CDC WONDER Research Articles

Trends in sepsis-associated cardiovascular disease mortality in the United States, 1999 to 2022

PurposeCardiovascular disease (CVD) is the leading cause of death in the United States, and sepsis significantly contributes to hospitalization and mortality. This study aims to assess the trends of sepsis-associated CVD mortality rates and variations in mortality based on demographics and regions in the US.MethodsThe Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database was used to identify CVD and sepsis-related deaths from 1999 to 2022. Data on gender, race and ethnicity, age groups, region, and state classification were statistically analyzed to obtain crude and age-adjusted mortality rates (AAMR). The Joinpoint Regression Program was used to determine trends in mortality within the study period.ResultsDuring the study period, there were a total of 1,842,641 deaths with both CVD and sepsis listed as a cause of death. Sepsis-associated CVD mortality decreased between 1999 and 2013, from AAMR of 65.7 in 1999 to 58.8 in 2013 (APC −1.06*%, 95% CI: −2.12% to −0.26%), then rose to 74.3 in 2022 (APC 3.23*%, 95% CI: 2.18%–5.40%). Throughout the study period, mortality rates were highest in men, NH Black adults, and elderly adults (65+ years old). The Northeast region, which had the highest mortality rate in the initial part of the study period, was the only region to see a decline in mortality, while the Northwest, Midwest, and Southern regions experienced significant increases in mortality rates.ConclusionSepsis-associated CVD mortality has increased in the US over the past decade, and both this general trend and the demographic disparities have worsened since the onset of the COVID-19 pandemic.

Demographic and regional patterns of epilepsy-related mortality in the USA: Insights from CDC WONDER data

Background: Epilepsy poses significant challenges globally, with varied clinical, social, and economic impacts. Despite advances in treatment, epilepsy-related mortality remains a concern. This study aimed to analyze the demographic and regional distributions of epilepsy-related mortality in the United States (U.S.) from 1999 to 2020, identifying high-risk populations for targeted interventions. Methods: Data on death certificates were obtained from the 1999 to 2020 Centers for Disease Control and Prevention Wide-Ranging Online Study Epidemiologic Research (CDC-WONDER) database. We gathered data on demographics, place of death, and urban/rural classification. Mortality rates per 100,000 people were computed and classified according to state, year, sex, race/ethnicity, and urban/rural status. Trends were examined using Joinpoint regression. Results: A total of 12,573 deaths (age <35), 22,947 (35–64), and 21,782 (65+) were attributed to epilepsy. Mortality rates varied by age group, sex, race/ethnicity, and region. Trends showed significant increases, notably in middle-aged and older adults, with higher rates in males and nonHispani, African American populations. Conclusion: Epilepsy-related mortality exhibits demographic and regional disparities in the U.S. Understanding these patterns can guide targeted interventions to mitigate mortality risk.

Post Covid-19 Upturn in Acute MI Related Mortality Trends in Young to Middle Aged Type-2 Diabetics: Observations from CDC Wonder

COVID-19 outbreak negatively impacted all aspects of adequate delivery of healthcare by overburdening the modalities. Care for acute myocardial infarction was heavily impacted attributable, in part, to reduced hospitalizations and cardiac care units not being able to function at full capacity. This paper attempts to elicit the resultant trend shift in Acute myocardial infarction (AMI) related mortality in young to middle-aged diabetics.CDC WONDER database was queried from 1999-2021. Only patients younger than 54 years old were included. Age-adjusted mortality rates (AAMR) per 100,000 with 95% confidence intervals were obtained. Joinpoint 5.0 software was used to analyze trend shift with average annual percent change (AAPC) values.A total of 10,011 AMI related deaths were encountered in the young/middle aged diabetics during our study period. Of which, around 14% (1,381) deaths were recorded in the years 2020 & 2021 alone. In these 2 years, 20.24% of subjects passed away in their homes vs only 11.06% deaths recorded in-patient. Overall AAMR more than doubled from 1999 (AAMR: 0.14 [0.13,0.16]) to 2021 (AAMR: 0.32 [0.3,0.34]) (AAPC: 3.7 [2.9,5.5]). Males had higher mortality rates (AAMR1999-2020: 2.55 [2.52,2.57]) than females (AAMR1999-2020: 1.49 [1.47-1.50]). Rural counties (AAMR1999-2020: 3.68 [3.63,3.74]) had nearly triple the mortality rates of large metropolitans (AAMR1999-2020: 1.70 [1.68,1.72]). AAMR were highest in the Midwest (AAMR1999-2020:2.3 [2.27,2.32]) and lowest in the Northeast (AAMR1999-2020: 1.41 [1.39,1.43]).COVID-19 had profound effects on cardiovascular healthcare. Post-pandemic, developing robust mechanisms to reverse the damage dealt in terms of increased morbidity and mortality has become imperative.

