The contemporary trends and geographic variation in premature mortality due to heart failure from 1999 to 2018 in the United States.

Abstract

We aimed to examine the contemporary trends and regional variations in premature mortality due to heart failure across the U.S. from 1999 to 2018. For most U.S. census regions, it is unknown whether premature mortality (deaths among persons under age 65) due to heart failure is increasing -or decreasing. In this descriptive study, the death certificate data were retrieved from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database and examined from 1999 to 2018 for the underlying cause of death. Age-adjusted mortality rates (AAMR) per 100,000 persons and annual percent change (APC) in rates stratified by census region were calculated using Joinpoint trend analysis software. There were 118,116 premature deaths due to heart failure from 1999 to 2018 across the U.S. Of these 52.40% of deaths were reported in the South, 20.30% in the Midwest, 15.10% in the West, and 12.20% in the Northeast. The AAMRs were the highest in the South region (range: 3.1-4.9) and the lowest in the Northeast region (range: 1.5-1.9). There was an overall decline in mortality across all regions from 1999 till 2011-2012. However, mortality has an upward trajectory throughout all the census regions after 2012. This study on nationwide data showed that overall premature mortality due to heart failure declined from 1999 to 2011-2012 followed by an upward trajectory from 2012 to 2018; the explanation for this merits further discovery.