Over the last two decades, ischemic stroke mortality rates in the U.S. have grown, with almost 3 in 10 deaths occurring at home, and increases particularly among racial minorities and rural residents. These growing disparities were among the findings of a new study publishing April 9, 2025, in the open-access journal PLOS One by Jason Lim of Georgetown University School of Medicine, U.S., and colleagues.
Stroke remains the fifth leading cause of mortality in the United States. Understanding trends in the location of death for ischemic stroke patients is crucial for improving end-of-life care and addressing healthcare inequities.
In the new study, researchers examined trends in ischemic stroke mortality using cause-of-death records spanning 1999 to 2020 from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. The analysis included 237,617 recorded ischemic stroke deaths.
The study found that age-adjusted ischemic stroke mortality rates, after years of decline, have increased across all urbanization levels since 2009, with the most pronounced rises in non-metropolitan areas. Additionally, there has been a noticeable shift in the place of death, with more people dying at home instead of in hospitals or other medical facilities. From 1999 to 2020, the percentage of at-home deaths increased from 8.44% to 29.31%. The trend away from specialized stroke care was particularly prominent among Black/African American individuals and those living in rural areas.
The authors note that it is unclear whether the shifts toward dying at home are due to personal preference or to insufficient access to hospital-based or specialized care. They conclude that rising stroke mortality and increased reliance on home-based end-of-life care call for new assessments of the factors that impact stroke outcomes.
The authors add: "Our study reveals a striking shift in where people are dying from ischemic stroke in the U.S.—with a clear trend toward more deaths occurring at home and fewer in hospitals. 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."
In your coverage, please use this URL to provide access to the freely available article in PLOS One: https://plos.io/4ja5VhZ
Citation: Lim JK, Pagnotta J, Lee R, Lim DH, Breton JM, Abecassis ZA, et al. (2025) Trends and disparities in ischemic stroke mortality and location of death in the United States: A comprehensive analysis from 1999–2020. PLoS ONE 20(4): e0319867. https://doi.org/10.1371/journal.pone.0319867
Author countries: U.S.
Funding: Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Aeaean Advisers, Metis Innovative, Genomadix, AIDoc and Arsenal Medical; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, Synchron and Hyperion Surgical; editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Arsenal Medical. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the 'author contributions' section.