Seasonal variation in suicide: age group and summer effects in the United States (2015–2020)

BackgroundSuicide is a global public health concern that affects more than 700,000 people globally every year. Seasonal variation in suicide rates is a phenomenon that has been well-documented, but recent data on the seasonality of suicide within specific age groups and sex in the United States remains less well understood.MethodsPublicly available data on monthly suicides was obtained from the Underlying Cause of Death database, CDC WONDER, from 2015–2020. The incidence of summer suicides, from June, July and August, for two groups, 15–24 and ages 25 + , was calculated and a two-sided test was performed. Seasonal Decomposition analysis was performed and time series created from 2015–2020 for every age group then converted into Trend, Seasonality, and Residual respectively.ResultsFor Americans ages 15–24, the highest spike in suicides was in autumn, September–October, with a trough in June. This is the only age group in which this occurred, differing from previous understanding of the seasonality of suicide in the literature. With all other age groups (25–34, 35–44, 45–54, 55–64, 65–74, 75 +) there was a consistent pattern of a peak in late spring/early summer, a small peak in fall, and a trough in late winter.ConclusionsThere is a seasonal variation in suicide deaths in the United States with the youngest group, ages 15–24, presenting a different pattern compared to other ages. There were no significant differences in suicide seasonality by sex.

Media bias in portrayals of mortality risks: Comparison of newspaper coverage to death rates

Chronic diseases are the leading cause of death in the United States, yet effective preventive measures receive minimal healthcare funding. This disparity may stem from public underestimation of these diseases’ impact and controllability, with distorted media coverage overemphasizing sensational risks and underemphasizing chronic illnesses. This study compares media coverage of mortality risks to objective measures of death rates to investigate such distortions. Data were collected on 14 mortality risks, including monthly US deaths from CDC Wonder and 823,406 relevant articles from major US newspapers via LexisNexis. Regression analyses and qualitative evaluations using natural language processing tools were performed. From 1999 to 2020, a significant disconnect was found between the deadliest risks and their media coverage. Media coverage fluctuations correlated with death rate changes, yet only 1.7–2.8% of the coverage was explained by these rates. Chronic illnesses were described neutrally as individual challenges, while sensational risks were depicted negatively as collective problems. These results illustrate how the media depict a skewed view of the risks facing the public, with disproportionate coverage of sensational risks while comparatively ignoring chronic diseases. Consumers may consequently come to a distorted understanding of the most threatening risks they face and how to combat them.

Cannabis and the overdose crisis among US adolescents.

