Stroke deaths and their racial disparities increased over last 20 years

People in the U.S. – especially racial minorities and rural residents – are increasingly dying of ischemic stroke at home without access to end-of-life stroke care

PLOS

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

 

image: 

Age-adjusted death rates for ischemic strokes classified by race. 1999-2020. The graph shows the trends in age-adjusted death rates per 100,000 people for Asian/Pacific Islander (blue), Black/African American (orange), and White (green) populations. Data were obtained from the CDC WONDER database. Age-adjusted rates were calculated using the 2000 U.S. standard population.

view more 

Credit: Lim et al., 2025, PLOS One, CC-BY 4.0 (https://creativecommons.org/licenses/by/4.0/)

Over the last two decades, ischemic stroke mortality rates in the U.S. have grown, with almost 3 in 10 deaths occurring at home, and increases particularly among racial minorities and rural residents. These growing disparities were among the findings of a new study publishing April 9, 2025, in the open-access journal PLOS One by Jason Lim of Georgetown University School of Medicine, U.S., and colleagues.

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.”

 

 

In your coverage, please use this URL to provide access to the freely available article in PLOS One: https://plos.io/4ja5VhZ

Citation: Lim JK, Pagnotta J, Lee R, Lim DH, Breton JM, Abecassis ZA, et al. (2025) Trends and disparities in ischemic stroke mortality and location of death in the United States: A comprehensive analysis from 1999–2020. PLoS ONE 20(4): e0319867. https://doi.org/10.1371/journal.pone.0319867

Author countries: U.S.

Funding: Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Aeaean Advisers, Metis Innovative, Genomadix, AIDoc and Arsenal Medical; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, Synchron and Hyperion Surgical; editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Arsenal Medical. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.

Percent of deaths for ischemic strokes classified by location of death, by year. 1999-2020. The graph displays the percentage of deaths occurring in different locations over time. Data were obtained from the CDC WONDER database. Locations of death include Decedent’s home, Hospice facility, Medical Facility - Dead on Arrival, Medical Facility - Inpatient, Medical Facility - Outpatient or ER, Medical Facility - Status unknown, Nursing home/long term care, Other, and Place of death unknown.

Credit

Lim et al., 2025, PLOS One, CC-BY 4.0 (https://creativecommons.org/licenses/by/4.0/)

Journal

PLOS One

DOI

10.1371/journal.pone.0319867 

Method of Research

Observational study

Subject of Research

People

Article Title

Trends and disparities in ischemic stroke mortality and location of death in the United States: A comprehensive analysis from 1999–2020

Article Publication Date

9-Apr-2025

COI Statement

Dr. Michael R. Levitt has received unrestricted educational grants from Medtronic and Stryker; has consulting agreements with Aeaean Advisers, Metis Innovative, Genomadix, AIDoc and Arsenal Medical; holds equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, Synchron and Hyperion Surgical; serves on the editorial board of Journal of NeuroInterventional Surgery; and is on the Data Safety Monitoring Board of Arsenal Medical. These competing interests do not alter our adherence to PLOS ONE policies on sharing data and materials, as there are no patents or products related to this submission.

 

Working to Preserve .Gov Websites Every four years, before and after the U.S. presidential election, the Internet Archive works with libraries and research organizations to preserve material from U.S. government websites during administration transitions. The project preserves a record of administrative changes over time, which researchers, journalists, students, and citizens from across the political spectrum rely on to help understand changes in policy, regulations, staffing, and other dimensions of the U.S. government.  Since 2004, these "End of Term" (EOT) Web Archive projects have documented transitions, and the ongoing 2024/2025 EOT crawl has already collected over 500 terabytes of material, including more than 100 million unique web pages. This valuable information is preserved and available for public access at the Internet Archive. Web archiving is more than just preserving history—it's about ensuring access to information for future generations.  As a nonprofit library, we are proud of our status as an unbiased repository of digital culture. We couldn’t achieve this without the support of monthly donors like you. Your consistent donations have helped us grow, improve, and become the vital resource that we are today. Visit the EOT Web Archive Take a Virtual Tour of the Internet Archive with Brewster Kahle What is a PetaBox? How does the Internet Archive digitize 3000 books a day? What is with all the statues? If you have never stepped inside our main campus at 300 Funston Street, I assure you it is worth a visit. For those who can't make it to San Francisco for our weekly Friday tour, enjoy this virtual tour of Internet Archive HQ led by our founder and Head Librarian, Brewster Kahle. Tour the Internet Archive

