Abstract Number: Esoc2026a2292 Mortality in Stroke Survivors During a Global Health Crisis: A Population-Based Study

Abstract Background and aims Individuals with comorbidities may have experienced excess mortality during the COVID-19 pandemic. We investigated whether stroke survivors had higher mortality during the pandemic years (2020–2021) compared with post-pandemic years (2022–2024), using a population-based cohort. Methods We analyzed all first-ever strokes occurring in 2018–2019 among residents of a defined regional area in Europe. Mortality over 5 years was assessed in 1123 patients (1000 ischemic stroke IS, 123 intracerebral hemorrhage ICH). Deaths were identified using official state records. Predictors of mortality were analyzed using Cox proportional hazards models. Mortality among stroke survivors (alive ≥90 days post-stroke) was compared with the general population by age group and calendar year using standardized mortality ratios (SMRs). Results Five-year mortality was 40.3% after IS and 56.1% after ICH. In IS, mortality was independently associated with age (HR 1.06), premorbid modified Rankin score (HR 1.28), stroke severity (NIHSS; HR 1.09), and atrial fibrillation (HR 1.12; all p0.001). In ICH, mortality was associated with age (HR 1.07) and stroke severity (NIHSS; HR 1.10; both p0.001). Throughout follow-up, stroke survivors had significantly higher mortality than the general population in all calendar years, particularly during the first post-stroke year (SMR 2.58 1.99–3.29 in 2018-2019). However, mortality among stroke survivors did not differ between pandemic (2020-2021) and post-pandemic periods (2022-2024) (SMR 1.88 1.56–2.25 vs 1.94 1.62–2.30; p=0.82). Conclusions Stroke survivors had persistently higher mortality than the general population, but no excess mortality was observed during the COVID-19 pandemic compared with post-pandemic years. Conflict of interest Siddhartha Pandit: nothing to disclose; Elisabeth Dirren: nothing to disclose; Emmanuel Carrera: : nothing to disclose