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5 June 2026
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https://doi.org/10.4081/cardio.2026.103

Carotid artery stenosis related mortality among older adults (>65 years): a retrospective analytical study

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Carotid artery stenosis, stroke, mortality, age-adjusted mortality rate
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Abu Huraira Bin Gulzar
abu.huraira.bin.gulzar@gmail.com
Department of Medicine, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan.
Ayesha Ahmed Cheema
Department of Medicine, Al-Tibri Medical College, Karachi, Sindh, Pakistan.
Hina Nadeem
Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan.
Syed Sarmad Javaid
Department of Medicine, The University of Mississippi Medical Center, Jackson, MS, United States.
Wolfram Doehner
Berlin Institute of Health Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Germany; Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), partner site Berlin, Germany; Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany.
Hafsa Azam
Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan.

Stroke is a leading cause of death, with carotid artery stenosis (CAS) contributing substantially to ischemic events. Although CAS-related strokes remain common in older adults in the United States, mortality patterns and demographic disparities are not well described. We aimed to evaluate nationwide trends and disparities in CAS-related mortality among US adults aged ≥65 years from 1999 to 2020 using the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. A retrospective analysis of the CDC WONDER database was conducted to investigate CAS-related mortality trends. Using Join-point regression analysis, age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 individuals, along with annual percent change, were calculated and stratified by year, sex, age, race/ethnicity, and geographic region. Between 1999 and 2020, 44,297 CAS-related deaths occurred among US adults aged ≥65 years. Overall, the AAMR declined from 3.13 in 1999 to 2.27 in 2009, then rose sharply from 3.86 in 2015 to 6.56 in 2020, with an overall average annual percent change of 1.58% (95% CI 0.99-2.16; p<0.001). Mortality was higher in men than women (AAMR 6.52 vs. 3.91) and increased with age, peaking among adults aged ≥85 years (CMR 12.5). Regionally, the Midwest had the highest AAMR (4.55), followed by the West (4.30), South (4.25), and Northeast (4.16). Nonmetropolitan and metropolitan areas showed comparable AAMRs. By race/ethnicity, non-Hispanic White individuals had the highest mortality (AAMR 4.6), followed by non-Hispanic Black (3.11) and Hispanic individuals (2.73). At the state level, Vermont had the highest AAMR (7.26), while Utah had the lowest (2.33). After an initial decline, CAS-related mortality among older US adults rose after 2009, reaching its highest levels in 2020. Persistent disparities by sex, age, race/ethnicity, and region highlight the need for targeted interventions in high-risk populations.

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1.
Bin Gulzar AH, Cheema AA, Nadeem H, Javaid SS, Doehner W, Azam H. Carotid artery stenosis related mortality among older adults (>65 years): a retrospective analytical study. Global Cardiol [Internet]. 2026 Jun. 5 [cited 2026 Jun. 5];. Available from: https://www.globalcardiology.info/site/article/view/103
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