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

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.