To examine trends in stroke-related mortality in Appalachia Kentucky from 1999-2020, focusing on regional disparities and changes over time.

Throughout the years, stroke has remained a prevalent cause of mortality among adults in the United States. However, trends in mortality have not been investigated within specific disease-ridden areas such as Appalachia Kentucky. 

A retrospective regional analysis was conducted to assess trends in stroke-related mortality among adults aged 25 and older in Appalachia Kentucky from 1999 to 2020, using the CDC WONDER database (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) and ICD codes I60-I64. Age-adjusted mortality rates (AAMRs) per 100,000 individuals and annual percentage changes (APC), with 95% confidence intervals, were analyzed across racial/ethnic groups and geographical regions using joinpoint analysis.

The study identified 21,314 stroke-related deaths among adults in Appalachia Kentucky from 1999 to 2020, with an average AAMR of 116.9. In contrast, the average AAMR in the rest of the U.S., excluding Kentucky, was 89.2. AAMRs in Appalachia Kentucky steadily declined to 97.0 by 2014 (APC: -3.1) but gradually increased to 108.2 by 2020 (APC: 1.2). Males (42.7% of total deaths) had a higher AAMR (119.6) compared to females (113.5), though both genders showed significant declines over time (AAPC: -1.7 for males vs -1.8 for females). Non-Hispanic Black individuals had the highest AAMR (130.7), while Hispanic/Latino individuals had the lowest (54.3). Metropolitan areas had a slightly higher AAMR (118.0) than nonmetropolitan areas (116.8). Among counties, Harlan County had the highest AAMR (150.8), while Gerrard County had the lowest (85.4). 

The overall AAMR was significantly higher in Appalachia Kentucky compared to the rest of the United States. This data signifies the necessity for strategies that will allow for early detection and prevention of stroke in adult patients to help reduce the rate of stroke-related mortality.