Rising mortality in cerebral atherosclerosis-related deaths in the United States (1999–2020): a 21-year retrospective analysis of CDC-WONDER database

Abstract

Background:

Cerebral Atherosclerosis-related mortality remains a major public health issue. This study analyzes trends in age-adjusted mortality rates (AAMR) for cerebral atherosclerosis deaths in the United States from 1999 to 2020.

Methods:

Mortality data from 1999 to 2020 for adults aged 25 years and older were analyzed. AAMRs were calculated, and trends were examined for the overall population, as well as by gender, urban–rural areas, race/ethnicity, and census region. Annual percentage changes (APC) were calculated to assess mortality trends.

Results:

A total of 146 016 deaths were recorded. The overall AAMR increased from 3.44 (95% CI: 3.36–3.53) in 1999 to 7.43 (95% CI: 7.32–7.53) in 2020. Mortality rates initially decreased from 1999 to 2006 (APC: −11.4 [95% CI: −19.7 to −7.85]), followed by a rise, with the sharpest increase from 2013 to 2016 (APC: 36.7 [95% CI: 23.0 to 45.9]). Mortality trends were similar across genders, with both males and females showing increases after an initial decline. Higher AAMRs were seen in urban areas compared to rural regions, with urban areas experiencing a steeper rise post-2013. Racial/ethnic disparities were apparent, with Hispanics showing the largest increase in mortality rates from 1999 to 2020. Regional disparities indicated the highest mortality rates in the South, with a sharp rise from 2012 to 2015.

Conclusion:

Cerebral Atherosclerosis-related mortality rates have significantly increased from 1999 to 2020, with notable disparities across gender, race, and geographic regions. Targeted interventions are needed to address these disparities and reduce mortality, particularly in high-risk populations.

Introduction

Atherosclerosis is a chronic inflammatory disease that plays a critical role in cardiovascular morbidity and mortality. It results from the accumulation of low-density lipoproteins (LDLs), oxidized LDLs, and cholesterol within the arterial walls, leading to the formation of atheromatous plaques ^[1]. This disease process is particularly devastating when it affects the cerebral arteries, leading to cerebral atherosclerosis. Plaque deposits in these arteries reduce blood flow to the brain, which can result in ischemic events, aneurysms, and strokes – both ischemic and hemorrhagic ^[2].

HIGHLIGHTS

• Rising mortality trends: The age-adjusted mortality rate (AAMR) for cerebral atherosclerosis-related deaths increased significantly from 3.44 in 1999 to 7.43 in 2020, reflecting a growing public health concern.

• Initial decline followed by a sharp rise: Mortality rates initially declined from 1999 to 2006, but after that, there was a sharp increase, especially from 2013 to 2016, with an annual percentage change (APC) of 36.7%.

• Urban versus rural disparities: Mortality rates were higher in urban areas compared to rural regions, with urban areas experiencing a steeper rise in deaths post-2013.

• Racial/ethnic disparities: Hispanics experienced the largest increase in cerebral atherosclerosis-related mortality rates from 1999 to 2020, indicating significant racial/ethnic disparities.

• Regional variations: The highest mortality rates were observed in the South, with a sharp increase in deaths occurring between 2012 and 2015, highlighting geographic disparities in mortality trends.

Intracranial atherosclerotic disease (ICAD) is a severe manifestation of atherosclerosis, involving plaque buildup within the intracranial arteries ^[3]. In 2022, cerebrovascular disease, which includes stroke, caused 49.6 deaths per 100 000 population, highlighting its status as the fifth leading cause of death in the United States ^[4]. Despite advances in medical research, the prevention and treatment of cerebral atherosclerosis remains challenging. Several risk factors, such as hypertension, hypercholesterolemia, diabetes, and a family history of cerebrovascular diseases, are well-documented ^[5]. However, existing preventative measures and treatments have not adequately addressed the rising incidence and mortality associated with this condition, particularly among the aging population. The complexities of managing cerebral atherosclerosis are compounded by the limited epidemiological data specific to this condition. While significant resources have been allocated to understanding and mitigating coronary artery disease, cerebral atherosclerosis has not received comparable attention.

Current gaps in the literature include a lack of comprehensive data on the epidemiological trends of cerebral atherosclerosis over extended periods and across diverse demographic groups. This paucity of data hampers the development of targeted public health strategies and healthcare policies aimed at reducing the burden of this disease. There is a critical need for longitudinal studies that analyze trends in cerebral atherosclerosis mortality to inform better healthcare practices and policymaking.

