Trends in Cerebrovascular Disease-Related Mortality and Disparities in the United States: A 25-Year National Cross-Sectional Analysis

Jianjun Ma; Qingmin Zeng; Chang Chen; He Wang; Zhibin Chen

doi:10.3791/71902

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Research Article

Trends in Cerebrovascular Disease-Related Mortality and Disparities in the United States: A 25-Year National Cross-Sectional Analysis

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DOI:

10.3791/71902

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July 24th, 2026

Jianjun Ma^*¹^,² , Qingmin Zeng^*² , Chang Chen³ , He Wang⁴ , Zhibin Chen¹

¹Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, ²Department of Neurology, Zhaotong Third People's Hospital, ³The Clinical Medicine College, Wannan Medical University, ⁴The Second Clinical Medical College, Zhejiang Chinese Medical University

^* These authors contributed equally

Summary

Cerebrovascular disease mortality in the United States declined through 2013, rebounded to 2021, and remained elevated in 2023. Persistent disparities by region, race/ethnicity, state, age, and urbanization highlight the need for equity-oriented stroke prevention and access to high-quality acute and post-stroke care.

Abstract

Cerebrovascular disease remains a leading cause of death in the United States, yet recent mortality trends and inequities across population subgroups remain incompletely characterized. Annual age-adjusted mortality rates (AAMRs; per 100,000 population) for cerebrovascular disease (ICD-10: I60–I69) were extracted from the CDC WONDER Multiple Cause of Death database for 1999–2023, standardized to the 2000 U.S. population. Temporal patterns were summarized using segmented log-linear Joinpoint models and reported as annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). Overall, AAMR declined from 61.61 (95% CI, 61.31 to 61.90) in 1999 to an observed nadir of 36.17 (95% CI, 35.97 to 36.37) in 2013, then increased to 41.14 (95% CI, 40.94 to 41.34) in 2021. The selected national Joinpoint model identified one inflection in 2012, with an APC of −4.28%/year (95% CI, −4.63 to −3.92) during 1999–2012 and an APC of 0.97%/year (95% CI, 0.49 to 1.46) during 2012–2023. AAMR decreased descriptively between 2021 and 2023 (38.96; 95% CI, 38.77 to 39.15), but remained above the 2013 nadir, and no distinct 2021–2023 national segment was selected. In 2023, mortality was highest in the South and lowest in the Northeast; non-Hispanic Black individuals experienced the greatest burden among the reported race/ethnicity groups. State-level AAMRs ranged from 23.96 in New York to 63.50 in Delaware. These findings indicate that the long-term decline in cerebrovascular disease mortality has stalled and partially reversed, with substantial geographic and sociodemographic inequities warranting targeted prevention and equitable access to evidence-based stroke care.

Introduction

Cerebrovascular disease, including stroke, is a leading cause of death and disability worldwide and remains a major driver of preventable health loss. Recent American Heart Association (AHA) statistical updates emphasize the persistent burden of stroke and its risk-factor profile in the United States¹. Globally, the Global Burden of Disease (GBD) Study continues to document substantial stroke-related mortality and disability-adjusted life-years, with large heterogeneity across regions and socioeconomic strata².

Although stroke mortality in the United States declined substantially from the late....