Abstract Body: Background: Chronic kidney disease (CKD) is an important risk factor for cerebrovascular disease (CVA), contributing to silent CVA and worsening outcomes.

Hypothesis: In our study, we analyze trends and disparities to uncover evolving patterns and healthcare inequities over a 25-year period (1999-2023) for individuals with both these conditions.

Methods: We analysed CDC Wonder data for adults aged 25+, using ICD-10 codes N18 and I60-I69. Age- adjusted mortality rates (AAMRs) were calculated per 100,000. Joinpoint regression was used to determine annual and average annual percentage change (APC & AAPC), with statistical significance defined as 95% CI excluding zero (p < 0.05). Forecasting was performed using ARIMA models to estimate future trends.

Results: A total of 167,558 deaths were reported from 1999 (3.56) to 2023 (3.23). AAMR fell to 2.40 in 2009, doubled till 2012 (4.82), fell to 2.18 in 2015 and rose to 3.23 in 2023 [APC: 7.74 (95% CI, 5.44 – 10.08)]. Females had slightly more deaths (50.46%), but males had a higher trending AAMR, starting from 4.26 and ending at 3.78 vs females (3.18 to 2.83). Both followed the pattern of the overall population with similar rise and fall. NH Blacks had the highest trending AAMR, starting from 11.72, ending at 6.34. NH Whites, NH Blacks and NH Asians followed the trend of the overall population. Hispanics saw their AAMR rise slightly from 1999 (4.82) to 2012 (5.89), after which it followed the overall population’s trend. All races had an overall declining mortality. Individuals aged 65+ had the highest deaths (83.07%) and the highest trending AAMR that remained stable overall, averaging at 12.94. All other age groups experienced an overall decline. AAMR for different regions had no overall change but observed the fluctuating pattern followed by the rest. South had the highest deaths (39.77%) and AAMR average (3.32), followed by Midwest (23.20%) (3.10), West (22.54%) (3.18) and Northeast (14.49%) (2.21). Urbanization data and states data, limited to 2020, revealed more deaths in metropolitan areas (68.13%) but a lower total AAMR (2.91) than nonmetropolitan ones (3.14). District of Columbia (4.55), North Dakota (4.47), West Virginia (4.47), South Carolina (4.44) and North Carolina (4.22) were the states in the 90th percentile.

Conclusion: Sudden big changes were observed in AAMR from 2009-2015, with an increasing mortality observed thereafter. Males, NH Blacks and 65+ adults are at an increased risk.