Rising stroke mortality in the wake of COVID-19: unraveling the long-term impact of the pandemic on cerebrovascular health

Evidence indicates that the risk of stroke has increased during the ongoing coronavirus disease 2019 (COVID-19) pandemic. This study aims to analyze recent trends in stroke mortality in the United States from 2018 to 2024. Data from the US Centers for Disease Control and Prevention National Center for Health Statistics (2018–2024) were analyzed using ICD-10 codes I63.X (ischemic stroke) and U07.1 (COVID-19). Age-adjusted death rates and cumulative excess mortality were calculated, with pre-pandemic years (2018–2019) as a baseline. The age-adjusted stroke death rates rose from 8.50×100,000 in 2018 to 11.76×100,000 in 2024, with a total of 45,847 excess stroke deaths recorded between 2020-2024 compared to the pre-pandemic period. Among these, COVID-19-associated stroke deaths accounted for 9,143 fatalities, representing 4.7% of total stroke mortality during the same period. Notably, COVID-19-associated stroke deaths contributed to nearly 20% of all excess stroke deaths from 2020 to 2024. However, the proportion of excess stroke deaths attributable to COVID-19 declined over time, starting at 50% in 2020 and decreasing progressively to 3% by 2024. While early pandemic mortality was driven by prothrombotic effects of COVID-19, the continued increase in stroke deaths indicates long-term impacts, including delayed management of cardiovascular risk factors and possible long-COVID effects. These findings underscore the need for enhanced preventive care and robust stroke management systems to address the ongoing cerebrovascular burden.