Abstract 13930: Trends in Aortic Dissection Mortality Rates by Race and Urban-Rural Classification in the United States, 1999-2019

Abstract

Introduction: Despite evolving risk assessment and surgical interventions, acute aortic dissection (AD) remains a life-threatening condition with a high mortality rate. Here, we report urban-rural and racial differences in AD related mortality rates in the US. 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. The National Center for Health Statistics Urban-Rural Classification Scheme was used to divide our population into urban (≥1 million), medium metropolitan (50,000–999,999) and rural (<50,000) counties per the 2013 census classification. Age-adjusted mortality rates (AAMRs) per 100,000 people and annual percentage change (APC) with 95% confidence intervals (CI) were calculated. Results: Following a period of decreasing AAMRs prior to 2012, Non-Hispanic White (NHW) and non-Hispanic Black (NHB) AAMRs increased significantly between 2012 and 2019 (APC 2.6 [95% CI 2.0 to 3.2] and APC 4.0 [95% CI 2.5 to 5.5], respectively). Hispanic and/or Latino (HL) AAMRs also increased between 2014 and 2019. NHB AAMRs were consistently higher compared to NHWs and HLs. Similar trends emerge when stratifying by metropolitan area (Figure 1). Following a period of decreasing AAMRs prior to 2013, urban AAMRs increased significantly between 2013 and 2019 (APC 2.8 [95% CI 1.8 to 3.9]). Similarly, medium metropolitan and rural AAMRs increased between 2012 and 2019 (APC 2.6 [95% CI 1.6 to 3.7] and APC 3.3 [95% CI 1.6 to 5.0], respectively) following a period of decreasing AAMRs prior to 2012. Conclusions: AD death rates among all races and urban-rural subgroups are increasing over the past five to ten years, reversing a decreasing trend from the prior decade. To mitigate the burden of AD-related mortality, future studies are needed to examine the reasons for these observed trends.