Ischemic stroke is the fifth leading cause of death in the United States. In spite of the recent advances in the management of ischemic stroke, mortality rates have increased in recent years. Importantly, mortality differs by race.

Using the Multiple Cause Of Death Database, we identified all patients who died of cerebral infarction (CI) using the International Classification of Diseases, 10th revision code I63. Age-adjusted mortality rates (AAMR) standardized to the 2000 US census data were used. Data for continuous variables were examined using simple linear regression models and multivariable linear regression models. All tests were two-tailed and p < .05 was considered significant.

A total of 201,157 CI deaths were identified between 1999 and 2018. AAMR showed a U-shaped trend, such that compared to 1999-2004 (4.52±.60) AAMR decreased from 2005-2014 (2.06±.20), p < .001, and increased from 2015-2018 (3.63±1.32), p <.001. AAMR differed significantly by race, p = .045. Rates were 3.05+1.26 for Caucasians and 4.04+1.74 for  African Americans (AA).  

AAMR decreased between 1999 and 2018 for thrombotic strokes, p < .001, while AAMR increased over this time for embolic stroke, p < .001. For AA, there was a significantly higher AAMR for thrombotic strokes (.56±.33) compared to embolic strokes (.33±.15), p = .006, no such difference was found amongst Caucasians.

AAMR has increased in the last 4 years by 1.8 times. AAMR in AA is 1.3 times that of Caucasians with AA mortality from thrombotic stroke being 1.7 times higher than from embolic stroke. Mortality from CI caused by embolism increased by 2.8 times over the study period while that due to thrombosis decreased by 5 times. Further studies are needed to clarify the reasons behind the recent increase in AAMR.