Abstract WP033: Trends and Disparities in Diabetes Mellitus and Stroke-Related Deaths Among Adults in the United States: A CDC WONDER Analysis (1999-2023)

Background: Stroke is a leading cause of death among individuals with diabetes in the United States. Diabetes affects approximately 38.4 million U.S. adults (≈11.6% of adults). The demographic and geographic distribution of stroke-related mortality in this high-risk group remains incompletely described. This study characterizes recent trends by sex, race/ethnicity, region, urbanization, and state. Hypothesis: We hypothesized that stroke-related mortality among U.S. adults with diabetes declined from 1999 to 2023 but varied significantly by sex, race/ethnicity, and geography. Methods: We analyzed the Centers for Disease Control and Prevention (CDC) WONDER Multiple Cause-of-Death dataset for 1999 to 2023. Stroke deaths among individuals with diabetes were identified using ICD-10 codes (E10–E14 and I60–I69). Age-adjusted mortality rates (AAMRs) per 100,000 were calculated and stratified by sex, race/ethnicity, census region, metropolitan status, and state. Joinpoint regression was used to estimate the average annual percent change (AAPC) with 95% confidence intervals. Statistical significance was defined as p < 0.05. Results: A total of 197,021 stroke deaths occurred among individuals with diabetes during 1999 to 2023. The national AAMR declined from 6.03 in 1999 to 3.62 in 2023, with an overall AAPC of −2.16 (95% CI: −3.32 to −0.99). Females had an AAMR of 3.89, while males had a higher AAMR of 4.56. Black adults had the highest mortality (7.71), followed by Hispanic (5.36), American Indian or Alaska Native (4.94), Asian or Pacific Islander (4.85), and White adults (3.79). The South recorded the highest regional rate (4.50), and nonmetropolitan areas exceeded metropolitan areas (5.18 vs 4.05). State-level analysis showed the highest mortality in Oklahoma (7.57) and Mississippi (7.31), while the lowest occurred in Nevada (2.06) and Arizona (2.53). Conclusion: From 1999 to 2023, stroke-related mortality among U.S. adults with diabetes declined significantly overall, though recent years suggest a plateau. Males consistently bore a higher mortality burden than females, and persistent disparities were evident by race/ethnicity, geography, and rurality. Elevated mortality in the South and nonmetropolitan areas underscores the need for equity-focused, regionally tailored stroke prevention and acute care strategies.