Our study aims to fill this gap by identifying longitudinal trends in cerebral atherosclerosis mortality in the United States from 1999 to 2020. By stratifying data by age, race, gender, and urban–rural locations, we seek to uncover patterns and risk factors that contribute to mortality. Understanding these trends is imperative for several reasons. Firstly, it will help identify high-risk groups that may benefit from targeted interventions. Secondly, it will provide insights into the effectiveness of past public health measures and inform future strategies. Lastly, by highlighting the sociodemographic disparities in cerebral atherosclerosis mortality, this study aims to advocate for more equitable healthcare policies and resource allocation.

Methods

Study setting and population

This retrospective cohort study utilized data from the Centers for Disease Control and Prevention’s (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database to examine mortality related to cerebral atherosclerosis in the United States from 1999 to 2020 ^[6].The analysis included individuals aged 25 years or older. Data were extracted from the Multiple Cause-of-Death Public Use files, identifying death certificates listing cerebral atherosclerosis as a contributing or primary cause of death, coded as I67.2 according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Our study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines ^[7] and institutional review board approval was not required due to the use of a de-identified, government-issued, publicly available dataset.

Data abstraction

The dataset was stratified by demographic variables, including age, gender, race/ethnicity, and census regions. Racial and ethnic categories were defined as Hispanic, Non-Hispanic (NH) Black, NH White, NH Asian or Pacific Islander, and NH American Indian or Alaska Native. Census regions were categorized into Northeast, Midwest, South, and West as per the US Census Bureau’s classification ^[8]. Urban–rural classification was based on the National Center for Health Statistics Urban-Rural Classification Scheme, which classifies areas into urban (large metropolitan areas with populations ≥1 million, medium/small metropolitan areas with populations 50 000–999 999) and rural (areas with populations <50 000)^[9].

Statistical analysis

A descriptive analysis of trends in cerebral atherosclerosis mortality was conducted across various dimensions, including temporal variations (annual trends), age, sex, race/ethnicity, and geographic location. Both crude and age-adjusted mortality rates (AAMR) per 100 000 individuals were calculated, with 95% confidence intervals (CI).

To determine crude mortality rates, the total number of deaths attributed to cerebral atherosclerosis was divided by the corresponding population for each year. Age-adjusted mortality rates were standardized to the 2000 US census population to account for changes in population age distribution over time.

Temporal trends in mortality rates were analyzed using the Joinpoint Regression Program (Version 5.0.2, National Cancer Institute). This involved fitting log-linear regression models to the crude mortality data and calculating the annual percent change (APC) in age-adjusted mortality rates (AAMR), with associated 95% CIs. APCs were classified as increasing or decreasing based on statistical significance, assessed using a two-tailed t-test with a significance threshold of P <0.05.

Results

During the study period from 1999 to 2020, a total of 146 016 deaths related to Cerebral Atherosclerosis were recorded among adults aged 25 and older. Of these, 92 857 were women, while 53 159 were men. In terms of racial distribution, the majority of deaths occurred among Non-Hispanic White individuals, accounting for 115 953 deaths. Non-Hispanic Black or African American individuals represented 14 903 deaths, while Non-Hispanic Asian or Pacific Islander individuals had 2937 deaths. Additionally, 11 631 deaths were recorded among Hispanic or Latino individuals (Supplemental Table 1, available at: http://links.lww.com/MS9/A798).

Annual trends for cerebral atherosclerosis-related mortality

The AAMR for Cerebral Atherosclerosis-related deaths was 3.44 (95% CI: 3.36 to 3.53) in 1999 and 7.43 (95% CI: 7.32 to 7.53) in 2020. The overall AAMR decreased between 1999 and 2006 (APC: −11.4 [95% CI: −19.7 to −7.85). The overall AAMR then increased between 2006 and 2013 (APC: 3.01 [95% CI: −3.87 to 9.80]) and rose sharply between 2013 and 2016 (APC: 36.7 [95% CI: 23.0 to 45.9]), followed by an increase up to the end of the study period in 2020 (APC: 12.2 [95% CI: 2.77 to 17.1]. A similar trend was seen in sensitivity analysis for Cerebral Atherosclerosis-related deaths when the underlying cause of death was restricted to Cerebral Atherosclerosis (Supplemental Table 2, available at: http://links.lww.com/MS9/A798).

