Abstract TP004: Mortality Trends in Rheumatoid Arthritis–Associated Stroke in Adults Aged ≥55: An Analysis of the CDC WONDER Database, 1999–2023

Introduction: Rheumatoid arthritis (RA) is associated with increased risks of ischemic and hemorrhagic stroke. This study evaluated national mortality trends due to RA and stroke among U.S. adults aged ≥55 from 1999 to 2023, with emphasis on demographic and geographic disparities. Methods: Mortality data were obtained from the CDC WONDER database. Deaths listing RA (ICD-10: M06) and stroke (ICD-10: I60–I69) as multiple causes of death were analyzed. Age-adjusted mortality rates (AAMRs) per 1,000,000 were calculated. Temporal trends were examined using Joinpoint regression to estimate annual percentage changes (APCs) and average annual percentage changes (AAPCs) with 95% confidence intervals (CIs). Subgroup analyses included sex, race/ethnicity, census region, and urbanization. Results: From 1999–2023, RA-associated stroke accounted for 19,505 deaths. Overall mortality declined from 16.9 to 10.9 per 1,000,000, with an AAPC of –1.7% (95% CI: –2.8 to –0.6; p=0.003). Declines were observed from 1999–2010, stabilization occurred from 2010–2018, and a recent increase emerged after 2018. Men had higher mortality than women, though both groups showed significant declines over time. By race, non-Hispanic Whites had the highest mortality, while Hispanics showed early declines followed by later fluctuations. Regionally, the Midwest and West demonstrated the greatest reductions. By urbanization, medium metropolitan areas saw the largest declines, while non-metropolitan areas showed the least improvement. Conclusion: Mortality from RA-associated stroke has decreased overall since 1999 but has risen again in recent years, with persistent disparities across sex, race, region, and urbanization. In conclusion, these findings emphasize the need for targeted prevention strategies and equitable healthcare access to improve outcomes in high-risk populations.