Trends in stroke mortality among older adults (≥65 years) with chronic kidney disease in the U.S. from 1999 to 2020

The U.S. population is aging alongside rising rates of chronic kidney disease (CKD). However, trends in stroke-related mortality among adults with CKD, particularly those aged >65 years, remain under-explored nationally. To assess temporal and regional trends in stroke-related mortality among older U.S. adults with CKD. Mortality data from the CDC WONDER database were analyzed from 1999 to 2020 for stroke-related deaths in adults with CKD aged >65 years. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, and geographic region. Between 1999 and 2020, 115935 stroke-related deaths occurred among adults with CKD aged >65 years. The AAMR declined from 14.4 in 1999 to 14.3 in 2020, with fluctuating trends throughout the period. Similar patterns were observed across sexes. Black individuals had the highest AAMRs, followed by American Indians and Hispanics. Regional variation was substantial, with the highest AAMRs in the West (13.5), and the lowest in the Northeast (9.6). Rural areas had higher AAMRs (13.5) than urban areas (12.4). States in the top 90th percentile of stroke-related mortality had approximately double the AAMRs compared to those in the lowest 10th percentile. Stroke-related mortality among older adults with CKD has fluctuated over time, with a recent upward trend since 2014. Disparities by race, region, and rurality persist. Targeted interventions are needed to reduce stroke mortality in this high-risk population.