Mortality patterns related to stroke and dementia among older adults in the U. S.: a CDC WONDER analysis from 1999 to 2024.

A total of 965,793 deaths due to stroke and dementia were recorded among older adults aged 65 years and above in the U.S. from 1999 to 2024.

• Data were sourced from the CDC WONDER (Wide-Ranging Online Data for Epidemiologic Research) database.
• The study period spanned 25 years, from 1999 to 2024.
• The study population was restricted to older adults aged ≥65 years.
• Age-Adjusted Mortality Rates (AAMRs) per 100,000 were calculated and categorized by demographics and region.

The overall Age-Adjusted Mortality Rate (AAMR) for stroke and dementia among older adults showed a steep increase from 69.34 per 100,000 in 1999 to 99.25 per 100,000 in 2024.

• Joinpoint regression was used to estimate Annual Percent Change (APC) and Average Annual Percent Change (AAPC).
• The increase represents approximately a 43% rise in AAMR over the 25-year study period.
• Mortality rates continued to increase in the post-pandemic era despite disruptions caused by COVID-19.
• The trend was described as a 'steep incline' over the full study period.

Among dementia subgroups, unspecified dementia reported the greatest mortality.

• Multiple subgroups of dementia were analyzed within the dataset.
• Unspecified dementia accounted for a larger share of mortality than other classified dementia subtypes.
• This finding suggests potential gaps in clinical diagnosis specificity among older decedents.
• The analysis captured both stroke and dementia as combined and separate mortality contributors.

Older females had higher overall AAMR for stroke and dementia-related mortality than older males.

• Sex-based differences in AAMR were identified through demographic categorization of CDC WONDER data.
• The sex disparity persisted across the full 1999–2024 study period.
• This pattern is consistent with the higher life expectancy of females and greater prevalence of dementia in older female populations.
• Both APC and AAPC were calculated separately by sex subgroup.

Non-Hispanic Black older adults had the highest overall AAMR for stroke and dementia-related mortality among all racial groups analyzed.

• Racial and ethnic categories were derived from CDC WONDER demographic classifications.
• The Non-Hispanic Black population showed the highest AAMR compared to other racial/ethnic subgroups including Non-Hispanic White and Hispanic populations.
• Racial disparities in stroke and dementia mortality were assessed across the full 25-year period.
• Joinpoint regression was applied within each racial subgroup to identify trend changes.

The Southern U.S. recorded the highest overall AAMR for stroke and dementia-related mortality among all U.S. regions.

• Regional analysis was conducted using CDC WONDER geographic classifications dividing the U.S. into standard census regions.
• The South was identified as the highest-burden region across the study period.
• Regional disparities may reflect differences in population demographics, healthcare access, and prevalence of vascular risk factors.
• Both APC and AAPC were estimated for each regional subgroup using joinpoint regression.

Stroke and dementia-related mortality among older adults continued to increase in the post-pandemic era despite the COVID-19 pandemic.

• The study period included data through 2024, encompassing both the acute COVID-19 pandemic years and the post-pandemic period.
• Mortality trends did not reverse or stabilize following the pandemic period.
• COVID-19 was noted as a potential confounding factor in mortality trends during 2020–2022.
• The persistence of increasing mortality post-pandemic was identified as a public health concern requiring targeted intervention.