Trends and disparities in population-based cerebrovascular disease-related mortality involving diabetes in the United States (1999-2023) and forecasts to 2035: a CDC WONDER analysis.

AIMS: To examine national trends and demographic/geographic disparities in population-based cerebrovascular disease (CeVD)-related mortality involving diabetes mellitus (DM) among US adults from 1999 to 2023, and secondarily forecast trajectories to 2035.

METHODS

CDC WONDER Multiple Cause of Death data for US adults aged ≥ 25 years were analyzed. Deaths involving both CeVD and DM were identified using ICD-10 codes I60-I69 and E10-E14. Population-based crude and age-adjusted mortality rates (AAMRs) per 100,000 US population were calculated. Trends were assessed using Joinpoint regression, and future trajectories were explored with ETS and ARIMA models.

RESULTS

Among 1,968,204 DM-related deaths, 827,181 (42.03%) also involved CeVD. Population-based CeVD-related mortality involving DM declined from 1999 to 2011, plateaued during 2011-2018, increased sharply during 2018-2021, and partially declined thereafter. Younger adults showed less favorable trends; non-Hispanic Black adults, the South, and nonmetropolitan areas remained disproportionately affected. Exploratory ETS and ARIMA models suggested possible renewed increases by 2035, with widening prediction intervals.

CONCLUSIONS

Population-based CeVD-related mortality involving DM improved early but worsened around the COVID-19 period. Persistent disparities and uncertain forecasts support continued surveillance, improved cardiometabolic risk management, and equitable prevention strategies.