Stratified by gender

During the study period from 1999 to 2020, males exhibited an overall AAMR of 2.96 (95% CI: 2.93 to 2.98), whereas females exhibited an overall AAMR of 3.04 (95% CI: 3.02 to 3.06)

A decreasing trend was noted for females between 1999 and 2006, followed by an increasing trend up to 2020. In 1999, the AAMR for females was 3.37 (95% CI: 3.26–3.47) which decreased to 1.37 (APC: −11.6 [95% CI: −19.0 to −8.12]) in 2006. Thereafter, an increasing trend was observed, with the AAMR reaching a value of 1.51 (APC: 3.44 [95% CI: −3.41 to 9.88]) in 2013, after which a much steeper increase in AAMR was seen, which went up to 4.50 (APC: 38.2 [95% CI: 24.3 to 47.8]) in 2016, followed by a further, less steep, increase to a value of 7.77 (APC: 12.3 [95% CI: 2.60 to 17.3]) in 2020.

The AAMR for males also exhibited a decreasing trend from 1999 to 2006, followed by an increasing trend up until 2020. In 1999, the AAMR for males was 3.50 (95% CI: 3.35–3.65), which reduced to 1.49 (APC: −11.3 [95% CI: −22.2 to −6.65]) in 2006. Following which, an increasing trend was noted, and the AAMR was seen to be 1.48 (APC: 2.50 [95% CI: −7.90 to 11.5]) in 2013, increasing steeply to a value of 3.89 (APC: 33.7 [95% CI: 7.28 to 43.4]) in 2016 and further rising to 6.80 (APC: 12.5 [95% CI: 3.06 to 18.6]) at the end of the study period in 2020 (Fig. 1; Supplemental Table 2, available at: http://links.lww.com/MS9/A798).

Figure 1.

Trends in cerebral atherosclerosis-related age adjusted mortality rates in the United States from 1999 to 2020, stratified by sex.

Stratified by race

When stratified according to race, Black or African American, White, and Asian or Pacific Islander exhibited a similar trend throughout the study period. However, Hispanics or Latino showed a slightly different trend until 2012, after which the trend was similar to the other three races. Age-adjusted mortality rate (AAMR) increased for all races and ethnicities. Hispanics or Latino had the highest increase in overall AAMR from 2.52 (95% CI: 2.14–2.91) in 1999 to 10.5 (95% CI: 10.0–10.9) in 2020, whereas for Black, White, and Asian it increased from 3.84 to 8.91, 3.48 to 7.17, and 1.69 to 4.07 respectively from 1999 till 2020.

Black or African American, White, and Asian or Pacific Islander showed a decreasing trend from 1999 till 2007 (APC, −9.74; 95% CI: −18.9 to −6.51), from 1999 to 2006 (APC, −11.4; 95% CI: −17.4 to −8.03), and from 1999 to 2004 (APC, −16.1; 95% CI: −40.4 to −2.63), respectively, followed by a slight increase until 2013. However, the Hispanic or Latino origin experienced a continuous decrease in the trend from 1999 till 2012 (APC, −6.69; 95% CI: −11.2 to −3.25). Subsequently, all races showed a rise until 2020.

Black or African American, White, and Asian or Pacific Islander showed a steep rise from 2013 till 2016 with the APC values of (APC, 34.5; 95% CI: 22.0–44.2), (APC, 33.4; 95% CI: 18.7–41.6), and (APC, 51.6; 95% CI: 29.5–70.0), respectively. In comparison, Hispanic or Latino had the steepest incline from 2012 to 2015 (APC, 90.4; 95% CI: 55.4–114). A gradual increase in trend was then seen by all ethnicities until 2020 (Fig. 2; Supplemental Table 3, available at: http://links.lww.com/MS9/A798).

Figure 2.

Trends in cerebral atherosclerosis-related age-adjusted mortality rates in the United States from 1999-2020, stratified by Race.

Stratified by urban–rural regions

During the study period, from 1999 to 2020, the overall AAMR for urban regions of the United States was 3.24 (95% CI: 3.23 to 3.26) while that of the rural regions was 2.47 (95% CI: 2.44 to 2.50).

Both urban and rural regions exhibited an initial decreasing trend in AAMR from 1999 to 2006 (urban: APC: −12.0 [95% CI: −24.0 to −7.81]; rural: APC: −12.1 [95% CI: −17.2 to −8.05]). Following this, an increasing trend in AAMR was observed in both regions, though the rise was much more drastic in the urban regions, especially after 2013, with the AAMR reaching a value of 8.49 (APC: 11.8 [95% CI: 2.33 to 16.6]) in 2020, whereas, rural regions exhibited a comparatively lower AAMR of 4.47 (APC: 13.3 [95% CI: 10.0 to 19.6]), by the end of the study period in 2020 (Fig. 3; Supplemental Table 4, available at: http://links.lww.com/MS9/A798).

