Key result
Stroke-diabetes co-mortality declines overall but reverses post-2014, hitting Hispanic, Southern, and rural groups hardest.
Why the study?
Stroke and diabetes mellitus share causes, but U.S. progress plateaued in the mid-2010s as risk-factor control faltered and stroke declines reversed, exposing disparities across demographics and geography.
U.S. stroke-diabetes co-mortality declined until the mid-2010s but has since reversed, highlighting worsening disparities in rural, Southern/Western, and minority populations.
Post-2014 reversal in stroke–diabetes co-mortality signals need for targeted surveillance; leaves open drivers of widening disparities in Hispanic, Southern, and rural groups.
Background: Stroke and diabetes mellitus share causes, making co-mortality a key risk marker. After decades of gains, U.S. progress plateaued in the mid-2010s as risk-factor control faltered and stroke declines reversed, exposing disparities by ethnicity, region, rurality, race, and sex. Objective: To evaluate national trends in stroke–diabetes co-mortality in the U.S. from 1999–2020, with emphasis on geographic and demographic disparities. Methods: We analyzed U.S. death certificates from CDC WONDER (1999–2020), defining stroke as the underlying cause (ICD-10: I60–I64, I69.0–I69.4) and diabetes as the contributing cause (E10–E14). Age-adjusted mortality rates (AAMRs), per 100,000, were calculated and stratified by sex, race, ethnicity, Census region, and urbanization. Trends were assessed with Joinpoint regression, estimating annual percent changes (APCs). Results: From 1999–2020, 222,658 stroke–diabetes deaths were identified. Nationwide, AAMR declined from 4.3 in 1999 to 2.7 in 2020, with a steep fall until the mid-2010s followed by a reversal. Hispanics had a higher mean AAMR (3.8) than non-Hispanics (3.1). Regional variation was marked, with the South (3.5) and West (3.4) exceeding the Midwest (3.0) and Northeast (2.4); post-2014 increases were concentrated in the South/West. Non-metropolitan areas had higher mean AAMRs (3.6) than metropolitan areas (3.0), with the sharpest resurgence after 2015 in rural settings. By race, Black/African Americans had the highest mean AAMR (5.6), Whites the lowest (2.7), while American Indians/Alaska Natives declined steadily, and Asians/Pacific Islanders reversed upward post-2015. By sex, men consistently had higher mean AAMRs (3.3) than women (2.8). Conclusions: Stroke–diabetes co-mortality in the U.S. shows a mid-2010s reversal, with Hispanic/Latino, Southern/Western, and rural groups most affected. These trends reflect faltering control of blood pressure and diabetes, unequal access to stroke-ready care, and a 2020 pandemic spike. Priorities include tighter control of hemoglobin A1c, blood pressure, and LDL cholesterol: optimized statin use; screening for nonalcoholic fatty liver disease (NAFLD) in diabetes care; and expanded rural access to intravenous thrombolysis and endovascular thrombectomy.
No takes yet. Share an insight, caveat, or question.
Mustafa et al. (2026) studied this question. From 1999 to 2020, stroke–diabetes co-mortality declined overall but reversed post-2014, particularly affecting Hispanic, Southern, and rural populations.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: