To examine national mortality trends, demographic disparities, and geographic variations in coexisting obstructive sleep apnea (OSA) and stroke from 1999 to 2023.
OSA is a prevalent and underrecognized condition that increases cerebrovascular risk. When combined with stroke, it may worsen outcomes, particularly in vulnerable groups. Although stroke burden is well documented, national patterns of coexisting OSA and stroke remain poorly characterized. Understanding these disparities can inform prevention and resource allocation.
A population-based analysis was performed using the CDC WONDER Multiple Cause-of-Death database. Deaths were identified using ICD-10 codes for stroke (I61, I62, I63, I64, G45.9) and OSA (G47.3). Mortality rates were analyzed by year, sex, race/ethnicity, age, region, and urbanization status. Age-adjusted mortality rates (AAMRs) were standardized to the 2000 U.S. population. Joinpoint regression estimated temporal trends with average annual percent change (AAPC).
From 1999-2023, 15,399 deaths involved both OSA and stroke. AAMR was 0.214, rising from 0.057 in 1999 to 0.437 in 2023 (AAPC: 7.65%). Males had higher AAMR (0.314) than females (0.141), though female rates increased more rapidly (AAPC: 9.20%). Non-Hispanic Black individuals had the highest AAMR (0.267), while non-Hispanic Whites had the most deaths, reaching 0.479 by 2023. Adults ≥75 years experienced the greatest burden, accelerating after 2012. Rural mortality exceeded urban (0.221 vs. 0.177), with sharp rural increases after 2018. The Midwest showed the highest AAMR, and the South the greatest number of deaths. Mortality rose steeply between 2016 and 2021, then plateaued.
Mortality involving OSA and stroke has increased markedly over two decades, disproportionately affecting older adults, males, non-Hispanic Black populations, rural residents, and those in the Midwest and South. Targeted prevention, improved screening, and equitable care access are needed to mitigate this growing burden.