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. 2025 Nov:141:111592.
doi: 10.1016/j.jocn.2025.111592. Epub 2025 Sep 4.

Disparities in pediatric stroke-related mortality in the United States: Insights from the CDC WONDER database

Waleed Tariq  1 , Shahzaib Ahmed  2 , Sophia Ahmed  3 , Eeman Ahmad  4 , Neha Waseem  5 , Hoor Ul Ain  6 , Shkaib Ahmad  7
Affiliations

Disparities in pediatric stroke-related mortality in the United States: Insights from the CDC WONDER database

Waleed Tariq et al. J Clin Neurosci. 2025 Nov.

Abstract

Objective: Stroke is a rare but significant cause of mortality among the pediatric age group. Despite advances in treatment, disparities in stroke-related mortality persist. We aim to analyze stroke-related mortality among pediatric age groups in the US for over two decades.

Methods: This retrospective cross-sectional study utilized the CDC WONDER database for stroke-related mortality in children (≤ 14 years). Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Annual percent changes (APC) with 95 % confidence intervals (CI) were determined from Joinpoint regression (Joinpoint Regression Program V 5.2.0).

Results: From 1999 to 2020, a total of 15,512 deaths in the United States pediatric-stroke-related mortality were reported. An overall decrease in AAMR was observed, from 1.26 in 1999 to 1.02 in 2020. Males had higher AAMR (1.28) than females throughout the period (1.03). Across regions, the Midwest had the highest AAMR (1.24), followed by the South (1.23), the West (1.17), and the Northeast (0.95). Non-Hispanic (NH) Black or African American group had the highest AAMR (1.97) followed by Hispanic or Latinos (1.08), NH Whites (1.00), and NH Asian or Pacific Islanders exhibited the lowest AAMR (0.94). The CMR per 100,000 was noted to be the highest for the <1 year age group (CMR: 8.14) while the 5-14 years group demonstrated the lowest crude rate (CMR: 0.56). Upon urbanization, the highest AAMR was observed in large central metro areas (1.23) while large fringe metro areas had the lowest AAMR (1.02). The highest AAMRs state-wise were observed in Alaska (1.79), South Dakota (1.77), and the District of Columbia (1.75).

Conclusion: An increase in mortality trends was observed from 2012 onwards with males, infants, and African American children being the high-risk groups. A multifaceted approach, focusing on prevention, early recognition, and optimized management is required to mitigate pediatric-stroke-related mortality.

Keywords: Epidemiology; Mortality; Pediatric; Stroke.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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