Abstract MP54: Increase in the Urban-Rural Divide in Cerebrovascular Mortality Among Middle-Aged Adults From 2013 to 2018

Abstract

Introduction: Despite observed overall decline cerebrovascular mortality in the United States over the past 2 decades, geographic pockets of increasing cerebrovascular mortality among middle aged adults have been reported on county-level data; and factors driving this regional increase are poorly understood. Methods: We extracted cerebrovascular mortality rates (ICD tenth revision codes I60-I69) in middle aged adults (age 35-64) from Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research database from 1999 to 2018. Variations in annual age-adjusted mortality rates, assessed with Joinpoint regression modeling, are expressed as estimated Annual Percentage Change [APC (95% confidence interval)], stratified by urbanization. In regions with increasing stroke mortality, race-ethnicity and gender subgroups were compared. Results: Mid-age cerebrovascular mortality decreased across urbanization strata between 1999 and 2012. Since 2013, stroke mortality has been increasing in Rural counties [APC +1.8% (+1.0% to +2.6%)] and stagnating in Small-to-Medium Metro counties [APC +0.7% (-0.1% to +1.5%)] and Large Metro counties [APC +0.1% (-0.8% to +0.9%)]. Focusing on rural counties, the profound rate difference between non-Hispanic African Americans and non-Hispanic whites decreased between 1999-2012 at Average APC -1.7% (-2.3% to -1.2%) and since then persisted [Average APC -0.2% (-2.1% to 1.8%)]. Both genders were affected. Conclusion: Since 2013, increase in cerebrovascular mortality in middle-aged adults in rural counties contributes to growing urban-rural divide; while the high stroke mortality rate in non-Hispanic African Americans have ceased to converge with non-Hispanic whites. Upstream drivers of stroke mortality in young and middle-aged rural residents and non-Hispanic African Americans should be further elucidated and vigorously targeted by public health initiatives.