COPD- and stroke-related mortality in U.S. adults ≥35 years declined from 1999 to 2009 but increased after 2018 (APC +7.6%, p=0.03), with widening demographic and geographic disparities.
Observational (n=324,642)
Yes
Stroke-related mortality among U.S. adults with COPD has increased since 2018, with widening disparities disproportionately affecting males, non-Hispanic Whites, and non-metropolitan populations.
Background: Chronic obstructive pulmonary disease (COPD) and stroke remain major contributors to U.S. mortality. Although age-adjusted mortality rates (AAMRs) have declined, disparities across sex, race/ethnicity, region, and urbanization persist. Methods: We used CDC WONDER data (1999–2023) to identify deaths among adults ≥35 years with COPD (ICD-10 J40–J47) and stroke (I60.x, I61.x, I63.x, I64, I69.0, I69.1, I69.3, I69.4). A total of 324,642 deaths were included. AAMRs per 100,000 ( 2000 U.S. standard population) were calculated. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC) by demographic and geographic factors Results: The overall AAMR was 7.52 (95% CI: 7.39–7.65). Mortality decreased from 1999–2009 (APC −4.5%, p<0.01), stabilized from 2009–2018, and increased after 2018 (APC +7.6%, p=0.03). Males experienced steeper early declines (APC −5.5%, p = 0.002) but sharper increases after 2018 (APC +6.1%, p = 0.006) compared with females (APC +7.9%, p = 0.03). Non-Hispanic Asian/Pacific Islanders showed the largest decline (APC −6.0%, p=0.002), while non-Hispanic Whites demonstrated significant increases post-2018 (APC +7.8%, p=0.017). Regionally, the Midwest and South exhibited post-2017 increases (APC +6.7% and +9.0%, respectively). Metropolitan areas declined until 2009 (APC −4.7%, p < 0.001), then plateaued, whereas non-metropolitan areas showed a persistent burden, with a rise after 2014 (APC +3.2%, p = 0.002). Conclusions: COPD- and stroke-related mortality declined overall since 1999 but has risen since 2018, disproportionately affecting males, non-Hispanic Whites, residents of the South and Midwest, and non-metropolitan populations. These findings highlight widening disparities and the need for targeted prevention and healthcare strategies.
UMAR et al. (2026) conducted an observational in Chronic Obstructive Pulmonary Disease (COPD) and stroke (n=324,642). COPD- and stroke-related mortality in U.S. adults ≥35 years declined from 1999 to 2009 but increased after 2018 (APC +7.6%, p=0.03), with widening demographic and geographic disparities.