 

Rising sea temperatures may promote loggerhead sea turtle nesting on Italy’s coastline, per analysis of citizen science data, highlighting importance of preserving natural beaches

PLOS

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

 

image: 

Loggerhead Sea Turtle (Caretta caretta).

view more 

Credit: Brian Gratwicke, Flickr, CC-BY 2.0 (https://creativecommons.org/licenses/by/2.0/)

Rising sea temperatures may promote loggerhead sea turtle nesting on Italy’s coastline, per analysis of citizen science data, highlighting importance of preserving natural beaches

 

 

Article URL: https://plos.io/41WgrDW

Article title: Modeling the impacts of natural and human factors on the hatching success of the loggerhead sea turtle Caretta caretta along the coasts of Italy

Author countries: Italy

Funding: This scientific activity was performed within the iNEST (Interconnected Nord-Est Innovation Ecosystem) project and received funding from the European Union NextGenerationEU (National Recovery and Resilience Plan – NRRP, Mission 4, Component 2, – D.D. 1058 23/6/2022, ECS00000043 - CUP: C43C22000340006) to LC, CC. In the case of AB, this study was also partly carried out within the RETURN Extended Partnership and received funding from the European Union NextGenerationEU (National Recovery and Resilience Plan – PNRR, Mission 4, Component 2, Investment 1.3—D.D. 1243 2/8/2022, PE00000005); AB, CC, SM and CM also gratefully acknowledges the support of the National Biodiversity Future Center—NBFC, funded under the National Recovery and Resilience Plan (NRRP), Mission 4 Component 2 Investment 1.4 - Call for tender No. 3138 of 16 December 2021, rectified by Decree n.3175 of 18 December 2021 of Italian Ministry of University and Research funded by the European Union NextGenerationEU (Project code CN_00000033, Concession Decree No. 1034 of 17 June 2022 adopted by the Italian Ministry of University and Research, Project title “National Biodiversity Future Center - NBFC”).

---

Journal

PLOS One

DOI

10.1371/journal.pone.0320733 

Article Title

Modeling the impacts of natural and human factors on the hatching success of the loggerhead sea turtle Caretta caretta along the coasts of Italy

Article Publication Date

9-Apr-2025

ABOLISH PRISONS

Incarcerated individuals and those with recent criminal-legal involvement report significantly higher rates of mental health diagnoses than other community members, calling for reforms in community mental health support

Survey results underscore the damaging phenomenon of criminalization of mental illness in the United States

PLOS

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

A new national epidemiological survey provides a demographic and diagnostic picture of people living with mental ill health in prison, those with criminal legal involvement in the last year, and those with no criminal legal history in the last year—finding significantly higher rates of five mental health conditions in incarcerated individuals and individuals with recent criminal legal history. The results are described in a study published on April 9, 2025 from Jeffrey Swanson of Duke University School of Medicine, United States, and colleagues.

In the second half of the 20th century, large public mental health institutions in the United States began to close and rates of mass incarceration increased. Today, individuals involved with the criminal legal system in the US have much higher rates of diagnosed mental ill health than the general US population, though studies around this topic are limited in scope and/or validity. Here, Swanson and co-authors attempt to refine the national picture of the psychiatric diagnostic and demographic profile of justice-involved adults as compared to other adults in the community to better understand the current gaps in community mental health support.

The authors surveyed persons sampled from households, prisons, hospitals, and homeless shelters across the US: currently-incarcerated adults (N=321); adults not incarcerated but involved with the criminal justice system in the past year (N=269); and adults with no criminal legal history in the past year (N=5,004). These semi-structured clinical interviews took place between October 2020 and October 2022, conducted by clinicians with at least a masters-level degree in mental health, social work, or a related field.

