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TOPLINE:

Overall deaths due to ischemic stroke have increased in several categories, especially in nonmetropolitan and minority populations, and at-home deaths due to ischemic stroke increased by 21% between 1999 and 2020, new research showed. The findings point to disparities in end-of-life care that deserve attention, investigators noted.

METHODOLOGY:

• Researchers analyzed more than 200,000 deaths (58% mortality in women) due to ischemic stroke recorded in the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2020.
• The analysis included age-adjusted mortality rates calculated using the 2000 US standard population as defined by the CDC, stratified by sex, urbanization level, and race.
• The location of death was classified as medical facility–based (inpatient, outpatient/emergency room, and dead on arrival) and nonmedical facility–based (home, hospice facility, nursing home/long-term care, and others) settings.

TAKEAWAY:

• The death rates due to ischemic stroke showed distinct racial trends. In Black/African American individuals, death rates per 100,000 people declined from 87.6 in 1999 to 34.8 in 2006, but rose back to 87.8 by 2020. In Asian/Pacific Islander individuals, rates increased from 17.5 in 1999 to 33.0 in 2020; but in White individuals, they declined gradually from 64.0 in 1999 to 57.1 in 2020.
• American Indian/Alaska Native individuals had the highest rates of deaths at inpatient facilities (55%); Asian/Pacific Islander individuals had the highest rates of deaths at home (18%), and White individuals had the highest rates of death at hospice (9%) and nursing home/long-term care (28%) facilities.
• The place of death due to ischemic stroke varied by urbanization. Deaths at home and in hospice facilities were more frequent in urban areas, whereas deaths in nursing homes/long-term care facilities were more prevalent in rural settings.
• Overall, deaths at medical facilities with inpatient services decreased from 47% in 1999 to 30% in 2020, and from 40% to 19% in nursing homes/long-term care facilities. Deaths increased from 8% to 29% in residential homes and from 0.1% to 15% in hospice facilities.

IN PRACTICE:

“Our study reveals a striking shift in where people are dying from ischemic stroke in the US — with a clear trend toward more deaths occurring at home and fewer in hospitals,” investigators said in a press release. “We also found that rural and minority populations are disproportionately affected, often dying in less specialized settings due to persistent gaps in access to care. These trends reflect evolving preferences in end-of-life care but also highlight urgent disparities that require targeted health policy interventions.”

SOURCE:

This study was led by Jason K. Lim, Georgetown University, Washington, DC. It was published online on April 9 in PLOS ONE.

LIMITATIONS: 

Study limitations included a reliance on retrospective claims and death certificate data, potential misclassification of stroke deaths, lack of individual-level clinical and socioeconomic variables, inability to separately analyze Hispanic ethnicity, and limited insights into causal mechanisms underlying disparities.

DISCLOSURES:

This study received unrestricted educational grants from Medtronic and Stryker. One investigator reported having financial ties with various sources. Full details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.