This editorial discusses the critical public health implications of a recent retrospective analysis by Khan et al on mortality trends from comorbid non-insulin-dependent diabetes mellitus and stroke in the United States (1999-2022). The analysis revealed an alarming reversal around 2014, with age-adjusted mortality rates shifting from a period of decline to a sharp and sustained increase, at an annual percentage change of 7.8%. This trend underscores a significant setback after prior gains and exposes profound, persistent disparities across racial, ethnic, geographic, and rural-urban lines. The editorial argues that these disparities are a symptom of systemic healthcare inequities rather than an inevitable outcome. It concludes with an urgent call for a paradigm shift towards precision public health strategies, including culturally tailored interventions, investment in rural telehealth infrastructure, earlier screening for at-risk populations, and policies that address the fundamental social determinants of health to mitigate these inequities.
BACKGROUND Comorbid non-insulin-dependent diabetes mellitus (NIDDM) and stroke significantly contribute to mortality among older adults. This study examines age-adjusted mortality rates (AAMRs) and disparities by demographics, region, and age groups to identify trends and guide public health efforts. AIM To analyze trends in AAMRs due to comorbid NIDDM and stroke among older adults. The study aims to identify demographic, geographic, and age-related disparities to inform targeted public health strategies. METHODS Mortality data from the Centers for Disease Control records were analyzed. AAMRs per 100000 and annual percentage changes (APCs) with 95%CI were calculated using Joinpoint Regression RESULTS Between 1999 and 2022, 209001 deaths among adults aged 55+ were attributed to comorbid NIDDM and stroke, with women accounting for 111481 and men 97520 deaths. Urban-rural disparities revealed distinct patterns, with a sharper rise in metropolitan areas post-2014 (APC: 8.6) as compared to non-metropolitan areas. Racial disparities were pronounced, particularly among the Asian/Pacific Islander population, with a steep increase post-2018 (APC: 17.6). Age-stratified analysis showed a marked rise in mortality for ages 55- 64 and 85+ from 2015 onwards (APC: 14.3 and 13.5, respectively). Regional trends highlighted the West as having the highest AAMR (14.4), while the Northeast exhibited the lowest (7.0). State-level analysis showed West Virginia with the highest AAMR (18.7) and Nevada the lowest (3.8). CONCLUSION Rising mortality from comorbid NIDDM and stroke underscores increasing disparities across gender, race, age, and regions. Urgent, tailored interventions are required to mitigate these inequities.
BACKGROUND A stroke is a significant brain event that impinges on individual motor or cognitive functions. In the lacunar stroke subtype of ischemic stroke, which results from blocked blood flow in certain brain areas, cases of dysarthria due to impaired blood flow are not uncommon. However, limited literature and research on the relevant pathophysiology and neural pathways exist. CASE SUMMARY We focus on a 60-year-old female with subacute stroke presenting symptoms including tongue deviation to the right, speech difficulty, choking on water, and biting the oral mucosa. She did not exhibit abnormalities in limb movement or sensation except for numbness in the tongue. We use single-photon emission computed tomography to reveal reduced blood flow in the left parietal lobe and bilateral temporal lobes. This report presents an atypical case of dysarthria, who exhibits abnormal articulation along with abnormal sensation and numbness in the tongue, prompting further investigation into the association between lacunar stroke subtypes, altered blood perfusion in affected brain regions, and neurological clinical status. CONCLUSION Dysarthria-plus syndrome in lacunar stroke isn’t solely related to motor function but also affects sensory function such as oral numbness.
