Stroke remains the fifth leading cause of mortality in the United States. Understanding trends in the location of death for ischemic stroke patients is crucial for improving end-of-life care and addressing healthcare inequities.

In the new study, researchers examined trends in ischemic stroke mortality using cause-of-death records spanning 1999 to 2020 from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. The analysis included 237,617 recorded ischemic stroke deaths.

The study found that age-adjusted ischemic stroke mortality rates, after years of decline, have increased across all urbanization levels since 2009, with the most pronounced rises in non-metropolitan areas. Additionally, there has been a noticeable shift in the place of death, with more people dying at home instead of in hospitals or other medical facilities. From 1999 to 2020, the percentage of at-home deaths increased from 8.44% to 29.31%. The trend away from specialized stroke care was particularly prominent among Black/African American individuals and those living in rural areas.

The authors note that it is unclear whether the shifts toward dying at home are due to personal preference or to insufficient access to hospital-based or specialized care. They conclude that rising stroke mortality and increased reliance on home-based end-of-life care call for new assessments of the factors that impact stroke outcomes.

The authors add: “Our study reveals a striking shift in where people are dying from ischemic stroke in the U.S. — with a clear trend toward more deaths occurring at home and fewer in hospitals. We also found that rural and minority populations are disproportionately affected, often dying in less specialized settings due to persistent gaps in access to care. These trends reflect evolving preferences in end-of-life care but also highlight urgent disparities that require targeted health policy interventions.”