Abstract TP167: Trends and Disparities in Mortality from Atrial Fibrillation-Related Stroke in the United States from 1999 to 2023: Insights from the CDC WONDER Database

Abstract

Introduction: Atrial fibrillation (AF) and stroke both increase the risk of mortality. The combined mortality from AF-related stroke is higher than from either condition alone. Understanding trends in deaths from AF–related strokes is crucial for informed public health strategies. We aim to examine trends by highlighting demographic differences in mortality from AF–related strokes among U.S. adults (age ≥55 years) from 1999 to 2023. Methods: We used the CDC WONDER database to extract combined mortality data for AF (ICD-10 code: I48) and stroke (ICD-10 codes: I60, I61, I63, I64, I69.0-I69.4). We calculated crude mortality rate (CMR) and age-adjusted mortality rates (AAMRs) per 100,000 individuals. Data were stratified by age, sex, ethnicity, and geography. Joinpoint regression was used to estimate annual percent change (APC). A p-value < 0.05 was considered significant, indicated by *. Results: A total of 130,951 deaths from AF-related strokes were recorded in the U.S. adult population from 1999–2023. Over this period, the AAMR rose slightly from 1999-2019 (APC 0.39), before declining until 2023 (APC -3.32*). Males had a lower AAMR than females (6.3 vs 7.5), with both sexes showing upward trend from 1999-2019 (male APC 0.95*; female APC 0.35), followed by a decline from 2020-2023 (male APC -2.74; female APC -5.06). When stratified by race, non-Hispanic (NH) Whites had the highest overall AAMR (7.67), while Hispanics had the lowest (3.86). All races showed notable increases in AAMR from 1999-2019. From 2020-2023, mortality declined in all groups except Hispanics (APC 1.94); declines in other groups were insignificant. Per regional analysis, the West had the highest overall AAMR (7.8), while the South had the lowest (6.6); all regions mirrored overall national trends, except for the South, which demonstrated a declining trend (APC -0.16) from 1999-2019. In addition, rural areas demonstrated slightly higher overall AAMRs than urban (8.10 vs. 6.98), with AAMRs increasing from 1999-2019 (urban APC 0.04; rural APC 0.65) and then declining post-2019. Finally, age-based analysis showed individuals ≥85 years had the highest CMR (150.07), whereas those aged 55-65 years had the lowest (1.11). All age groups showed declining overall CMRs. Conclusion: AF-related stroke mortality rose slightly from 1999-2019 but declined thereafter, with persistent disparities by sex, race, geography, and age. Continued surveillance and targeted prevention are needed to address these gaps.