Figure 3.

Trends in cerebral atherosclerosis-related age adjusted mortality rates in the United States from 1999 to 2020, stratified by urban–rural status.

Stratified by census

When examining total AAMRs in various geographical areas, the highest mortality was seen in the South 4.2 (95% CI: 4.19 to 4.25), followed by the West 2.91 (95% CI: 2.88 to 2.94), Midwest 2.50 (95% CI: 2.47 to 2.53), and Northeast 1.80 (95% CI: 1.77 to 1.83). All four census regions showed a unique trend during the initial years; however, a similar trend, i.e., an increase, was seen toward the end of the study.

A steep rise was observed by the South region and West regionfrom 2012 to 2015 (APC, 53.9; 95% CI: 27.9 to 70.0) and 2013 to 2016 (APC, 47.5; 95% CI: 32.3 to 60.3), respectively, followed by a gradual increase till 2020. The Midwest showed an increase from 2007 to 2010 (APC, 16.8; 95% CI: −4.08 to 24.9), followed by an immediate drop from 2010 till 2013 (APC, −10.5; 95% CI: −15.9 to 12.7) (Fig. 4; Supplemental Table 5, available at: http://links.lww.com/MS9/A798).

Figure 4.

Trends in cerebral atherosclerosis-related age adjusted mortality rates in the United States from 1999 to 2020, stratified by census region.

Stratified by state

The AAMR across the United States exhibits significant variation, ranging from a low of 0.880 in Utah to a high of 8.463 in Florida. The states with the highest AAMRs include Florida (8.463), District of Columbia (8.025), Alabama (4.945), Nevada (3.835), and Tennessee (3.848). In contrast, the states with the lowest AAMRs are Utah (0.880), New Hampshire (0.998), Montana (1.048), Minnesota (1.397), and Mississippi (1.277) (Fig. 5; Supplemental Table 6, available at: http://links.lww.com/MS9/A798).

Figure 5.

Trends in cerebral atherosclerosis-related age adjusted mortality rates in the United States from 1999 to 2020, stratified by states.

Discussion

Our study examines cerebral atherosclerosis-related mortality trends in the United States from 1999 to 2020 in ages 25 and older using data from the Centers for Disease Control and Prevention’s WONDER database. This analysis explores temporal trends across demographic dimensions – age, gender, race/ethnicity, and geographic location – and investigates the factors, policies, and reforms that shape these trends. Overall, our study yielded various key findings. To the best of our knowledge, this is the first study to analyze these trends. From 1999 to 2020, AAMR for cerebral atherosclerosis fluctuated significantly.

From 1999 to 2006, declines could be driven by advancements in cardiovascular disease management because statins lower cholesterol and reduce plaque buildup, their use increased from 32% to 44% in those aged 60–74 and from 28% to 42% in people aged ≥75 years, according to the 2001 and 2004 NCEP ATP III recommendations^[10,11]. A decrease in AAMR was also influenced by improved control of hypertension brought about by efficient antihypertensives and public health initiatives encouraging lifestyle modifications^[12]. Additionally, the 1998 Master Settlement Agreement (MSA) and anti-smoking initiatives, such as the CDC’s “Tips from Former Smokers,” improved cardiovascular health, which may contribute to this decrease^[13].

However, from 2006, mortality rates increased, peaking from 2013 to 2016 and continuing to rise through 2020. This reversal could be linked to demographic shifts, economic influences, healthcare challenges, and increased chronic conditions like hypertension and diabetes^[14]. The 2008 global recession likely exacerbated these trends, reducing healthcare access and worsening cardiovascular health^[15]. Despite Medicaid expansions, care disparities persisted, particularly in rural and socioeconomically disadvantaged areas. Rising obesity rates and sedentary lifestyles are also linked with worsened cardiovascular risk profiles^[16].

Overall trends in AAMR for death from cerebral atherosclerosis were comparable for both sexes, suggesting that healthcare interventions were met equally. Research indicates that strokes affect more women in general because they have a longer life expectancy, and the probability of having a stroke increases markedly with older age^[17]. Cardiovascular disease typically strikes women later in life than it does men, which may lead to worse outcomes and more severe illness at diagnosis. According to several studies, estrogen has no discernible positive effect on the cerebral vasculature but protects the coronary circulation in the premenopausal years^[18,19].

