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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Trends in concomitant cerebrovascular disease and coagulation disorders-related mortality in the United States,
Ibrahim Nagmeldin Hassan1, Mohamed Ibrahim2, Siddig Yaqub3
1Department of Medicine, University of Khartoum Faculty of Medicine, ElQasr Avenue, Khartoum, Sudan. ibrahimnagmmrcp@gmail.com.
Insights
Coagulation disorders contribute to cerebrovascular disease (CVD) deaths. While overall CVD mortality declined, disparities in outcomes by sex, race, and region highlight critical gaps in care.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Research
Background:
- Cerebrovascular disease (CVD) is a major cause of death in the U.S.
- Conventional stroke risk factors are known, but coagulation disorders' impact on long-term CVD mortality is understudied.
Purpose of the Study:
- To analyze the impact of coagulation disorders on cerebrovascular disease (CVD) mortality in the U.S.
- To evaluate temporal trends and demographic disparities in CVD mortality among adults with coagulation disorders.
Main Methods:
- Cross-sectional analysis of U.S. death certificate data (CDC WONDER, 1999-2020).
- Included adults aged ≥25 years with CVD as the underlying cause and a coagulation disorder as a contributing cause.
- Calculated age-adjusted mortality rates (AAMRs) and used joinpoint regression to assess temporal trends (APC, AAPC).
Main Results:
- 54,545 CVD deaths occurred among adults with coagulation disorders (1999-2020).
- Overall AAMR declined (AAPC: -0.58%), but with significant disparities: higher rates in males, Black, and American Indian individuals, with varying decline rates.
- Trends differed by region (Northeast showed reduction, South stagnant), and Hispanic populations showed recent increases; mortality rose with age.
Conclusions:
- Overall CVD mortality linked to coagulation disorders saw a modest decline.
- Widening disparities by sex, race, region, and age indicate critical gaps in CVD prevention and care for individuals with coagulation disorders.
Background:
Cerebrovascular disease (CVD) remains a leading cause of death in the United States. Although the role of conventional stroke risk factors is well established, the impact of coagulation disorders-both inherited and acquired-on long-term CVD mortality remains underexplored.
Methods:
We conducted a cross-sectional analysis using U.S. death certificate data from the CDC WONDER platform (1999-2020). Adults aged ≥ 25 years with CVD as the underlying cause and any coagulation disorder listed as a contributing cause were included. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Joinpoint regression was used to evaluate temporal trends, estimating Annual Percent Change (APC) and Average Annual Percent Change (AAPC) across subgroups.
Results:
Between 1999 and 2020, 54,545 CVD-related deaths occurred among adults with coagulation disorders. The overall AAMR was 1.16, with a significant decline over time (AAPC: - 0.58%, 95% CI: - 0.87 to - 0.28; p = 0.0010). Males had higher mortality than females (1.35 vs. 1.01), but females showed greater declines (AAPC: - 0.96% vs. - 0.32%). Black and American Indian individuals experienced the highest rates but also the steepest improvements (AAPCs: - 1.87% and - 2.02%, respectively). In contrast, Hispanic populations showed early declines followed by recent increases. Only the Northeast region had a statistically significant mortality reduction. Rural residents and those in the South had stagnant trends. Mortality rose sharply with age, peaking in adults ≥ 85 years, although older groups also showed significant declines. Most deaths (77%) occurred in inpatient settings.
Conclusions:
Although overall CVD mortality declined modestly, widening disparities by sex, race, region, and age group signal critical gaps in prevention and care.
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