ArticleFrontiers in cardiovascular medicine2026
Trends and disparities in deaths involving atherosclerotic cardiovascular disease and stroke-related conditions among U.S. adults, 1999-2025.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: ASCVD and stroke remain leading causes of death in the United States, sharing overlapping risk factors and clinical consequences. Long-term declines in vascular mortality have slowed while disparities persist. We evaluated national trends and disparities in mortality involving coexisting ASCVD- and stroke-related conditions among U.S. adults from 1999 to 2025. Methods: We performed a retrospective population-based study using the CDC WONDER Multiple Cause of Death database. Adults aged ≥25 years were included. Deaths were identified when prespecified ASCVD-related and stroke-related ICD-10 codes were both documented on the same death certificate, whether as underlying or contributing causes. The outcome represents a death-certificate-defined mortality phenotype rather than clinically adjudicated concurrent disease. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Trends were assessed overall and by sex, age group, race/ethnicity, census region, urbanization, and state. Urbanization analyses were restricted to 1999-2020. Sensitivity analyses included restriction to atherosclerotic-specific codes (I25.x) and exclusion of provisional 2025 data. Results: A total of 876,383 deaths were identified. Overall average AAMR was 15.01 per 100,000. Mortality declined from 26.82 in 1999 to 10.91 per 100,000 in 2025, with an AAPC of -3.53% (95% CI, -4.27 to -2.78; Conclusion: Although mortality involving coexisting ASCVD- and stroke-related conditions declined substantially from 1999 to 2025, this progress was interrupted by a borderline reversal in the pandemic period and remained marked by persistent disparities. These findings support the need for stronger and more equitable prevention strategies, particularly for younger adults and high-burden populations and regions.
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