Abstract Body (Do not enter title and authors here): Background
Chronic kidney disease (CKD) contributes to an increased risk and severity of cerebrovascular accidents. The mortality trends related to these two conditions have not been extensively investigated in the literature. Recognizing these trends can help clinicians better manage patients with these highly prevalent conditions. Given the limited data, this study explores the contemporary mortality trends among adult American patients (≥25 years) with coexisting CKD and cerebrovascular disease from 1999 to 2019.
Methods
We analyzed death data using the CDC WONDER database. We extracted the age-adjusted mortality rates (AAMR) per 100,000 population from 1999 to 2019. CKD was identified using ICD-10 code N18. Cerebrovascular disease was identified using the ICD-10 codes I160-I69. We included those mortalities in the analysis where both cerebrovascular disease and CKD were the contributing or underlying cause of death. Trends were analyzed by year, age, sex, race and ethnicity, census region, state, and metropolitan status. Joinpoint regression was used to calculate the annual percent change (APC) in AAMR with 95% confidence intervals.
Results
During the study period, a total of 131,774 deaths occurred in patients with concomitant CKD and cerebrovascular disease, with an overall AAMR of 2.93 per 100,000. The AAMR remained almost stable over the study period, that is, 3.56 in 1999 to 2.73 in 2019 (APC: -1.53, p = 0.085). Men had a higher AAMR (3.55) than women (2.53). The old age subgroup, that is, ≥65 years, had the highest AAMR (12.51). Racial disparities showed that Black/African Americans had the highest AAMR (7.42), followed by American Indian/Alaska Natives (4.10), Hispanics/Latinos (3.29), Asians/Pacific Islanders (3.02), and Whites (2.33). Significant geographic variation was observed, with the South region (3.21) and the state of Alabama (5.6) exhibiting the highest AAMR. Non-metropolitan areas had a higher AAMR (3.13) than metropolitan areas (2.89).
Conclusion
The mortality related to coexisting stroke and CKD has been stable from 1999 to 2019. This study also highlights several notable sociodemographic disparities in the mortality trend. Further investigation is warranted to address these disparities among these vulnerable sociodemographic groups.