Abstract 4140819: Trends and Racial Disparities in Cardiovascular Deaths in Chronic Kidney Disease in the United States, 1999-2020

Background: Previous studies have shown that chronic kidney disease (CKD) is associated with increased cardiovascular disease (CVD) burden, but few studies have investigated trends in CVD deaths in CKD. We evaluated the temporal changes in the CVD-related age-adjusted mortality rate (AAMR) in CKD based on sex, race, rural-urban status, and census region from 1999-2020. Methods: This was a retrospective repeated cross-sectional analysis of national death certificate data from the CDC WONDER from 1999 to 2020. We included persons aged ≥25 years of age with CKD (ICD-10 code N18) as the underlying cause of death. We used ICD-10 codes I10-I178 to identify CVD-related deaths from the multiple cause-of-death dataset. We calculated the CVD-related AAMR in CKD per 100,000 population. The exposure variable was the year of death, and the outcome was the changes over time in CVD- related AAMR in CKD, stratified by sex, race, rural-urban status, and census region. We used the Mann-Whitney test and ANOVA for group comparisons as appropriate. Racial disparities were assessed with the Black-White AAMR ratio. Trends were evaluated with Joinpoint regression and expressed as average annual percentage change (AAPC) with 95% confidence interval (CI). P<0.05 defined statistical significance. Results: Of the 4.4 billion people, 260,679 with CKD had CVD-related deaths (AAMR 5.5). The AAMR was higher in males (7 vs 4.4 in females; P<0.001), Black people (12.6 vs 4.7 in White; P<0.001), and the Northeast and South census regions (AAMR 5.8). The AAMR did not differ by rural-urban status. From 1999 to 2020, the overall AAMR increased from 4.7 to 6.5 (AAPC 1.6%; CI: 1.4-1.8). Similarly, the AAMR increased significantly in males (AAPC 1.5%; CI: 1.2-1.7), females (AAPC 1.4%; CI: 1.1-1.6), rural areas (AAPC 2%; CI: 1.6-2.3), urban areas (AAPC 1.4%; CI: 1.1-1.7), White race (AAPC 1.9%; CI: 1.7-2.2) and across each of the four census regions. There was no significant change in Black race (AAPC 0.2%; CI: -0.04-0.5). The overall Black-White AAMR ratio was 2.8 and it declined from 3.4 to 2.4 (AAPC -1.7%; CI, -1.9, -1.5). Conclusion: CVD-related deaths increased in CKD patients over the last two decades. While racial disparities in CVD-related deaths persisted, they narrowed during the study period. These findings underscore the need to intensify CVD screening and multidisciplinary management in CKD patients. The reasons for the persistence of the racial disparity require further study.