Temporal trends and disparities in stroke and diabetes mellitus comorbidity-related mortality from 1999 to 2023.

Publication date: Dec 17, 2025

Stroke and diabetes mellitus (DM) frequently co-occur and interact through shared vascular and metabolic pathways. The comorbidity-related mortality patterns of the two diseases and the disparities across different subgroups remain insufficiently investigated on a global scale. This study aims to explore these trends using a nationally representative mortality database. We examined mortality statistics from the CDC WONDER database (1999-2023), incorporating deaths where stroke or DM was listed as an underlying or contributing condition. Age-adjusted mortality rates (AAMR) per 100,000 were computed using the 2000 U. S. Census standard. Joinpoint regression analysis assessed annual percentage change (APC) and average APC (AAPC) with 95% confidence intervals, stratified by age, sex, race/ethnicity, urbanization level, and region. Between 1999 and 2023, stroke AAMR decreased from 78. 24 to 38. 20 per 100,000; DM AAMR declined modestly from 38. 56 to 34. 48. For those with both conditions, AAMR fell from 16. 47 to 9. 70. This downward trend occurred across most subgroups but was slower among individuals aged ≥ 85 years, non-Hispanic Black populations, and non-metropolitan area residents. The COVID-19 pandemic caused a temporary reversal. The mortality rate associated with comorbid stroke and DM has shown an overall declining trend; however, it remains elevated among older adults and populations with limited access to healthcare services. Although based on a national database, the analytical approach employed in this study provides a generalizable framework for monitoring and addressing chronic disease mortality across diverse healthcare systems globally.

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