Mortality trends in patients with co-occurring chronic kidney disease and venous thromboembolism in the United States: A 25-year CDC wonder analysis (1999–2023)

Abstract

Abstract Introduction: Chronic kidney disease (CKD) patients face elevated venous thromboembolism (VTE) risk due to nephrotic syndrome, chronic inflammation, and vascular access complications. This dual diagnosis creates a high-risk clinical syndrome with substantial mortality burden. Despite the known association between CKD and VTE, comprehensive mortality surveillance data examining long-term trends and disparities in this vulnerable population remains limited. This study aims to assess mortality trends and identify demographic and geographic disparities in patients with co-occurring CKD and VTE to inform targeted public health interventions and guide equitable healthcare resource allocation. Methods: We analyzed death certificates from the CDC WONDER Multiple Cause of Death database (1999-2023) for adults aged ≥25 years with co-occurring CKD (ICD-10 codes: N17-19) and VTE (ICD-10 codes: I26, I80, I82). Age-adjusted mortality rates per 100,000 population were calculated and stratified by demographics, geography, and time. Joinpoint regression analysis identified significant trend changes and temporal patterns across the 25-year study period. Results: Co-occurring CKD and VTE caused 56,324 deaths from 1999-2023. Joint point regression revealed four distinct phases: gradual increase (1999-2006), spike (2011-2012), stability (2014-2019), and COVID-19 surge (2020-2023). AAMR increased from 0.78 in 1999 to 1.33 in 2011, stabilized around 0.75-0.88 during 2013-2019, then surged to 1.35 in 2021 before declining to 1.10 in 2023. Males showed consistently higher mortality (0.94-1.61) compared to females (0.68-1.16). Black/African American populations experienced the highest burden (2.18-2.85), 2.6-fold higher than White populations (0.66-1.22). Geographic analysis revealed Midwest states with highest rates, followed by South, West, and Northeast. Top percentile states (90th percentile) included Colorado (2.53), District of Columbia (2.67), Maryland (2.26), and West Virginia (1.64), representing a 23% higher mortality burden than bottom percentile states. Conclusion: Mortality from co-occurring CKD and VTE has increased substantially since 2018, with pronounced racial and geographic disparities. The COVID-19 pandemic exposed critical vulnerabilities in this high-risk population. Public health interventions must prioritize equitable access to specialized care, enhanced clinical protocols for dual-diagnosis management, and targeted resources for disproportionately affected communities. Keywords: Chronic kidney disease, venous thromboembolism, mortality trends, health disparities, epidemiology.