Trends in concomitant cerebrovascular disease and coagulation disorders-related mortality in the United States, 1999-2020.

Abstract

Background: Cerebrovascular disease (CVD) remains a leading cause of death in the United States. Although the role of conventional stroke risk factors is well established, the impact of coagulation disorders-both inherited and acquired-on long-term CVD mortality remains underexplored.

Methods: We conducted a cross-sectional analysis using U.S. death certificate data from the CDC WONDER platform (1999-2020). Adults aged ≥ 25 years with CVD as the underlying cause and any coagulation disorder listed as a contributing cause were included. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Joinpoint regression was used to evaluate temporal trends, estimating Annual Percent Change (APC) and Average Annual Percent Change (AAPC) across subgroups.

Results: Between 1999 and 2020, 54,545 CVD-related deaths occurred among adults with coagulation disorders. The overall AAMR was 1.16, with a significant decline over time (AAPC: - 0.58%, 95% CI: - 0.87 to - 0.28; p = 0.0010). Males had higher mortality than females (1.35 vs. 1.01), but females showed greater declines (AAPC: - 0.96% vs. - 0.32%). Black and American Indian individuals experienced the highest rates but also the steepest improvements (AAPCs: - 1.87% and - 2.02%, respectively). In contrast, Hispanic populations showed early declines followed by recent increases. Only the Northeast region had a statistically significant mortality reduction. Rural residents and those in the South had stagnant trends. Mortality rose sharply with age, peaking in adults ≥ 85 years, although older groups also showed significant declines. Most deaths (77%) occurred in inpatient settings.

Conclusions: Although overall CVD mortality declined modestly, widening disparities by sex, race, region, and age group signal critical gaps in prevention and care.