Temporal trends and disparities in stroke mortality among adults with chronic kidney disease in the United States, 1999-2020

doi:10.5527/wjn.v14.i4.114871

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World Journal of Nephrology

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2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Nephrol. Dec 25, 2025; 14(4): 114871
Published online Dec 25, 2025. doi: 10.5527/wjn.v14.i4.114871

Temporal trends and disparities in stroke mortality among adults with chronic kidney disease in the United States, 1999-2020

Muhammad Ibrahim, Malik Aqeel Ahmad, Ayesha Mansoor, Husnain Ali, FNU Sahil

Muhammad Ibrahim, Department of Nephrology, Faisalabad Medical University, Faisalabad 38000, Punjab, Pakistan

Malik Aqeel Ahmad, Department of Pediatrics, Faisalabad Medical University, Faisalabad 38000, Punjab, Pakistan

Ayesha Mansoor, Husnain Ali, Department of Medicine, Faisalabad Medical University, Faisalabad 38000, Punjab, Pakistan

FNU Sahil, Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Sindh, Pakistan

Author contributions: Ibrahim M contributed to conceptualized and designed the study, performed data extraction from the CDC WONDER database, conducted statistical analysis, interpreted the results, and drafted and revised the manuscript; Ahmad MA contributed to contributed to data interpretation, assisted in drafting the discussion section, and critically reviewed the manuscript for intellectual content; Mansoor A contributed to contributed to study design, wrote the study setting, and participated in manuscript revision; Ali H contributed to assisted in data cleaning and validation, created tables and figures, and reviewed the results for accuracy and clarity; Sahil F contributed to supervised the study process, provided methodological guidance, reviewed the manuscript critically, and approved the final version for submission.

Institutional review board statement: This study utilized publicly available, de-identified data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. As the data are aggregated, anonymized, and do not involve identifiable human participants, biological materials, or private information, institutional review board (IRB) approval and informed consent were not required. This exemption aligns with the ethical standards set forth in the 1964 Declaration of Helsinki and its later amendments.

Informed consent statement: As the data are aggregated, anonymized, and do not involve identifiable human participants, biological materials, or private information, informed consent were not required.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

Data sharing statement: All data used in this study are publicly available through the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) platform. The dataset can be accessed freely at https://wonder.cdc.gov/.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Muhammad Ibrahim, MD, Academic Fellow, Researcher, Senior Researcher, Department of Nephrology, Faisalabad Medical University, Faisalabad - Samundri Road, Faisalabad 38000, Punjab, Pakistan. mi0100042@gmail.com

Received: September 30, 2025
Revised: October 26, 2025
Accepted: November 14, 2025
Published online: December 25, 2025
Processing time: 84 Days and 11.7 Hours

Abstract

BACKGROUND

Chronic kidney disease (CKD) is a major independent stroke risk factor. This study characterizes 22-year national trends and disparities in stroke mortality among United States adults with CKD.

AIM

To evaluate 22-year national trends and demographic disparities in stroke mortality among United States adults with CKD to inform targeted strategies for reducing cerebrovascular risk in this vulnerable population.

METHODS

Using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Multiple Cause-of-Death data (1999-2020), we analyzed stroke deaths (underlying cause) with CKD (contributing cause) among adults ≥ 25 years. Age-adjusted mortality rates per 100000 population were calculated. Joinpoint regression estimated annual percentage changes (APCs) and average APCs with 95% confidence intervals, stratified by sex, race/ethnicity, region, and urbanization.

RESULTS

Among 37308 stroke deaths with CKD, the overall age-adjusted stroke mortality rates (AAMR) declined from 1.08 (95%CI: 1.03-1.13) in 1999 to 0.71 (95%CI: 0.68-0.75) in 2020 (average annual percent change: -1.79%). Significant trends included a decline from 1999-2009 (APC: -4.25%), followed by an increase from 2009-2012 (APC: 23.25%), a sharp decline from 2012-2015 (APC: -28.10%), and another increase from 2015-2020 (APC: 8.72%). Males had higher mortality than females (AAMR 0.79 vs 0.71). Non-Hispanic Black individuals had the highest AAMR (1.95), followed by Hispanic (0.87) and Non-Hispanic White individuals (0.63). Regionally, the West had the highest AAMR (0.89). State-level mortality varied more than three-fold (District of Columbia: 1.27 vs Arizona: 0.38). Small metropolitan areas had the highest urbanization-stratified AAMR.

CONCLUSION

While stroke mortality among United States adults with CKD significantly declined over two decades, reflecting improvements in prevention and management, substantial disparities persist. The findings underscore the critical need for targeted public health interventions to address underlying biological, structural, and systemic determinants of cerebrovascular risk in this vulnerable population.

Keywords: Stroke; Chronic kidney disease; Epidemiology; Mortality; CDC WONDER

Core Tip: This national study examines 22-year trends in stroke mortality among United States adults with chronic kidney disease (CKD), a high-risk population often overlooked in cerebrovascular research. Using population-level mortality data, we identified periods of both decline and resurgence in mortality, along with striking disparities by sex, race/ethnicity, region, and urbanization. Non-Hispanic Black individuals and residents of small metropolitan areas experienced the greatest burden. These findings highlight evolving epidemiologic patterns and the urgent need for targeted, equity-driven interventions to reduce stroke mortality in adults with CKD.