Since 2019, the drug overdose death rate among adolescents 14-18 years of age in the United States more than doubled. That cannabis legalization may have contributed to this tragedy is investigated by comparing the death rate in jurisdictions that have legalized medicinal or both medicinal and recreational use with those that have not. Unintentional drug overdose death data for each state and District of Columbia (jurisdictions) were obtained from CDC WONDER and separately evaluated according to the jurisdiction legalization implementation of cannabis: recreational legalization, medicinal legalization but not recreational legalization, and nonlegalization. After a decade of similar and decreasing overdose death rates, jurisdictions that implemented cannabis legalization had a statistically significant greater increase in overdose deaths than nonlegalizing states. Those that implemented recreational legalization had the greatest increase, in which the rate was 88%, 479%, and 115% greater in 2019, 2020, and 2021, respectively, than in nonlegalizing jurisdictions. The overdose death rate versus cannabis legalization correlations are apparent in both females and males and in White, Black, and Hispanic individuals, and a statistically significant greater rate increases between recreational cannabis legalization implementation and nonlegalization. Legalization of cannabis is associated with overdose deaths in American adolescents, especially recreational legalization, and regardless of sex or White-Black-Hispanic race/ethnicity. Cause and effect relationships of these previously unreported correlations, if verified, merit investigation of biologic and psychosocial mechanisms, interventions, and prevention strategies.

Trends and disparities in age, gender, ethnoracial background, and urbanization status in adult mortality due to thoracic aortic aneurysm: a retrospective nationwide study in the United States

Introduction: Thoracic aortic aneurysms (TAA) are a significant health concern, with the true prevalence likely underestimated due to undiagnosed cases. Outcomes in TAA are influenced by factors like age, gender, and comorbidities such as hypertension. This study examines mortality trends and disparities associated with TAA in US adults. Methodology: This study analyzed death certificates from 1999 to 2020 using the CDC WONDER Database to identify TAA-related deaths in individuals aged 25 and older using ICD-10 codes I71.1 and I71.2. Age-adjusted mortality rates (AAMRs) per 1,000,000 and annual percent changes (APCs) were calculated and stratified by year, gender, age group, race/ethnicity, region, and urbanization status. Results: Between 1999 and 2020, 47,136 TAA-related deaths were reported among US adults. The AAMR decreased from 16.2 to 8.2 per 1,000,000, with a significant decline from 1999 to 2013 (APC: −5.00; 95% CI: −5.54 to −4.54; P<0.001). Older adults had the highest AAMRs at 44.6 per 1,000,000. Men had higher AAMRs than women (11.2 vs. 9). AAMRs were highest among non-Hispanic (NH) Black (11), followed by NH White (10.3), NH Asian or Pacific Islander (9.5), NH American Indian or Alaska Native (7.8), and Hispanic (5.2) populations. Non-metropolitan areas had higher AAMRs than metropolitan areas (11 vs. 9.8). Conclusions: The analysis showed a significant decline in TAA mortality since 1999, with recent stabilization. However, disparities persist, with higher AAMRs among men, older adults, NH Black adults and non-metropolitan residents, highlighting the need for targeted and equitable interventions.

Abstract 4134912: Geographic, Gender,&Racial Trends in Mortality Due to Coronary Artery Disease in Diabetes among Adults Aged 25 and Older in the United States, 1999-2020: A CDC WONDER Database Analysis

Background: Coronary artery disease (CAD) is a significant contributor to mortality among adults with diabetes mellitus (DM) in the United States. This study examines the patterns of CAD-related mortality in individuals aged 25 and above with DM, with a particular focus on geographic, gender, and racial/ethnic discrepancies from 1999 to 2020. Methods: The study analyzed death certificate information from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were computed per 100,000 individuals, categorized by year, gender, race/ethnicity, and geographic areas. Results: Between 1999 and 2020, CAD in individuals with DM resulted in 1,462,279 deaths among adults aged 25 and above in the United States. The majority of these deaths occurred in medical facilities (44.2%) and at home (29.3%). The overall age-AAMR for CAD in DM-related deaths decreased from 36.3 in 1999 to 31.7 in 2020, with an AAPC of -0.96 (95% CI: -1.29 to -0.77 p < 0.000001). Men had higher AAMRs (41.6) compared to women (22.6), with a more significant decrease in women (AAPC: -2.10, p < 0.000001) than in men (AAPC: -0.34, p = 0.001200). Racial/ethnic disparities showed the highest AAMRs in American Indians/Alaska Natives (43.6), followed by Blacks (37.8), Hispanics (33.8), Whites (29.7), and Asians/Pacific Islanders (22.5). The most significant decrease was in Hispanics (AAPC: -1.64, p < 0.000001). Geographically, AAMRs ranged from 13.7 in Nevada to 51.3 in West Virginia, with the highest mortality observed in the Midwest (AAMR: 34.5). Nonmetropolitan areas exhibited higher AAMRs (35.2) than metropolitan areas (29.7), with a more pronounced decrease in urban areas (AAPC: -1.22, p < 0.000001) compared to nonmetropolitan areas (AAPC: -0.03, p = 0.854629). Conclusion: The decrease in AAMRs for CAD among individuals with DM from 1999 to 2020 indicates improvements in healthcare management. However, the ongoing disparities based on race, gender, and geography call for targeted public health interventions to guarantee fair access to cardiovascular care. Additional endeavors are necessary to comprehend and alleviate the root causes of these inequalities.

