To evaluate trends and disparities in stroke mortality among adults with mental disorders (MDs) in the United States (US) from 1999-2022.

Mental disorders (MDs) are associated with an elevated risk of stroke, with 1 in 6 strokes being linked to mental health. Yet their mortality trends and disparities among adults in the US remain underexplored.

We analyzed the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) for death certificates (1999-2022) of adults 25 years and older, with MDs (ICD-10 code: F01-F99) and stroke (ICD-10 code: I60-I69). Age-adjusted mortality rates (AAMR) per 100,000, annual percent change (APC), and average annual percent change (AAPC) with a 95% confidence interval (CI) were calculated through joint-point regression and trends were analyzed across gender, year, race, region, and state. 

Between 1999 and 2022, a total of 1,114,024 stroke-related deaths were reported among adults with mental disorders. Overall, the AAMR increased from 13.5 in 1999 to 27.4 in 2022, a two-fold increase [AAPC: 2.34*%; 95% CI, 1.9 to 3.1]. AAMR rose substantially from 2016 to 2022 [APC: 5.45*; 95% CI, 3.6 to 11.3)]. Males had higher AAMR (22.6) than females (19.1). Non-Hispanic (NH) African Americans/Blacks had the highest AAMR (27.8), followed by NH American Indians (21.6), NH Whites (21), Hispanics (13.9), and NH Asians/Pacific Islanders (11.4). Regionally, the Midwest had the highest AAMR (23.1), followed by South (22.1), West (20.6), and Northeast (15.9). States above the 90^th percentile for AAMR were Oregon, Vermont, Washington, North Dakota, and South Carolina.

Our study demonstrates a significant increase in stroke-related mortality among adults with mental disorders, particularly from 2016 to 2022, among men, NH African Americans, and residents of the Midwest region. A collaborative care approach, involving mental health professionals, primary care providers, and specialists is needed to lessen the mortality burden.