Understanding disparities in cerebral atherosclerosis mortality across the United States: An analysis of the CDC WONDER database.

BACKGROUND

Cerebral atherosclerosis is a significant contributor to ischemic stroke, accounting for approximately 50% of ischemic strokes in some populations. Its prevalence and associated mortality exhibit variation across demographics, yet no prior studies have assessed the location of death for individuals succumbing to cerebral atherosclerosis. This study evaluates trends in mortality, racial disparities, and location of death in the United States.

METHODS

Data from the CDC WONDER database were analyzed, including all deaths attributed to cerebral atherosclerosis. We conducted analyses using both underlying cause of death (primary cause) and multiple causes of death (any mention of the condition). Variables analyzed included race, ethnicity, sex, age group, year of death, geographic region, urban-rural status, and location of death. A multinomial logistic regression model was used to assess factors influencing the location of death, with odds ratios (ORs) calculated.

RESULTS

From 1999 to 2022, cerebral atherosclerosis was listed as the underlying cause of death in 83,978 cases and as either an underlying or contributing cause in 162,489 deaths. Decedents were predominantly White (87.7 % underlying, 88.5 % multiple) and female (65.9 % underlying, 63.8 % multiple), with the majority aged ≥ 85 years (68.6 % underlying, 62.9 % multiple). The most common locations of death were nursing homes (42.2 % underlying, 42.2 % multiple) and home (38.4 % underlying, 33.6 % multiple). Older age was consistently associated with a higher likelihood of death outside the hospital, particularly at home (OR ≥ 85 years: 3.08 underlying, 4.24 multiple) or in hospice (OR ≥ 85 years: 2.00 underlying, 4.24 multiple). African American decedents had lower odds of dying at home (OR: 0.52 underlying, 0.57 multiple) and in nursing homes (OR: 0.35 underlying, 0.40 multiple). Year, geographic region, and urban/rural status also significantly influenced the location of death in both analyses, demonstrating complex regional and temporal trends.

CONCLUSION

Significant demographic and racial disparities exist in the location of death for individuals with cerebral atherosclerosis. These findings highlight the need for targeted interventions to address disparities in end-of-life care and improve access to preferred settings of death, particularly for minority populations.