Abstract
Introduction: Despite evolving medical risk assessment and surgical interventions, acute aortic dissection (AD) remains a life-threatening condition with a high mortality. Here, we report sex and age-stratified AD mortality rates in the United States. Methods: Death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database were used to determine all-cause AD-related mortality trends from 1999 to 2019 among adults older than twenty-five. For the age stratified analysis, crude mortality rates (CMRs) per 100,000 people were calculated for five sub-groups (25-39, 40-54, 55-69, 70-84, and ≥ 85 years old). For the sex stratified analysis, age-adjusted mortality rates (AAMRs) per 100,000 people were calculated for males and females. Annual percentage change (APC) with 95% confidence intervals (CI) were calculated for both analyses. Results: Female AAMRs decreased between 1999 and 2012 (APC -1.5 [95% CI -1.8 to -1.1]) and increased between 2012 and 2019 (APC 3.1 [95% CI 2.3 to 4]). Similarly, male AAMRs decreased between 1999 and 2013 (APC -1.6 [95% CI -2 to -1.3]) and increased between 2013 and 2019 (APC 2.6 [95% CI 1.4-3.8]). Male AAMRs were consistently higher than female AAMRs (Figure 1). CMRs for those 25-39 and 40-54 increased significantly between 1999 and 2019 (APC 1.3 [95% CI 0.9 to 1.8] and APC 1.3 [95% CI 0.9 to 1.7], respectively). Among individuals 55-69, 70-84, and ≥85 years old, CMRs between 1999 and 2012 decreased significantly. However, CMRs for these three groups increased significantly between 2012 and 2019, with those ≥85 years old having the highest APC during this period (APC 3.8 [95% CI 2.4 to 5.2]). Conclusions: AD death rates are increasing among all sex and age subgroups over the past decade. To mitigate the burden of AD-related mortality, future studies are needed to examine the reasons for these observed trends.
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