Abstract 4134768: Geographic, Gender,&Racial Trends in Mortality Due to Heart Failure in Coronary Artery Disease Among Adults Aged 65 and Older in the United States, 1999-2020: A CDC WONDER Database Analysis

Backgrounds: Heart failure (HF) associated with coronary artery disease (CAD) is a significant contributor to mortality in the elderly population of the United States. This study examines trends in HF in CAD-related mortality among adults aged 65 and older, focusing on geographic, gender, and racial/ethnic disparities from 1999 to 2020. Methods: A retrospective analysis was performed using the CDC WONDER database death certificates from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region. Results: Between 1999 and 2020, there were 6,571,263 deaths attributed to coronary artery disease (CAD) and 6,135,540 deaths related to Heart Failure (HF) in the US. Among adults aged 65 and older, HF in CAD caused 1,597,451 deaths, with 37.1% occurring in medical facilities and 30.3% in nursing homes. The AAMRs for HF in CAD decreased from 241.7 in 1999 to 156.2 in 2020 (AAPC: -2.23, p < 0.000001). This reduction was significant from 1999 to 2014, followed by a slight increase from 2014 to 2020. Men consistently had higher AAMRs than women (227.4 vs. 137.1), with women experiencing a more significant decline in rates (AAPC: -3.23, p < 0.000001). Racial disparities revealed the highest AAMRs among Whites (183.0), followed by American Indians/Alaska Natives (153.7), Blacks (134.6), Hispanics (123.7), and Asians/Pacific Islanders (81.6). The most significant reductions were observed in Hispanics (AAPC: -2.68, p < 0.000001). Geographically, AAMRs varied, ranging from 92.1 in Hawaii to 257.3 in West Virginia, with the Midwest showing the highest mortality (191.0). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (202.6 vs. 166.1), although both showed moderate declines over time, more pronounced in urban areas (AAPC: -2.41, p < 0.000001). Conclusion: The study uncovers notable variances in HF in CAD-related mortality among elderly individuals in the United States based on race, gender, and geographic location. While the decrease in AAMRs from 1999 to 2014 indicates progress in cardiovascular care, the subsequent rise from 2014 to 2020 and enduring disparities call for specific public health measures to tackle these inequalities.

Abstract 4132212: Trends in Atrial Fibrillation or Flutter Related Mortality Among Adults in the United States: Insights from CDC WONDER Database from 1999-2020

