Abstract Body (Do not enter title and authors here): Introduction: Stroke is one of the leading causes of morbidity and mortality in the United States resulting in significant health and socioeconomic burden. Accordingly, examining the temporal trends of stroke is essential for the development of effective stroke management strategies and prevention.

Research question: Is there a change in stroke mortality trends in the United States over the past 3 decades?

Aim: To investigate trends in stroke mortality in the United States over the past three decades, focusing on gender and age-specific variations.

Methods: We analyzed the Global Burden of Diseases 2019 database for stroke mortality trends stratified by age and gender. Trends were expressed using annual percentage change (APC) and average APC (AAPC) calculated via Joinpoint Trend Analysis Software (v5.2.0, NCI).

Results: A total of 4,968,927 stroke-related mortality were reported during the time period of 1990-2019. An overall decline in the stroke-related death has been identified, with females displaying a declining mortality from 1990 to 2019 with AAPC of -0.238 (95%CI: -0.291 to -0.183; p<0.001). Additionally. a declining mortality among all age groups has been identified, that is most significantly in the age group of under 50 years of age (AAPC -0.611, 95%CI: -0.655 to -0.565; p<0.001) followed by the 50-74 years of age ((AAPC -0.307, 95%CI: -0.332 to -0.277; p<0.001) and the 75 years and older group (AAPC -0.220, 95%CI: -0.283 to -0.1512; p<0.001).

Conclusion: Temporal trends for the past 3 decades in the United States demonstrates a slightly reassuring decline in stroke mortality across the female gender and all age groups. However, more research is warranted to compare to global trends and identify the driving factors behind these trends in the United States.