Trends in Cerebrovascular Disease and Diabetes Mellitus-Related Mortality in the United States from 1999 to 2020: An integrated Analysis of Comorbid Mortality
Fatima Hussain1, Abeer Tahir2, Syed Nubaid Hussain1, Ahmed Raza3, Hamza Ahmed1, Emaan Majed4
1Medicine, Dow International Medical College, 2Medicine, Rawal Institute of Health Sciences, 3Medicine, Services Institute of Medical Sciences, 4Medicine, FMH College of Medicine & Dentistry
Objective:
To analyze trends in cerebrovascular disease mortality among diabetic adults in the U.S. from 1999 to 2020, focusing on demographic and regional disparities.
Background:
Diabetes increases the risk of cerebrovascular diseases 2 to 6 times by promoting endothelial dysfunction, atherosclerosis, oxidative stress, and hypercoagulability; and significantly increases the risk of mortality. However, the mortality patterns in patients with diabetes and cerebrovascular diseases remain unexplored.
Design/Methods:
Using the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database, a retrospective comorbid analysis of death certificate data was conducted for cerebrovascular disease (ICD I60-I69) in diabetic adults (>25; ICD E10-E14), spanning from 1999 to 2020. Joinpoint analysis was utilized to determine the age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC) with a 95% confidence interval.
Trends were stratified by sex, race/ethnicity, and region.
Results:
The study identified 696,849 cerebrovascular-related deaths among adults with diabetes mellitus from 1999 to 2020, with an average AAMR of 14.7. AAMRs declined steadily until 2018 (APC: -4.1), reaching 12.3, then rose, peaking at 16.04 by 2020 (APC: 14.1). Males, who accounted for 46.4% of total deaths, had higher average AAMRs (16.7) compared to females (13.6), though both showed significant downward trends (AAPC: -1.7 for males vs. -0.9 for females). Among racial groups, non-Hispanic (NH) Blacks had the highest AAMRs (29.3), while NH Whites had the lowest (13.4). Regionally, the West had the highest average AAMR (16.0), with non-metropolitan areas exhibiting elevated rates (17.8). Mississippi recorded the highest state-specific AAMR (24.2), while Nevada had the lowest (7.2).
Conclusions:
These findings reveal a significant decline in cerebrovascular disease mortality in diabetes mellitus patients in the US. However, disparities exist, with males, NH Blacks, the Western region, and non-metropolitan areas exhibiting the highest mortality burden. This highlights the need for targeted interventions to address these disparities.
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