AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Nationwide Mortality Trends for Cerebrovascular Disease with Underlying Chronic Lower Respiratory Diseases: A CDC WONDER Analysis, 1999-2023
By Shehryar F, Hassan A, Kumar S et al.
Introduction: Chronic lower respiratory diseases (CLRDs) are associated with a 30% higher risk of cerebrovascular disease (CVD) and are recognized as an independent risk factor for stroke. Despite this well-established relationship, the nationwide mortality burden and temporal trends of coexisting CVD and CLRD remain poorly characterized. Methodology: Data were extracted from the CDC WONDER database for adults aged ≥55 years, with CVD (ICD-10: I60–I69) and CLRD (ICD-10: J40–J47) identified from 1999 to 2023. Age-adjusted mortality rates (AAMRs) were stratified by sociodemographic and geographic characteristics. Joinpoint regression was used to estimate annual percent change (APC). Temporal trends were further evaluated using ARIMA models following assessment of stationarity using the Augmented Dickey–Fuller (ADF) and KPSS tests, with Box–Cox transformation applied where appropriate. Results: Between 1999 and 2023, 125,938 deaths were recorded, with the mean AAMR of 4.35 (95% CI: 4.15–4.55). ARIMA modeling projected a decline in mortality to 3.44 (95% CI: 3.17–3.76) by 2025 and 3.10 (95% CI: 2.71–3.63) by 2030, with good model fit (RMSE = 0.81; Ljung–Box p = 0.45). Adults aged ≥85 years had the highest crude mortality rate (32.00; 95% CI: 31.55–32.55). Mortality trends increased significantly in males from 2015–2023 (APC = 2.19; 95% CI: 0.38–6.59) and in females from 2014–2023 (APC = 3.51; 95% CI: 2.44–4.99), with males exhibiting a higher mean AAMR than females (7.60 vs 6.30). Non-Hispanic individuals had a substantially higher mean AAMR than Hispanics (7.10 vs 3.70), with mortality rates increasing significantly in both groups from 2013–2023 (APC 2.72 and 1.98, respectively). Whites had the highest mean AAMR (7.10), followed by Blacks (6.65), American Indians/Alaska Natives (5.15), and Asians (2.85). The Midwest had the highest mean regional AAMR (11.05), followed by the South (7.80), West (7.05), and Northeast (4.25). By urbanization level, Large Central Metro areas demonstrated a significant increase in mortality from 2013–2023 (APC = 3.75; 95% CI: 2.48–5.46; p < 0.01), as did Medium Metro areas (APC = 2.20; 95% CI: 1.63–2.92; p < 0.01). Conclusion: CVD and CLRD demonstrate a sustained nationwide rise, with the highest burden observed among older adults, males, Non-Hispanic Whites, and residents of the Midwest region. These findings call for targeted, region- and subgroup-specific risk-reduction strategies.