The analysis revealed that approximately 40 percent of individuals surveyed with any criminal involvement in the past year met diagnostic criteria for at least one of the following: schizophrenia-spectrum disorder, bipolar 1, obsessive-compulsive disorder, major depression, generalized anxiety disorder, and/or post-traumatic stress disorder. The prevalence of these disorders was highest for people currently incarcerated (42 percent; 95% CI: 33-51 percent), lower in the community resident population with past-year criminal-legal history (37 percent; 95% CI: 25-51 percent), and lowest for individuals with no recent criminal-legal history (24 percent; 95% CI: 22-27).

The authors analyzed demographic representation within the three populations in order to better understand the needs of specific communities and thus inform interventions. They report that within the surveyed participants, men were the significant majority in both the currently incarcerated (93 percent) and recent criminal-legal history groups (70 percent), though the minority (48 percent) in the general community group. They also report that among incarcerated individuals and those with recent criminal legal history, the largest proportion identified as Hispanic/Latino (34 and 44 percent, respectively).

It's critical to remember that these results may not represent the population on a national level and can only show correlation but not necessarily causation. As the authors note, there are many complex racial, class, and societal factors at play in terms of who is incarcerated in the United States. The authors also note they relied on self-reporting, which has implications for transparency - especially when exploring recent criminal-legal history among individuals not currently incarcerated.

Nonetheless, the results underscore the critical need for informed and appropriate care and treatment for individuals who need support for psychiatric conditions as a way to reduce the high rates of incarceration in the United States and better support community members in crisis.

Lead author Jeffrey Swanson, also affiliated with the Wilson Center for Science and Justice at Duke Law School, adds: “We found that schizophrenia-spectrum disorders were at least three times more common in prison than in people who hadn’t been arrested or incarcerated in the past year.  Prison is no place to recover from such a serious illness. What’s new about this study is more specific diagnostic information to help address the U.S. mental health crisis where we find it.”

####

In your coverage please use this URL to provide access to the freely available article in PLOS Mental Health: https://plos.io/42uec9Y

Citation: Swanson JW, Stenger M, Easter MM, Bareis N, Chwastiak L, Dixon LB, et al. (2025) Mental disorders and criminal legal involvement: Evidence from a national diagnostic epidemiological survey. PLOS Ment Health 2(4): e0000257. https://doi.org/10.1371/journal.pmen.0000257

Author Countries: United States

Funding: This work was supported by the Substance Abuse and Mental Health Services Administration (SAMHSA, Grant/Award Number: H79FG000030 (authors: HG, MJE); the National Institute of Mental Health (NIMH) grant ID: K23 MH129628 (author: NB), the Elizabeth K. Dollard Charitable Trust (authors: JS, MS, MSS, MME), and the Wilson Center for Science and Justice (authors: JS, MS, MSS, MME). The funders had no role in the conceptualization, design, data collection, analysis, decision to publish or preparation of the manuscript.

---

Journal

PLOS Mental Health

DOI

10.1371/journal.pmen.0000257 

Method of Research

Survey

Subject of Research

People

Article Publication Date

9-Apr-2025

 

A new robotic gripper made of measuring tape is sizing up fruit and veggie picking

University of California - San Diego

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

 

image: 

The gripper can pick a wide variety of objects, including fruit. 

view more 

Credit: David Baillot/University of California San Diego

It’s a game a lot of us played as children—and maybe even later in life: unspooling measuring tape to see how far it would extend before bending. But to engineers at the University of California San Diego, this game was an inspiration, suggesting that measuring tape could become a great material for a robotic gripper. 

The grippers would be a particularly good fit for agriculture applications, as their extremities are soft enough to grab fragile fruits and vegetables, researchers wrote. The devices are also low-cost and safe around humans.

The team published their process and design in the journal Science Advances on April 9, 2025. They call their robot GRIP-tape, with GRIP serving as an acronym for Grasping and Rolling In-Plane. 

Building the ideal robotic gripper is still a work in progress. Existing grippers that can expand are bulky because they need additional mechanisms to get gripping appendages to expand. The gripper the UC San Diego team developed solves this problem. 

That’s because the tape is both robust and flexible; can be stored in a small container when retracted; and can reach far when extended. After a series of trial-and-error experiments, the engineers determined that the best configuration for a gripper is actually two of the tapes bound together with adhesive. 

