2019 by sex and race/ethnicity. Methods: We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. Stroke related deaths among individuals age 15- 44 years were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC) overall and stratified by sex and race/ethnicity. Results: AAMR was higher in men (3.3) than women (2.8). AAMR was highest in non-Hispanic Black (NHB) (6.6) followed by non-Hispanic American Indian or Alaska Native (NH-AIAN) (4.36), Hispanic (2.65), non-Hispanic White (NHW) (2.45) and lastly non-Hispanic Asian or Pacific Islander (NH-API) (2.24) ethnic groups. AAMR was highest in NHB males (7.07). AAMR related to stroke decreased from 3.7 in 1999 to 2.69 in 2011 and then increased to 2.87 in 2019 (APC 1.0[95% CI, 0.4 to 1.5]). After initial decline, AAMR increased in men (APC 1.2) since 2011, and women (APC 1.8) since 2013 (Figure, Panel A). AAMR increased among NHW (APC 2.4) persons since 2013 and Hispanic (APC 1.5) persons since 2011 (Figure, Panel B). AAMR decreased in NHB (APC -3.9) persons from 1999-2012, and remained stable thereafter. AAMR decreased in NH-API (APC -0.9) persons and did not change significantly in NH-AIAN persons during the entire study period. Conclusion: After initial decline, stroke-related mortality among young adults has increased over the past decade. Stratification by sex and racial/ethnic status reveals significant disparities. Further research is needed to understand and mitigate the factors driving these trends.
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