2025 American Academy of Neurology Abstract Website

Objective:

To evaluate the impact of the COVID-19 pandemic on stroke mortality rates in patients with comorbid cardiovascular disease (CVD) in the U.S., using CDC WONDER data (1999-2022).

Background:

Stroke and CVD are leading causes of mortality. People with CVD have a 2–4 times greater risk of stroke than the general population, placing them at higher risk of severe outcomes, especially during the COVID-19 pandemic. Limited research has explored stroke mortality trends in this vulnerable group in relation to the pandemic.

Design/Methods:

Mortality data were extracted from CDC WONDER for adults aged 25+ who died from stroke (ICD-10 I60-I69) and comorbid CVD (ICD-10 I00-I99, except I69) from 1999-2022. Mortality rates pre-pandemic (1999-2019) were compared with post-pandemic years (2020-2022). Age-adjusted mortality rates (AAMRs) were calculated, and trends were analyzed using average annual percent changes (AAPCs) with 95% confidence intervals (CI) via Joinpoint Regression.

Results:

From 1999 to 2019, stroke mortality among patients aged 25+ with comorbid CVD declined with an average annual percent change (AAPC) of -1.75% (95% CI: -2.11 to -1.48). However, during the pandemic (2020-2022), this trend sharply reversed with mortality rates increasing by 5.87% annually (95% CI: 3.96 to 9.09). Males consistently had higher age-adjusted mortality rates (AAMRs) than females (72.2 vs. 64.3 ). The post-COVID rise was more pronounced in males (AAPC: 6.52; 95% CI: 4.17 to 10.26), while females saw a smaller increase (AAPC: 5.87; 95% CI: 3.96 to 9.10). Non-Hispanic (NH) Whites had the highest post-pandemic rise (AAPC: 6.20), followed by NH Blacks (AAPC: 4.36) and Hispanics (AAPC: 2.14).

Conclusions:

The COVID-19 pandemic reversed prior declines in stroke mortality among patients with CVD, particularly in males and non-Hispanic Whites. Targeted interventions are needed to mitigate these increased risks in future public health crises.