”We like to look for non-traditional, non-intuitive robot mechanisms. The tape measure is such a wonderful structure because of its combined softness and stiffness together,” said Nick Gravish, the paper’s senior author and a faculty member in the UC San Diego Department of Mechanical and Aerospace Engineering. 

The gripper has two “fingers,” made of two spools–each made of two rolls of measuring tape bound together. Each spool is rolled up, in a compact configuration, with only a small part extending out in a triangle shape to form a finger. These triangle sections are controlled by four motors each that control the finger’s motion. Each finger can move independently. The triangle sections can lengthen to reach objects that are farther away. They can also retract to bring objects closer to the robot arm the gripper is mounted on. 

The researchers had already worked with measuring tape as part of a grant from the National Science Foundation to investigate soft materials that could bend while holding their shape. Measuring tape is springy—you can bend it any way you want and it goes back to its original state. It’s also made of steel, which is both robust and durable, as well as thin enough that it won’t damage objects on contact. In fact, it’s as soft as the silicone used in most soft robots. 

The gripper is unique because it uses the whole length of the tape as a gripping surface. The tape can also move to rotate objects or act as a conveyor belt. The gripper can hold a wide range of objects with different shapes and stiffness, from a rubber ball or a single tomato to a whole tomato vine or a lemon. Because the tape itself can act as a conveyor belt, the gripper can then deposit the objects it grasps into containers. 

Because the tape is flexible, it can also navigate the obstacles the gripper might encounter on the way to picking up an object. 

Experiments showed that the gripper could easily lift large fruits like fresh lemons. 

Next versions of the gripper could improve on the original by adding advanced sensors and AI-driven data analysis so that the gripper can operate autonomously. 

The work was partially funded by the National Science Foundation. 

Grasping and Rolling In-plane Manipulation Using Deployable Tape Spring Appendages
Genzhi He, Curtis Sparks and Nicholas Gravish, Department of Mechanical and Aerospace Engineering, UC San Diego Jacobs School of Engineering

Journal

Science Advances

Method of Research

Experimental study

Subject of Research

Not applicable

Article Publication Date

9-Apr-2025

Hopping gives this tiny robot a leg up

MIT engineers developed an insect-sized jumping robot that can traverse challenging terrains and carry heavy payloads.

Massachusetts Institute of Technology

Faceboo

XLinkedInWeChatBlueskyMessageWhatsAppEmail

CAMBRIDGE, MA — Insect-scale robots can squeeze into places their larger counterparts can’t, like deep into a collapsed building to search for survivors after an earthquake.

However, as they move through the rubble, tiny crawling robots might encounter tall obstacles they can’t climb over or slanted surfaces they will slide down. While aerial robots could avoid these hazards, the amount of energy required for flight would severely limit how far the robot can travel into the wreckage before it needs to return to base and recharge.

To get the best of both locomotion methods, MIT researchers developed a hopping robot that can leap over tall obstacles and jump across slanted or uneven surfaces, while using far less energy than an aerial robot.

The hopping robot, which is smaller than a human thumb and weighs less than a paperclip, has a springy leg that propels it off the ground, and four flapping-wing modules that give it lift and control its orientation.

The robot can jump about 20 centimeters into the air, or four times its height, at a lateral speed of about 30 centimeters per second, and has no trouble hopping across ice, wet surfaces, and uneven soil, or even onto a hovering drone. All the while, the hopping robot consumes about 60 percent less energy than its flying cousin. 

Due to its light weight and durability, and the energy efficiency of the hopping process, the robot could carry about 10 times more payload than a similar-sized aerial robot, opening the door to many new applications.

“Being able to put batteries, circuits, and sensors on board has become much more feasible with a hopping robot than a flying one. Our hope is that one day this robot could go out of the lab and be useful in real-world scenarios,” says Yi-Hsuan (Nemo) Hsiao, an MIT graduate student and co-lead author of a paper on the hopping robot.

