Temporal trends and disparities in stroke mortality among adults with chronic kidney disease in the United States, 1999-2020
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND Chronic kidney disease (CKD) is a major independent stroke risk factor. This study characterizes 22-year national trends and disparities in stroke mortality among United States adults with CKD. AIM To evaluate 22-year national trends and demographic disparities in stroke mortality among United States adults with CKD to inform targeted strategies for reducing cerebrovascular risk in this vulnerable population. METHODS Using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Multiple Cause-of-Death data (1999-2020), we analyzed stroke deaths (underlying cause) with CKD (contributing cause) among adults ≥ 25 years. Age-adjusted mortality rates per 100000 population were calculated. Joinpoint regression estimated annual percentage changes (APCs) and average APCs with 95% confidence intervals, stratified by sex, race/ethnicity, region, and urbanization. RESULTS Among 37308 stroke deaths with CKD, the overall age-adjusted stroke mortality rates (AAMR) declined from 1.08 (95%CI: 1.03-1.13) in 1999 to 0.71 (95%CI: 0.68-0.75) in 2020 (average annual percent change: -1.79%). Significant trends included a decline from 1999-2009 (APC: -4.25%), followed by an increase from 2009-2012 (APC: 23.25%), a sharp decline from 2012-2015 (APC: -28.10%), and another increase from 2015-2020 (APC: 8.72%). Males had higher mortality than females (AAMR 0.79 vs 0.71). Non-Hispanic Black individuals had the highest AAMR (1.95), followed by Hispanic (0.87) and Non-Hispanic White individuals (0.63). Regionally, the West had the highest AAMR (0.89). State-level mortality varied more than three-fold (District of Columbia: 1.27 vs Arizona: 0.38). Small metropolitan areas had the highest urbanization-stratified AAMR. CONCLUSION While stroke mortality among United States adults with CKD significantly declined over two decades, reflecting improvements in prevention and management, substantial disparities persist. The findings underscore the critical need for targeted public health interventions to address underlying biological, structural, and systemic determinants of cerebrovascular risk in this vulnerable population.
Source: World Journal of Nephrology
Institution: Liaquat University of Medical & Health Sciences
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7116723282