Regional Disparities in Chronic Respiratory Diseases and Stroke Mortality Across the United States from 1999 to 2020
Adeena Jamil1, Obaid Rehman2, Muteia Shakoor1, Aamna Kamdi1, Eeshal Fatima2, Hiba Sohail1, Zain Nadeem3, FNU Pirih4, Zunera Khalid1, Syed Inam5, Muhammad Inam Ul Haq5
1Dow International Medical College, 2Services Institute of Medical Sciences, 3Allama Iqbal Medical College, 4People’s University of Medical and Health Sciences, 5Marshall Neurology
Objective:
This study aims to assess temporal and regional trends in chronic respiratory diseases (CRD) and stroke-related mortality among adults aged ≥55 in the US.
Background:
Individuals with CRD face a heightened risk of cardiovascular events like stroke, which exacerbates morbidity and mortality. However, comprehensive mortality data on the co-occurrence of CRD and stroke, as well as disparities across demographic and geographic groups, are lacking.
Design/Methods:
Utilizing data from the CDC WONDER database, CRD and stroke-related deaths from 1999 to 2020 were identified. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were determined. Joinpoint regression was used to analyze trends and annual percentage change (APC).
Results:
From 1999 to 2020, 271,986 CRD and stroke-related deaths were identified. Most occurred in inpatient medical facilities (35.7%), followed by nursing homes/long-term care facilities (31.2%), homes (20.6%), and hospice/outpatient/ER facilities (4.3% each). AAMRs declined from 1999 to 2009 (APC -4.6), plateaued until 2019, then increased significantly until 2020 (APC 9.2). Males had higher AAMRs (21.3) than females (14.7), although the decline was more pronounced in males. While most inpatient deaths were male, a greater proportion of female deaths occurred in nursing homes or long-term care facilities (54.2% vs 45.8%). Large metropolitan areas had the highest incidence of deaths (41.5%), but greater AAMRs were observed in rural areas (23.6 vs. 14.2). AAMRs also varied regionally: Midwest (18.8), South (18.7), West (17.8), and Northeast (12.8). States in the upper 90th percentile of CRD and stroke-related deaths included West Virginia, Oklahoma, Mississippi, Kentucky, Tennessee, and Vermont, which had triple the AAMRs of states in the lower 10th percentile.
Conclusions:
Following a period of decline, CRD and stroke-related mortality in the US has plateaued since 2009. Persistent disparities exist, particularly among males and individuals in the Midwest and rural areas, highlighting the need for targeted interventions and policy amendments for vulnerable groups and regions.
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