To examine trends of stroke and dementia-related mortality stratified by sex, race, and region among older adults in the United States (US) from 1999 to 2022 and the impact of COVID-19 on them.

Stroke and dementia, the two leading causes of neurological deaths globally, have an integrated relation with increased risk of stroke in patients with dementia and 1 in 3 patients with stroke developing dementia. Data for stroke and dementia-related mortality remain underexplored in the US. 

Between 1999 and 2022, a total of 882,676 deaths attributed to stroke and dementia were reported. Overall, the AAMR increased from 70.1 in 1999 to 102 in 2022 [(APC 1999-2002 = 14.74*), (APC 2002-2006 = -10.9*); (APC 2006-2015 = -0.56); (APC 2015-2022 = 5.4*)]. Women had a higher AAMR (87.98) than men (80.89). The AAMR peaked during COVID-19 (2020-2021) [AAMR =103.4] showing a percentage change of 23% as compared to the pre-COVID period (1999-2019) [AAMR = 83.6]. AAMR varied by race [Non-Hispanic (NH) African Americans=112.4; NH Whites=85.8; NH American Indians=66.5; Hispanics=64.4; and NH Asians or Pacific Islanders=57.2] and by region [West=93.5; South=93.4; Midwest=88.9; and Northeast=61.9]. States above the 90^th percentile were Vermont, Oregon, Washington, South Carolina, and Alaska.

Stroke and dementia-related mortality has spiked recently in the US from 2015 to 2022, among women and African Americans, especially during COVID-19. Insights gained from this study can help identify high-risk populations and inform healthcare service requirements for managing stroke and dementia in the US.