Khan Allahdad, Ullah Waseef, Ikram Moeen, Qasim Rameez, Alam Umama, Sheraz Maheen, Khan Ayesha, Kanwal Kainat, Collins Peter, Ahmed Raheel
Department of Medicine, Nishtar Medical University, Multan, Pakistan.
Department of Medicine, Lady Reading Hospital, Peshawar, Pakistan.
Endocrinol Diabetes Metab. 2025 Sep;8(5):e70091. doi: 10.1002/edm2.70091.
Diabetes mellitus (DM) significantly increases the risk of cerebrovascular disease (CeVD), a major cause of mortality and long-term disability. Despite improvements in healthcare, disparities in CeVD-related mortality among diabetic populations in the United States persist.
We conducted a retrospective analysis using the CDC WONDER database from 1999 to 2020 to assess mortality trends related to CeVD among adults aged ≥ 45 years with DM. Deaths were identified using ICD-10 codes I60-I69 (CeVD) and E10-E14 (DM). Age-adjusted mortality rates (AAMRs) were calculated, and trends were analysed using Joinpoint regression, stratified by age, race/ethnicity, geography, urbanisation, and place of death.
A total of 689,846 CeVD-related deaths occurred in diabetic individuals. AAMR decreased from 36.9 in 1999 to 29.3 in 2020, with an average annual percentage change (AAPC) of -1.41%. However, a sharp rise was observed from 2018 to 2020 (APC 14.87%), indicating a concerning reversal in progress. The highest crude mortality rates were in the 75-84 age group, and the lowest in the 45-54 group. Black and Hispanic populations, rural residents, and those in the Southern United States had the highest mortality rates. The Northeast and Asian populations had the lowest, reflecting persistent disparities in access to care and preventive services.
While CeVD mortality in diabetics declined over two decades, the recent reversal highlights emerging challenges, possibly due to healthcare disruptions and socioeconomic disparities. These findings underscore the need for targeted public health interventions to address inequities and improve outcomes in high-risk populations.
糖尿病（DM）显著增加了脑血管疾病（CeVD）的风险，而CeVD是导致死亡和长期残疾的主要原因。尽管医疗保健有所改善，但美国糖尿病患者中与CeVD相关的死亡率差异仍然存在。
我们使用疾病控制与预防中心（CDC）的WONDER数据库进行了一项回顾性分析，以评估年龄≥45岁的糖尿病成年人中与CeVD相关的死亡率趋势。使用国际疾病分类第十版（ICD - 10）编码I60 - I69（CeVD）和E10 - E14（DM）来识别死亡病例。计算年龄调整死亡率（AAMR），并使用Joinpoint回归分析趋势，按年龄、种族/民族、地理位置、城市化程度和死亡地点进行分层。
糖尿病患者中共有689,846例与CeVD相关的死亡。AAMR从1999年的36.9降至2020年的29.3，平均年百分比变化（AAPC）为 - 1.41%。然而，在2018年至2020年期间观察到急剧上升（APC为14.87%），表明进展出现了令人担忧的逆转。粗死亡率最高的是75 - 84岁年龄组，最低的是45 - 54岁组。黑人和西班牙裔人群、农村居民以及美国南部居民的死亡率最高。东北部和亚洲人群的死亡率最低，这反映了在获得医疗保健和预防服务方面持续存在的差异。
虽然糖尿病患者的CeVD死亡率在二十年间有所下降，但最近的逆转凸显了新出现的挑战，这可能是由于医疗保健中断和社会经济差异所致。这些发现强调了需要有针对性的公共卫生干预措施，以解决不平等问题并改善高危人群的结局。