Women may also have different risk factor profiles and present with atypical symptoms, which could alter their management strategies leading to underdiagnosis and undertreatment as compared to men^[20]. Nevertheless, a thorough meta-analysis revealed that men tend to have more vulnerable carotid plaques, which are noted for their larger size, and reduced calcification when compared to women. This underscores the importance of implementing sex-specific assessments and imaging techniques for stroke risk^[21]. Overall, Socioeconomic disparities and lifestyle factors could further contribute to varying disease severity and mortality rates. Understanding these gender-specific dynamics is crucial for improving cardiovascular health strategies tailored to women’s unique needs and reducing mortality associated with cerebral atherosclerosis.

Stratification by race and ethnicity revealed complex patterns in mortality rates. Non-Hispanic Black, White, and Asian populations initially experienced declines until the mid-2000s, followed by varying increases post-2013. These increases were quite drastic, particularly in the blacks. This could be attributed to factors like the increased prevalence of co-morbid such as hypertension, increased rate of complications, and socioeconomic factors^[22]. Hispanic individuals showed continuous declines until 2012, followed by rapid escalations, highlighting socioeconomic and cultural influences on disease outcomes. There are several reasons for the differences in death rates among Hispanic people. First, the ongoing drop till 2012 can be due to better access to healthcare and public health campaigns aimed at this demographic^[23]. The substantial increases that followed after 2012, however, point to potential difficulties and new health problems in Hispanic populations. Socioeconomic variables like wealth inequality, restricted access to medical care, language hurdles that impact health literacy, and cultural factors that impact health-seeking behaviors are a few examples of these^[23]

Furthermore, changes in Hispanic mortality trends may also be influenced by changes in demographic patterns, such as aging populations or shifting migration patterns. Over time, these discrepancies may be lessened by addressing these variables through focused public health initiatives and expanding access to healthcare.

Significant geographic variations in mortality rates were observed across U.S. regions, with Southern and Western regions consistently reporting higher AAMRs. This could be due to lifestyle, and healthcare inequities. For instance, these regions are observed to have higher rates of uninsured individuals, limited access to healthcare facilities in rural areas, and disparities in healthcare infrastructure compared to Northern and Eastern regions^[23,24]. Additionally, disparities in access to preventive care, higher prevalence of chronic diseases like diabetes and cardiovascular conditions due to lifestyle factors, and varying levels of public health investment could be among other contributing reasons for higher mortality in the southern states^[25]. A study found a severe shortage of healthcare facilities and physicians in rural areas, leading to delayed care and poorer outcomes^[26]. Due to a variety of regionally unique variables and regulations, certain U.S. states had higher rates of cerebral atherosclerosis-related death over the research period. These include South Carolina, Florida, Vermont, Alabama, and the District of Columbia. The District of Columbia may have higher rates due to its urban setting and possible inequalities in access to healthcare, which are made worse by a dense population^[27]. Age-related vascular alterations and lifestyle variables may be the cause of Florida’s large senior population living in retirement homes being at higher risk^[28]. South Carolina’s varying socioeconomic status and healthcare access could influence mortality rates, alongside differential implementation of public health initiatives^[29]. State-level initiatives focus on enhancing healthcare infrastructure, training local healthcare providers, and addressing social determinants of health are crucial for reducing geographic disparities.

The AAMR in the United States varied significantly between urban and rural regions. Urban areas initially saw a decline in AAMR from 1999 to 2006, attributed to improvements in healthcare and public health initiatives^[30]. Urban areas saw a sharp rise in AAMR after 2006, reaching 8.49 by 2020. This increase may have been caused by a higher incidence of diseases linked to lifestyle, socioeconomic inequalities, and difficulties accessing healthcare. Rural areas, on the other hand, showed more moderate growth in AAMR after initially declining from 1999 to 2006, eventually reaching 4.47 by 2020. Despite lower baseline mortality rates than their urban counterparts, this discrepancy may be caused by ongoing problems with healthcare access and socioeconomic variables affecting rural areas^[31].Addressing these disparities requires targeted interventions to improve healthcare access, mitigate lifestyle-related risks, and address socioeconomic inequalities across both urban and rural settings.