Background: Atrial fibrillation or flutter (Afib/AFL) incidence rates continue to rise and are linked to significant mortality, particularly in older populations. Our analysis examines Afib/AFL mortality trends across different demographics and regions in the U.S. from 1999 to 2020, highlighting the importance of understanding these patterns. Aim: To guide preventive measures that alleviate the impact of Afib/AFL and identify high-risk populations and regions, we sought to quantify trends associated with Afib/AFL related mortality in the U.S. Methods: We conducted a comprehensive search of death certificates from 1999-2020 using Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database focusing on Afib/AFL mortality in adults with ICD-10 codes I48. Gender, race, geographical and urban-rural parameters were investigated by calculating annual percent change (APC) and age-adjusted mortality rates (AAMRs) per 100,000 persons using the Joinpoint Regression Program (Joinpoint V 4.9.0.0, National Cancer Institute). Results: A total of 2,581,488 deaths occurred in patients with Afib/AFL from 1999 to 2020. The AAMR displayed an abrupt rise from 2018 to 2020 (APC: 8.51; 95% CI: 4.84-10.47). Men consistently exhibited a higher AAMR (overall AAMR male: 79.4, 95% CI 79.3-79.6; female: 60.8, 95% CI 60.7-60.9). Non-metropolitan areas showed higher AAMRs than metropolitan areas (overall AAMR non-metropolitan areas: 74.9, 95% CI 74.7-75.1; metropolitan: 67.2, 95% CI 67.1-67.2). Disparities were also observed in AAMRs by region with the West region showing the highest mortality rate with a notable rise between 2010 and 2020 (APC: 3.70, 95% CI 3.30-5.37). Non-hispanic (NH) White population showed the highest mortality (overall AAMR: 74.2, 95% CI 74.1-74.3), followed by NH American Indian (AAMR: 50.3), NH Black (AAMR: 45.8), NH Asian (AAMR: 35.0) and Hispanic (AAMR: 37.9) populations. Conclusion: Mortality from Afib/AFL has risen from 1999 to 2020. Men, NH white populations, and residents in non-metropolitan areas and Western U.S. are at higher risk. Targeted interventions and strategic healthcare resource allocation are needed to address these disparities and improve outcomes.

Abstract 4134922: Trends in Coronary Artery Disease-Related Mortality in Adults with Hyperlipidemia in the United States: A CDC WONDER Database Analysis

Background: Coronary artery disease (CAD), related to high blood lipid levels, is a significant contributor to adult mortality in the United States. This study examines the patterns of CAD-related deaths associated with high lipid levels in adults aged 25 and above, with a specific focus on variations related to geography, gender, and race/ethnicity from 1999 to 2020. Methods: This study employed a comprehensive retrospective analysis using death certificate data from the CDC WONDER database, covering 21 years from 1999 to 2020. We calculated age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) per 100,000 persons, categorized by year, gender, race/ethnicity, and geographic regions. This approach ensured a robust and reliable analysis of the trends in CAD-related deaths associated with high lipid levels. Results: Between 1999 and 2020, CAD in individuals with high levels of lipids resulted in 407,667 deaths among adults aged 25 and above in the United States. The majority of these deaths occurred in medical facilities (40.1%) and at home (37.3%). The AAMR for CAD in individuals with high lipid levels increased from 4.1 in 1999 to 12.1 in 2020, showing an AAPC of 4.44 (95% CI: 3.69 to 5.48, p < 0.000001). Men had a higher AAMR (12.4) than women (5.6), and both sexes experienced significant increases over time. Disparities in AAMRs by race/ethnicity revealed the highest rates among Whites (8.9), followed by American Indians/Alaska Natives (8.6), Blacks (7.3), Hispanics (6.5), and Asians/Pacific Islanders (5.9). The most significant increase was observed in Blacks (AAPC: 5.07, p < 0.000001). This detailed breakdown of the disparities in CAD mortality rates among different racial and ethnic groups provides a clear picture of the health inequalities that need to be addressed. Conclusion: This study emphasizes the discrepancies in CAD mortality related to high lipid levels among adults in the United States based on race, gender, and geographic location. The consistent rise in AAMRs between 1999 and 2020 emphasizes the necessity for specific public health interventions to tackle these increasing inequalities.

