Trends and disparities in population-based cerebrovascular disease-related mortality involving diabetes in the United States (1999-2023) and forecasts to 2035: a CDC WONDER analysis.

AIMS: To examine national trends and demographic/geographic disparities in population-based cerebrovascular disease (CeVD)-related mortality involving diabetes mellitus (DM) among US adults from 1999 to 2023, and secondarily forecast trajectories to 2035. METHODS: CDC WONDER Multiple Cause of Death data for US adults aged ≥ 25 years were analyzed. Deaths involving both CeVD and DM were identified using ICD-10 codes I60-I69 and E10-E14. Population-based crude and age-adjusted mortality rates (AAMRs) per 100,000 US population were calculated. Trends were assessed using Joinpoint regression, and future trajectories were explored with ETS and ARIMA models. RESULTS: Among 1,968,204 DM-related deaths, 827,181 (42.03%) also involved CeVD. Population-based CeVD-related mortality involving DM declined from 1999 to 2011, plateaued during 2011-2018, increased sharply during 2018-2021, and partially declined thereafter. Younger adults showed less favorable trends; non-Hispanic Black adults, the South, and nonmetropolitan areas remained disproportionately affected. Exploratory ETS and ARIMA models suggested possible renewed increases by 2035, with widening prediction intervals. CONCLUSIONS: Population-based CeVD-related mortality involving DM improved early but worsened around the COVID-19 period. Persistent disparities and uncertain forecasts support continued surveillance, improved cardiometabolic risk management, and equitable prevention strategies.