Temporal trends and demographic disparities in mortality from chronic renal failure with cerebrovascular disease as a contributing cause – a retrospective, population-based observational study in the United States, 1999-2020

Abstract

Background: Chronic renal failure (CRF) is a major cause of mortality worldwide. However, most studies focus on CRF alone and overlook the contribution of coexisting conditions. Methods: A retrospective population-based study was conducted using the CDC wonder multiple cause of death database from 1999-2020. Deaths among U.S adults aged ≥25 years with chronic renal failure (ICD-10: n18) as the underlying cause and cerebrovascular disease (ICD-10: i60-i69) as a contributing cause were identified. Mortality trends were analyzed by sex, race, urbanization status, and place of death. Age-adjusted mortality rates and annual percentage changes were calculated using joinpoint regression analysis. Results: A total of 22,719 deaths were identified, corresponding to a crude mortality rate of 5.1 per million population. The age adjusted mortality rate (AAMR) increased significantly from 2013-2020 (annual percentage changes (APC) +2.9%). Females accounted for 52.1% of deaths and males for 47.9%. Most deaths occurred among whites (68.7%) and black individuals (27.0%). Metropolitan areas accounted for 81.7% of deaths, while inpatient facilities represented the most common place of death (52.3%). Mortality increased among black populations from 2005 (APC +2.6%) and among whites from 2012 (APC +3.1%). Conclusions: Mortality associated with CRF and cardiovascular disease (CVD) increased after 2013, with substantial disparities across racial, sex, and urbanization groups.