Evolving trends and disparities in malnutrition-linked stroke mortality in the United States: insights from CDC WONDER data

Stroke and malnutrition remain significant contributors to preventable mortality in the United States. Stroke is a leading cause of death and disability, while malnutrition, often underrecognized, exacerbates neurological and systemic vulnerability. Characterizing long-term national and subgroup-specific mortality patterns is critical for guiding public health interventions. Mortality data for stroke and malnutrition were analyzed from 1999 to 2023 using the CDC WONDER database. Age-adjusted mortality rates (AAMR) per 1,000,000 population were calculated and stratified by sex, race/ethnicity, census region, state and urbanization status. Joinpoint regression estimated average annual percent change (AAPC) with 95% confidence intervals (CIs). From 1999 to 2023, 44,368 deaths were attributed to malnutrition and stroke. The overall AAMR rose from 12.11 in 1999 to 14.75 in 2023, with an overall AAPC of 0.88% (95% CI: −0.14 to 1.91). Males had higher AAMRs than females. By race, Non Hispanic (NH) Black experienced the greatest AAMRs, whereas NH Asian had the lowest rates. Regionally, the South showed the highest rate, whereas Northeast had the lowest. Nonmetropolitan areas exceeded metropolitan areas. At the state level, the highest rates were observed in South Dakota and Arkansas, while Massachusetts recorded the lowest rates. From 1999 to 2023, combined mortality from stroke and malnutrition increased modestly nationwide, with enduring disparities across demographics and geography. The highest burdens fell on NH Black individuals, people living in the South and nonmetropolitan areas, and certain central states. These findings highlight the need for region-specific prevention and better access to nutritional and neurological care.