Abstract 4134396: Trends and Disparities in Ischaemic Heart Disease Mortality in the United States: An Analysis of CDC WONDER Database, 1999-2020

Backgrounds: Ischemic heart disease (IHD) remains a leading cause of mortality globally and has a high prevalence in the United States, necessitating an understanding of long-term trends to inform interventions. This study examines IHD-related mortality trends among US adults from 1999 to 2020, considering demographic and geographic disparities. Aim: This study aimed to evaluate patterns and geographical variations in mortality associated with IHD among adults in the United States. Methods: Death certificates from the CDC WONDER database spanning from 1999 to 2020 were analyzed to investigate mortality related to IHD among adults aged 35 years and above. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated, stratified by year, sex, race/ethnicity, and geographic region. Results: Ischemic Heart Disease (IHD) caused 12,756,359 deaths among U.S. adults aged 35 and above from 1999 to 2020. Annual trends in age-adjusted mortality rates (AAMRs) showed a decline from 48.7 in 1999 to 28.9 in 2020, with notable fluctuations. Men consistently had higher AAMRs than women. NH Black or African American individuals exhibited the highest AAMRs. Geographically, significant disparities existed among states and regions, with the Northeast having the highest mortality. Nonmetropolitan areas consistently had higher AAMRs compared to metropolitan areas, showing varying trends over the study period. Conclusion: Fluctuations in mortality trends among IHD patients were observed over the study duration, revealing significant disparities across demographic and geographic parameters. Targeted interventions are imperative to alleviate the burden of IHD and mitigate mortality rates in the United States.

Abstract 4120332: RISING TRENDS IN ISCHEMIC HEART DISEASE RELATED MORTALITY AMONG OLDER ADULTS WITH SLEEP APNEA IN THE UNITED STATES FROM 1999 TO 2021

Introduction: Sleep apnea (SA) is often underrecognized and undertreated despite its high prevalence in the adult population and its association with adverse cardiovascular outcomes. There are limited estimates of national trends on cardiovascular mortality in older patients with sleep apnea. We aimed to assess the sex and race-related trends of ischemic heart disease (IHD) mortality in the older adults with SA using a large population-based database. Methods: We utilized the Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) database which provides information from death certificates of all US residents according to the International Classification of Diseases, Tenth Revision (ICD-10). The demographic and mortality data were obtained for the United States population >65 years from 1999 to 2021. Ischemic heart disease (ICD-10 codes I20-I25) was listed as the underlying cause of death, and SA (G47.3) as a contributing cause of death. Age adjusted mortality rates (AAMRs) per 1,000,000 population were calculated by standardizing deaths to the year 2000 US population. We used Jointpoint Regression Program to analyze temporal trends in mortality from 2000 to 2021. Average annual percentage change (AAPC) with 95% CI were calculated to examine trends in AAMR over time. Results: Overall, AAMR of IHD mortality for patients with SA increased from 7.9 per 1,000,000 (95% CI, 6.9-8.8) in 1999 to 53.4 per 1,000,000 (95% CI, 51.4-55.4) in 2021 with an AAPC of 9.1% per year (95% CI, 8.8-9.5). Men had consistently higher AAMR than women throughout the study period (overall AAMR men: 45.51 (95% CI, 44.8-46.2); women: 12.5 (95% CI, 12.2-12.8). Both the groups had a similar increasing trend in AAMR, with men having a steeper increase. [AAPC men: 9.3% (95% CI, 8.5-10.8) versus AAPC women: 8.6%, 95% CI, 8.1-9.7]. Non Hispanic (NH) White population had the greatest AAMR throughout the study period, followed by NH Black and Hispanic or Latino. The NH White population had the largest increase in AAMR from 1999 to 2021 (AAPC 9.4%, 95% CI:8.9-10.1). Conclusion: In the United States, there has been a general increase in IHD mortality related to sleep apnea over the last two decades. This rising trend as noted in our analysis is concerning and underscores the need for more robust cardiovascular surveillance in these patients.

