Abstract Body (Do not enter title and authors here):
Abstract:
Background: Globally, more than 350 million people are affected by chronic kidney disease (CKD), a sinister condition associated with poor cerebrovascular outcomes, such as stroke. They share a number of risk factors, including diabetes mellitus (DM) and hypertension (HTN). The co-occurrence of CKD and stroke are responsible for higher mortality rates and soaring healthcare costs for affectees. The limited understanding of multi-decade linear national mortality trends among stroke patients with CKD leaves a lot to be desired. With an emphasis on socio-demographic stratification and regional inequalities, this study assesses nation-wide trends in mortality among individuals with co-occurring CKD and stroke in the United States (U.S.), from 1999 to 2023.
Methods: Death certificate information from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) multiple cause of death database was used in this retrospective observational research. N18 (CKD) and I64 (stroke) were the ICD-10 codes utilized to identify our targeted individuals. We computed and stratified data on the basis of age, sex, race/ethnicity, geographic location and degree of urbanization, to get the age-adjusted mortality rates (AAMR) per 1,000,000 people. The study employed Joinpoint regression to estimate annual percentage changes (APC) with 95% confidence intervals and assess temporal patterns.
Results: The overall mortality rate associated with CKD in stroke patients dropped from 1999 to 2009. It was followed by a period of growth till 2012. A short period of decline (2013-2015) was followed by a progressive increase till 2023 again. The trend for male patients showed a steady decline. However, we note that the temporal swings for women were greater. The highest AAMRs were seen among non-Hispanic (NH) Black people and older persons. Similarly, the non-metropolitan areas and regions in the South were affected to a greater degree. Disparities based on sex, race and geography were persistent over the study period.
Conclusion: The co-existence of stroke and CKD mortality exhibits a complicated temporal pattern with periods of growth and decline. This is underpinned by persistent differences in trends based on geographical and demographic disparities. Our conclusions arrive at the necessity of a targeted public health approach, geared towards reducing the persistent disparities and systemic inequities.