Ischemic heart disease mortality trends and disparities in US adults from 1999 to 2023: a CDC WONDER analysis

Abstract

Background Ischemic heart disease (IHD) remains a leading cause of mortality in the United States, yet it remains unclear whether postpandemic recovery patterns differ across population subgroups. Methods Using CDC WONDER data (1999–2023), we analyzed IHD deaths among US adults aged ≥25 years. Age-adjusted mortality rates (AAMRs) were stratified by sex, race/ethnicity, urbanization, and region; crude mortality rates (CMRs) by age. Urban–rural analyses were restricted to 1999–2020. Joinpoint regression estimated temporal trends, and tests of parallelism assessed between-group differences. Results Among 10,200,362 IHD deaths, overall AAMRs declined from 300.8 to 127.07 per 100,000 (average annual percent change, AAPC = −3.51; p < 0.001), with the fastest decline during 2021–2023 (APC = −5.59). Males had higher AAMRs than females (245.58 vs. 138.69; p < 0.001). Non-Hispanic (NH) Black individuals had the highest AAMR (217.58). The steepest age-specific CMR decline occurred at 75–84 years (AAPC = −4.04). Metropolitan areas had lower AAMRs than non-metropolitan areas (189.07 vs. 212.60; p < 0.001). Pairwise tests confirmed significant trend differences across most subgroups (all p < 0.05), except NH Other vs. NH White (p = 0.396). Conclusions Despite sustained IHD mortality declines, significant disparities persist across demographic and geographic subgroups, supporting targeted prevention for high-risk populations.