Aging, Alzheimer's disease, and stroke: A 25-year longitudinal analysis of U.S. mortality trends

Background: Alzheimer's disease (AD) and stroke, both of which are age-related conditions, exhibit common risk factors such as hypertension, smoking, diabetes, and the APOE ε4 genotype, which frequently coexist in older adults. Objective: This study investigates disparities in stroke-related mortality among AD patients, categorized by sex, race/ethnicity, and geographic region. Methods: The age-adjusted mortality rates (AAMRs) per 100,000 for adults 65 and older were sourced from the CDC WONDER database using ICD codes for AD (G30) and stroke (I60–I61, I63–I64, I69). Joinpoint regression estimated the Annual Percent Change (APC) and Average Annual Percent Change (AAPC), with statistical significance at p < 0.0001. Results: From 1999 to 2023, there were 154,323 deaths related to strokes in AD patients, primarily occurring in nursing homes (53.4%). The AAMRs decreased from 19.4 in 1999 to 10.5 in 2023 (APC: −2.6%, p < 0.01). Women exhibited higher AAMRs than men (15.9 versus 12.6), although men experienced a steeper decline (AAPC: −2.7%). Non-Hispanic (NH) Blacks reported the highest AAMR at 16.9, while NH Whites demonstrated the most considerable decline (AAPC: −2.7%, p < 0.01). AAMRs varied considerably, ranging from 27 in Mississippi to 6 in New York, with the Northeast region reflecting the most significant decline (AAPC: −3.5%). Furthermore, rural areas displayed higher AAMRs than urban regions (19.4 versus 14.3), although both populations exhibited declining trends. Conclusions: Stroke mortality in AD patients has decreased but remains unevenly distributed, especially among women, NH Black individuals, rural communities, and Western U.S. residents. Targeted interventions are essential.