Abstract 4133488: Persistent Disparities in Chronic Ischemic Heart Disease-Related Mortality across Age, Sex, Race/Ethnicity in the United States, 1999 - 2020

Background: Chronic Ischemic Heart Disease (CIHD) is a heterogeneous group of cardiac diseases that cause significant morbidity and mortality. Previous studies demonstrated a decline in CIHD mortality rate (MR) but there is paucity of data on contemporary trends across different demographics in the United States (US). We examined the national trends in age-adjusted CIHD-MR (overall and stratified by demographics) in the US from 1999 to 2020. Methods: We retrospectively analyzed national death certificate data from the CDC WONDER database from 1999 to 2020. The underlying cause of death from CIHD was identified with ICD-10 code I25 in adults aged ≥35 years and the age-adjusted mortality rate was calculated per 100,000 population. We categorized race/ethnicity as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Latino or Hispanic, and other non-Hispanic groups. Trends in age-adjusted CIHD-MR (AAMR) were analyzed by age, gender, race/ethnicity, and geographic region were evaluated with Joinpoint regression, and expressed as an average annual percentage change (AAPC) with a 95% confidence interval. For sensitivity analysis, we repeated the study with data from death certificates that had CIHD as a contributing cause of death. Results: Out of 3.55 billion people aged ≥ 35 years, 5,985,088 died of CIHD (AAMR: 158.2 per 100, 000) [53.9% male, 81.6% NHW, 38.8% ≥85 years]. The AAMR was highest in males, the Northeast region, and NHB (Table 1). The AAMR was highest in those aged ≥85 years and was directly related to age (35-44 years: 8.3 per 100,000; ≥85 years: 1,943 per 100,000). The CIHD AAMR declined significantly overall in males, all races/ethnicities, and geographical areas (Table 1). Reanalysis (Sensitivity analysis) with any mention of CIHD as a contributing cause of death showed similar trends. Conclusion: Over the 22 years, CIHD-related mortality in the US has declined overall and for almost all demographic groups. However, there are age, gender, and racial disparities in the CIHD AAMR. These findings highlight the need for further longitudinal studies to understand the drivers of these disparities and for focused public health interventions to improve CIHD mortality outcomes in these populations.

Abstract 4137880: Access to exercise opportunities, physical inactivity and cardiovascular mortality: A nationwide study in the U.S.

Aims: Despite efforts to promote physical activity, the prevalence of physical inactivity continues to rise. Exercise access influences population activity levels, but county-level variation in physical activity and its link to cardiovascular disease (CVD) mortality is unclear. We explored the associations between access to exercise opportunities, levels of physical inactivity, and CVD mortality across U.S. counties Methods: The County Health Rankings and Roadmaps data and CDC WONDER mortality data were integrated. We compared age-adjusted CVD mortality across county-level quartiles of access to exercise opportunities and physical inactivity. Stratification was performed based on age, sex, race, and urbanization. The rate ratio (RR) for CVD mortality was calculated using generalized linear models. Results: CVD mortality decreased from high to low values of the county-level of physical activity across all demographic subgroups (P<0.001) (Table 1&Figure 1). Access to exercise opportunities was significantly associated with a reduced risk of CVD mortality (RR, 0.93 [0.91–0.95]), which was most pronounced in relation to acute myocardial infarction (AMI) mortality (RR, 0.80 [0.76–0.85]). The county-level physical inactivity was associated with an increased risk of CVD mortality (RR, 1.16 [1.14–1.17]), especially for ischemic heart disease (IHD) mortality (RR, 1.35 [1.31–1.38]) and AMI mortality (RR, 1.32 [1.25–1.38]) (Figure 2). All demographic subgroups demonstrated similar benefits by improving the county-level indicators of physical activity. Conclusion: Counties have the potential to make significant strides in preventing CVD and improving the cardiovascular health of their populations by enhancing access to exercise opportunities and reducing physical inactivity.

Abstract 4134851: Demographic and regional disparities in cerebrovascular disease mortality among adult patients with pre-existing atherosclerosis in the United States from 1999-2020