Hsiao is joined on the paper by co-lead authors Songnan Bai, a postdoc at the City University of Hong Kong; and Zhongtao Guan, an incoming MIT graduate student who completed this work as a visiting undergraduate; as well as Suhan Kim and Zhijian Ren of MIT; and senior authors Pakpong Chirarattananon, an associate professor of the City University of Hong Kong; and Kevin Chen, an associate professor in the MIT Department of Electrical Engineering and Computer Science and head of the Soft and Micro Robotics Laboratory within the Research Laboratory of Electronics. The research appears today in Science Advances.

Maximizing efficiency

Jumping is common among insects, from fleas that leap onto new hosts to grasshoppers that bound around a meadow. While jumping is less common among insect-scale robots, which usually fly or crawl, hopping affords many advantages for energy efficiency.

When a robot hops, it transforms potential energy, which comes from its height off the ground, into kinetic energy as it falls. This kinetic energy transforms back to potential energy when it hits the ground, then back to kinetic as it rises, and so on.

To maximize efficiency of this process, the MIT robot is fitted with an elastic leg made from a compression spring, which is akin to the spring on a click-top pen. This spring converts the robot’s downward velocity to upward velocity when it strikes the ground.

“If you have an ideal spring, your robot can just hop along without losing any energy. But since our spring is not quite ideal, we use the flapping modules to compensate for the small amount of energy it loses when it makes contact with the ground,” Hsiao explains.

As the robot bounces back up into the air, the flapping wings provide lift, while ensuring the robot remains upright and has the correct orientation for its next jump. Its four flapping-wing mechanisms are powered by soft actuators, or artificial muscles, that are durable enough to endure repeated impacts with the ground without being damaged.

“We have been using the same robot for this entire series of experiments, and we never needed to stop and fix it,” Hsiao adds.

Key to the robot’s performance is a fast control mechanism that determines how the robot should be oriented for its next jump. Sensing is performed using an external motion-tracking system, and an observer algorithm computes the necessary control information using sensor measurements.

As the robot hops, it follows a ballistic trajectory, arcing through the air. At the peak of that trajectory, it estimates its landing position. Then, based on its target landing point, the controller calculates the desired takeoff velocity for the next jump. While airborne, the robot flaps its wings to adjust its orientation so it strikes the ground with the correct angle and axis to move in the proper direction and at the right speed.

Durability and flexibility

The researchers put the hopping robot, and its control mechanism, to the test on a variety of surfaces, including grass, ice, wet glass, and uneven soil — it successfully traversed all surfaces. The robot could even hop on a surface that was dynamically tilting.

“The robot doesn’t really care about the angle of the surface it is landing on. As long as it doesn’t slip when it strikes the ground, it will be fine,” Hsiao says.

Since the controller can handle multiple terrains, the robot can easily transition from one surface to another without missing a beat.

For instance, hopping across grass requires more thrust than hopping across glass, since blades of grass cause a damping effect that reduces its jump height. The controller can pump more energy to the robot’s wings during its aerial phase to compensate.

Due to its small size and light weight, the robot has an even smaller moment of inertia, which makes it more agile than a larger robot and better able to withstand collisions.

The researchers showcased its agility by demonstrating acrobatic flips. The featherweight robot could also hop onto an airborne drone without damaging either device, which could be useful in collaborative tasks.

In addition, while the team demonstrated a hopping robot that carried twice its weight, the maximum payload may be much higher. Adding more weight doesn’t hurt the robot’s efficiency. Rather, the efficiency of the spring is the most significant factor that limits how much the robot can carry.

Moving forward, the researchers plan to leverage its ability to carry heavy loads by installing batteries, sensors, and other circuits onto the robot, in the hopes of enabling it to hop autonomously outside the lab.

###

This research is funded, in part, by the U.S. National Science Foundation and the MIT MISTI program. Chirarattananon was supported by the Research Grants Council of the Hong Kong Special Administrative Region of China. Hsiao is supported by a MathWorks Fellowship, and Kim is supported by a Zakhartchenko Fellowship.

---

Journal

Science Advances

DOI

10.1126/sciadv.adu4474 

Article Title

Hybrid locomotion at the insect scale – combined flying and jumping for enhanced efficiency and versatility

Article Publication Date

9-Apr-2025