Abstract 4365591: The Overlapping Burden: Trends in Cerebrovascular Mortality with Underlying Alzheimer’s Disease in the United States; A nationwide analysis (1999-2023) using CDC Wonder and ARIMA approach

Abstract

Introduction: Cerebrovascular Disease accounted for more than 5 million deaths in last two decades in the U.S. population. The combined impact of cerebrovascular disease and Alzheimer’s on mortality remains insufficiently demonstrated. This study seeks to evaluate temporal shifts in mortality of adult U.S. population with dual effect of these conditions. Research Question: How have mortality trends among the adult U.S. population evolved from 1999 to 2023 across various demographic and geographic factors? Methods: A retrospective analysis was conducted using CDC WONDER database in adults aged >55 years with cerebrovascular disease (ICD-10: I60-I69) as major cause and Alzheimer’s (G30) as a contributing factor. Age-adjusted Mortality rates per 100,000 population were calculated across different demographic and geographic variables. We assessed Annual percentage changes (APCs) using Bayesian Information Criterion (BIC) approach in Joinpoint regression (JPR) analysis. ARIMA models with Box-Cox transformation were fitted after ADF/KPSS tests. Results: Both conditions reported 72,991 deaths from 1999-2023 in adults aged >55 years with mean annual AAMR of 4.44. The rate is projected to decline to 2.24 (95% CI: -2.14 to 4.07) till 2030 (RMSE: 0.278; Ljung-box p: 0.817). Annual mortality trends displayed consistent decline over the study period with most significant from 2020 to 2023 with APC value of -9.39 (95% CI: -16.71 to -4.82; p=0.00). Females accounted for 70.1% of total deaths, showing an unusual inflection from 2013-20 with APC of 1.86 (95% CI: 0.14-7.47; p=0.03). Male, non-Hispanics and Whites exhibited notable decline in mortality trends with APCs of -10.6 (95% CI: -17.08 to -6.79; p=0.00), -8.89 (95% CI: -16.1 to -4.7; p=0.00) and -9.03 (95% CI: -15.79 to -4.47; p=0.00) from 2020-2023, respectively. CENS R2: Midwest and CENS R3: south observed significant down-trending curve in mortality trends with APC of -5.76(95% CI: -11.86 to -2.16; p=0.008) and -13.79(95% CI: -19.64 to -9.08; p=0.00) from 2020-2023, respectively. Noncore (non-metro: 5.73) and Vermont (7.5) stood highest in terms of AAMR across the whole study period. Among all deaths, 52.32% deaths occurred in nursing homes. Conclusion: Our study revealed consistent decline in mortality trends over the study period, however, significant disparities exist in females, 2013-Urbanization levels and states which suggest the implementation of targeted interventions and sustained healthcare strategies.