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Leveraging national mortality data over 2 decades, researchers found that ischemic stroke mortality rates in the United States have risen, with a shift toward deaths occurring at home and notable increases observed among racial minority groups and individuals living in rural areas. These growing disparities were among findings from a retrospective study published in PLOS One.

Understanding trends in location of death from ischemic stroke is crucial to improving end-of-life care while addressing healthcare inequities, noted Michael Levitt, MD, and colleagues.

The researchers analyzed ischemic stroke mortality trends using cause-of-death data from 1999 to 2020 from the CDC’s Wide-ranging ONline Data for Epidemiologic Research, or WONDER, database. They identified 237,617 recorded ischemic stroke deaths and categorized each patient according to reported age, sex, race, and urbanization level. They then analyzed the relationships of three main indicators: overall number of deaths, age-adjusted rates of death due to ischemic stroke, and location of deaths.

Disparities Based on Region, Access to Care, & Race

Age-adjusted ischemic stroke mortality rates, after years of decline, increased across all urbanization levels since 2009, with the most prominent rises seen in nonmetropolitan areas. People residing in rural areas were more prone to die at nursing homes or long-term care facilities than specialized medical centers, according to the study results.

From 1999 to 2020, Dr. Levitt and colleagues observed significant changes in where deaths occurred. The overall percentage of at-home deaths increased from 8.44% to 29.31%, whereas deaths in medical facilities decreased from 46.41% to 29.56%.

The researchers also found notable disparities in access to specialized end-of-life care, particularly among racial minority groups. Black patients had the highest rate of death at medical facilities, with death on arrival at 0.37%, and the second highest rate at hospice facilities and nursing homes or long-term care facilities at 7.19% and 19.63%, respectively. Conversely, White patients had the lowest rates of death at medical facilities with inpatient/outpatient emergency department services but the highest death rates at hospice facilities (8.58%) and nursing homes or long-term care facilities (87.87%).

“While disparities in mortality and location of death are well-documented in this study, further work is needed to elucidate the causal mechanisms driving these inequities,” the researchers wrote. “Addressing these disparities will require multifaceted strategies, including expanding telemedicine networks and mobile stroke units to bridge geographic gaps, as well as implementing culturally tailored prevention and education programs in underserved communities.”