Abstract 14401: Temporal Trends and Disparities in Heart Failure and Cerebrovascular Disease Mortality in the United States Between 1999-2020: A CDC WONDER Study

Abstract

Background: To analyze trends and disparities in heart failure and cerebrovascular disease (CVD) mortality in American adults aged 45 years and older from 1999-2020. Methods: Retrospective analysis of the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database was conducted. For heart failure and CVD, International Classification of Disease-10 codes I50 and I60-69, respectively, were used. Age-adjusted mortality rates (AAMRs) and crude death rates (CDRs) per 100,000 persons were calculated. Trends were analyzed using Joinpoint regression to determine average annual percentage change (AAPC). Temporal trends were analyzed in terms of sex, race, geographical distribution, and patient age-related mortality. Results: A total of 453,394 deaths were reported. Bidirectional trends in AAMR were seen with an initial decline from 27.3 to 13.71 between 1999-2014, followed by an increase from 13.72 to 18.17 between 2014-2020, resulting in an overall AAMR of 17.61 (AAPC:-2.04;p<0.001). Males had a higher AAMR (18.69 vs. 16.72) but a smaller decline in mortality compared to females (AAPC:-1.71 vs. -2.37;p<0.001 for both). When stratified by race, highest AAMR was observed for non-Hispanic (NH) Black/African Americans (24.3) followed by NH White (17.5), NH American Indians/Alaskan Natives (16.0), Hispanic (12.8), and NH Asian/Pacific Islander (10.9). All races experienced statistically significant declines in AAMR, with the greatest decline noted among NH Asian/Pacific Islanders (AAPC:-3.14;p<0.001). Geographically, the highest AAMR was reported in Midwest (19.33). AAMRs declined significantly across all census regions, with Northeast experiencing the steepest decline (AAPC:-2.84;p<0.001). Nonmetropolitan areas showed disproportionately higher AAMRs than metropolitan areas(22.7 vs 16.5), though both showed similar rates of decline (nonmetropolitan AAPC:-2.02; metropolitan AAPC:-2.0;p<0.001 for both). CDR was highest for 85+ years (190.1). While 65-74, 75-84, and 85+ age groups saw a significant decline in CDR, 45-54, and 55-64 age groups saw a significant increase in CDR. Conclusion: Despite significant overall decline in heart failure and CVD mortality from 1999-2020, notable disparities persist. Elderly males, NH Blacks, residents of Midwest, and nonmetropolitan areas experienced disproportionately higher mortality rates. Elderly individuals saw a decline in mortality while middle-aged individuals saw an increase.