Key result
Non-Hispanic Black adults experienced significantly rising stroke and AKI mortality compared to other demographics.
Why the study?
Despite the emerging recognition of the combined impact of stroke and acute kidney injury, comprehensive analyses of national mortality trends related to both conditions remain limited.
Mortality related to stroke and acute kidney injury in the US fluctuated between 1999 and 2020, highlighting persistent disparities among men, Non-Hispanic Black adults, and non-metropolitan residents.
Persistent disparities in stroke-AKI mortality among non-Hispanic Black adults warrant surveillance; this cohort study leaves open causal factors and interventions.
Introduction: Stroke is the fifth leading cause of death in the United States, and acute kidney injury (AKI) frequently complicates stroke, significantly increasing the risk of mortality. The interplay between stroke and AKI is driven by overlapping pathophysiological mechanisms, including hemodynamic instability, neurohormonal dysregulation, and systemic inflammation. Despite the emerging recognition of their combined impact, comprehensive analyses of national mortality trends related to stroke and AKI remain limited. Methods: We analyzed mortality due to AKI (ICD-10 code: N17) and stroke (ICD-10 code: I60-I69), using the CDC-WONDER database from 1999 to 2023. Age-Adjusted Mortality Rates (AAMR) per 100,000 were calculated and categorized by demographics and region. Joinpoint regression was used to estimate the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) in AAMR. Results: A total of 71,877 deaths were reported due to stroke and AKI as contributing factors of death from 1999 to 2020. The AAMR initially rose significantly from 1.45 in 1999 to 1.65 in 2010 (APC: 1.13; 95% CI: 0.65 to 1.57; p=0.0001) and then declined to 1.4 in 2018 (APC: -2.35; 95% CI: -3.10 to -1.59; p=0.00001). The AAMR finally increased to 1.79 in 2020 (APC: 11.9; 95% CI: 6.04 to 18.13; p=0.0005). Men demonstrated a higher total AAMR than women (1.86 vs. 1.26). Non-Hispanic (NH) Black adults showed the highest AAMR (2.84), followed by Hispanic (1.52), NH Asian (1.44), and NH White individuals (1.37). Non-metropolitan areas had a higher mortality burden than metropolitan areas (AAMRs: 1.77 and 1.45, respectively). One sentence for the census region. Conclusion: The observed variations in mortality trends may indicate advances in critical care and management of acute stroke, improvements in AKI prevention, and evolving healthcare access. However, the persistently higher mortality among men, NH Black population, and residents of non-metropolitan areas underscores the ongoing inequities in healthcare delivery and social determinants of health. Enhancing the early recognition and integrated management of AKI in patients with stroke may improve patient outcomes. Overall, addressing the challenging interplay between stroke and kidney injury through multidisciplinary approaches is essential to improve the survival and quality of life of affected populations across the United States.
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Affan et al. (2026) studied this question. From 1999 to 2020, mortality due to stroke and acute kidney injury increased significantly among non-Hispanic Black adults (AAMR 2.84) compared to other demographics.
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