This study assesses trends and sociodemographic disparities in U.S. adult mortality from CVAs co-occurring with epilepsy (1999–2020), highlighting inequities by sex, race, region, and urbanization to inform equitable interventions for epilepsy care barriers.

Between 1999 and 2020, 7,138 deaths (3,744 females; 3,394 males) in the U.S. were attributed to both epilepsy and cerebrovascular accidents, among U.S. adults aged ≥25. The AAMR in females declined from 0.10 in 1999 to 0.09 in 2011 (APC: 0.45), before rising to 0.31 in 2020 (APC: 14.38). The AAMR in males declined from 0.13 in 1999 to 0.1 in 2008 (APC: -5.43), then increased to 0.36 in 2020 (APC: 12.27). Among racial groups, Black/African American had the highest AAMR (0.77), followed by White (0.29), Hispanic/Latino (0.26), while the Asian/Pacific Islanders had the lowest AAMR (0.17). Regionally, AAMRs were highest in the West (0.43) and South (0.34), followed by Midwest (0.28), with the lowest in the Northeast (0.27). The Midwest showed the highest AAPC (5.67), followed by the South (5.46), and West (4.91). For urbanization, AAPC was highest in Large Fringe Metro areas (6.57), followed by Medium Metro (6.34), and Large Central Metro (5.58). 

Epilepsy with cerebrovascular accidents has shown fluctuating mortality trends with recent increases across both sexes and regions, highlighting disparities and targeted prevention needs.