Effective public health strategies could be crucial for reducing mortality related to cerebral atherosclerosis. Strengthening primary prevention efforts is key, focusing on modifiable risk factors like hypertension, diabetes, obesity, and smoking. Improving healthcare access is critical, necessitating policies that expand Medicaid, support community health centers, and incentivize healthcare providers to work in underserved areas. Community engagement plays a vital role by promoting culturally tailored interventions and implementing community-based health education programs. These efforts empower individuals to adopt healthier lifestyles and adhere to treatment regimens, ensuring that interventions are both relevant and effective in addressing the disparities in cerebral atherosclerosis-related mortality.

Limitations

A significant limitation of our study is the absence of critical clinical data, including hypertension prevalence, LDL cholesterol levels, and other key biomarkers such as HDL, TAG, and HbA1c. These missing variables are essential for understanding the full scope of risk factors contributing to cerebral atherosclerosis-related mortality trends. Hypertension, a primary modifiable risk factor for atherosclerosis and stroke, directly influences long-term outcomes. Without data on blood pressure or hypertension management, we cannot account for the impact of advancements in hypertension control or the varying prevalence across different racial and geographic groups. This omission may lead to an underestimation of how improved blood pressure control has influenced mortality trends.

LDL cholesterol is another central driver of atherosclerosis, and the absence of lipid profile data limits our ability to evaluate the effectiveness of lipid-lowering treatments such as statins. Statins play a critical role in reducing atherosclerosis progression and stroke risk, and the lack of this data restricts our understanding of their contribution to observed trends in mortality. Moreover, other biomarkers, including HbA1c and markers of renal function, are crucial for assessing comorbid conditions like diabetes and chronic kidney disease. These conditions are prevalent in atherosclerotic disease and worsen outcomes. Without these biomarkers, we cannot assess the impact of diabetes management or kidney function on mortality trends.

Incorporating these clinical variables into future studies would provide a more comprehensive understanding of factors influencing cerebral atherosclerosis-related mortality and help improve the accuracy of public health strategies aimed at reducing disparities and improving outcomes.

Implications for public health and policy

Our analysis highlights significant racial and geographic disparities in cerebral atherosclerosis-related mortality, with non-Hispanic Black populations and residents of Southern and Western regions disproportionately affected. These increases may be attributed to a higher prevalence of comorbidities, barriers to healthcare, and socioeconomic disparities. Coordinated public health initiatives are needed to address these gaps, which include enhancing healthcare access and lowering modifiable risk factors through community-level interventions. Policies should concentrate on targeted investments and systemic reforms to address the disparities in mortality attributable to cerebral atherosclerosis. Legislators ought to fund neighborhood-based programs that target high-risk populations, such publicly sponsored exercise classes and smoking cessation campaigns. These doable actions, which are based on preventive and equity, might lessen inequalities and enhance results for impacted groups^[32].

Federally supported programs should require the incorporation of culturally and linguistically appropriate services, such as translation support and Spanish-language health education, in all healthcare settings for Hispanic populations^[33]. Cultural competency can also be improved by diversifying the workforce by providing scholarships to underrepresented groups in the medical field^[34]. Incorporating physical awareness and nutrition education initiatives into the workplace will help people lead healthier lives^[35]. State-level task teams should also be established to put the rules and regulations pertaining to the regional health officers’ initiatives into effect.

Conclusion

This study on cerebral atherosclerosis is essential due to its significant impact on public health, particularly in increasing the risk of stroke and other serious cardiovascular events. This condition contributes substantially to morbidity and mortality, especially among older adults and those with comorbid conditions like hypertension and diabetes. Understanding the epidemiology, risk factors, and underlying mechanisms of cerebral atherosclerosis is crucial for developing targeted prevention and treatment strategies. Moreover, addressing health disparities related to race, ethnicity, and socioeconomic status can lead to more equitable healthcare outcomes. Research in this area can also inform public health initiatives and policies aimed at reducing the incidence and economic burden of stroke and improving overall patient care.

Ethical approval

This study was exempted from the institutional review board’s approval because it uses publicly available data that is deidentified.

Consent

None.

Sources of funding

None.

Author contributions

M.H.S.: conceptualization, data curation, formal analysis, and writing – original draft; A.S. and A.A..: writing – original draft; S.B.A.: conceptualization and writing – original draft; M.A. and Z.K.: data curation and writing – original draft; M.E. and M.F.: writing – original draft; M.H.: writing, editing – original draft, and visualization.

Conflicts of interest disclosure

The authors declare that there is no conflict of interest.

Research registration unique identifying number (UIN)

None.

Guarantor

Muhammad Hamza Shuja.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Data availability statement

All the data used in this study from pre-existing sources. The reference section contains link to the data analyzed in the study.