We analyzed trends and disparities in mortality associated with multiple sclerosis (MS) and stroke across various demographic and geographic groups in the United States (US) from 1999 to 2020.

MS affects the vascular system reducing blood flow and elevating the risk of stroke, indicating a potential shared pathophysiology and comorbidity. Mortality disparities and temporal trends remain understudied, prompting our analysis.

A retrospective analysis was conducted using the CDC WONDER database to examine MS and stroke-related deaths. Age groups for the middle-aged and the elderly were included. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per million were calculated. Trends and annual percent changes (APCs) were assessed overall and stratified by sex, race, region, and age.

A total of 4,471 deaths attributed to stroke among middle-aged and elderly individuals living with MS were reported in the US between 1999 and 2020. Mortality initially declined from 1999 to 2017 (APC: -1.35), but sharply increased from 2017 to 2020 (APC: 9.74). AAMRs were higher in females (2.14) than in males (1.19). Non-Hispanic (NH) Whites had the highest AAMR (1.91), while NH Asians or Pacific Islanders had the lowest, ranging from 0.06 to 0.20. Regionally, the Midwest reported the highest AAMR (2.18), followed by the West (1.97), Northeast (1.61), and South (1.28). The states with the highest AAMRs included Minnesota and Montana (both at 3.28), Nebraska (3.22), and Washington (3.20). In contrast, Alaska, the District of Columbia, and Hawaii reported the lowest AAMRs. Rural areas had a higher AAMR (1.97) than urban regions (1.66), and individuals aged 85 and older exhibited the highest CMR (3.33) among all age groups.

The analysis reveals a concerning rise in mortality rates associated with MS and stroke, particularly among females, older adults and NH Whites. Regional disparities underscore the necessity for focused solutions.