Trends in diabetes and stroke-related mortality in the United States, 1999–2024: a population-based analysis

Introduction: Stroke remains a leading cause of cardiovascular mortality and disability in the United States, with diabetes serving as a major comorbidity that exacerbates outcomes and economic burden. Individuals affected by both diabetes and stroke experience heightened risks of death, disability, and healthcare utilization. This study examines national trends in diabetes and stroke-related mortality from 1999 to 2024, stratified by demographic and geographic factors. Methods: Mortality data were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Multiple Cause of Death database. Deaths were identified using International Classification of Diseases, 10th Revision codes for diabetes mellitus and stroke, defined as deaths in which both conditions were listed on the death certificate, either as underlying or contributing causes. Both crude and age-adjusted mortality rates (AAMRs) per 100 000 were calculated, standardized to the 2000 US population. Temporal patterns were assessed using Joinpoint regression to estimate annual percent change with 95% confidence intervals. Analyses were further stratified by age, sex, race, ethnicity, urbanization, and census region. Results: Between 1999 and 2024, 617 059 deaths were attributed to the combined burden of diabetes and stroke. National AAMR declined from 10.4 to 7.0 per 100 000, showing significant decreases until 2018, followed by an increase during 2018-2021 and subsequent decline through 2024. Mortality remained higher among men, non-Hispanic Black individuals, rural populations, and residents of Southern states. Conclusion: Although long-term mortality declined, recent reversals and enduring disparities emphasize the urgent need for integrated prevention and equitable public health strategies.