Introduction: Atherosclerosis (ATH) is a major risk factor for cerebrovascular disease (CEVD), with persistent mortality disparities. Our study aims to identify vulnerable regions and demographics in the US adult population with pre-existing ATH at risk of CEVD. Methods: CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to access National Vital Statistics System data from 1999 to 2020. ATH-related CEVD was identified using CEVD as the underlying cause of death and ATH as a contributing cause of death. Results were presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC). Results: A total of 325,408 CEVD occurred in patients with ATH from 1999 to 2020 (AAMR = 6.9, 95% CI: 6.8-7). Increased mortality rates were observed in males (AAMR = 6.3) as compared to females (AAMR = 5.1) (Figure, Panel A). AAMRs were highest in Non-Hispanic Whites [NHW] (5.7, 95% CI: 5.7 - 5.8), followed by non-Hispanic blacks [NHB] (5.5, 95% CI: 5.4 - 5.5), Hispanics (4.1, 95% CI: 4.0 - 4.1) and non-Hispanic American Indian/Alaska Native [NH-AIAN] (3.6, 95% CI: 3.4 - 3.8). Non-Hispanic Asian/Pacific Islander [NH-API] had the lowest mortality rates (3.4, 95% CI: 3.4 - 3.5). Region-wise analysis revealed that mortality rates were highest in the West (6.4, 95% CI: 6.3-6.4) and Midwest (6.2, 95% CI: 6.1-6.2). The South reported the rate of 5.5 (95% CI: 5.5-5.6), while the Northeast had the lowest rate (4.4, 95% CI: 4.3-4.4). Mortality rates were consistently higher in rural areas (6.1, 95% CI: 6.0-6.1) compared to urban areas (5.3, 95% CI: 5.3-5.4) throughout the study period. Overall AAMR rose from 9.0 in 1999 to 10.4 in 2001, then steadily declined before increasing to 3.6 from 2016 to 2020 (APC: 0.41). After an initial decline, AAMR increased in men (APC: 1.09) from 2016 and in women (APC: 5.09) from 2018. AAMR also increased among NH-API (APC: 8.9) and NHB (APC: 8.3) from 2018 onwards, and NHW (APC: 0.1) from 2016 (Figure, Panel B). Conclusions: Our study reveals significant mortality disparities from CEVD in patients with ATH, identifying males, NHW, and residents in the West and Midwest as particularly at increased risk. Rural areas consistently show higher mortality rates than urban areas. These findings highlight the need for targeted interventions and strategic provision of healthcare resources to improve outcomes for vulnerable populations.

Abstract 4130622: Neonatal Outcomes of Hypertensive Women Across US Races: 2016-2022

Background: Maternal hypertension, a major pregnancy complication, can adversely affect newborn health. We aim to evaluate the racial and ethnic disparities in neonatal outcomes among hypertensive pregnant women in the United States. Methods: Using data from the CDC WONDER Natality database, we conducted a retrospective cohort study focusing on live births to hypertensive mothers from 2016 to 2022. Neonatal outcomes, including NICU admissions, low birth weight, infant mortality, and assisted ventilation, were analyzed by calculating rates [95% CIs] per 1000 live births across maternal racial/ethnic groups and the US Census Bureau's regional classification: Northeast, Midwest, South, and West. Results: We analyzed 2,336,679 live births to hypertensive women (23% pre-pregnancy; 77% gestational). This cohort comprised: 0.2% infants born to Native Hawaiian/other Pacific Islander women (NH/PI), 0.9% to American Indian/Alaska Native women (AI/AN), 3.8% to Asian American women (AA), 19.6% to Hispanic/Latino women (H/L), 20.0% to Black/African American women (BA), and 55.4% to White American women (WA). Infant mortality rates were highest in BA (3.6 [3.5, 3.8]), followed by AA (2.1 [1.8, 2.4]), AI/AN (2.1 [1.6, 2.7]), H/L (1.9 [1.8, 2.0]), NH/PI (1.9 [1.0, 3.3]), and lowest in WA (1.5 [1.4, 1.6]). Similarly, NICU admission rates were highest in BA (217.2 [216.1, 218.4]) and lowest in WA (156 [155.4, 156.6]). Assisted ventilation rates were highest in NH/PI (131.8 [123.4, 140.7]) and lowest in AA (87.8 [86.0, 89.7]). Low birth weight rates were highest in BA (235.1 [233.9, 236.3]) and lowest in WA (121.8 [121.2, 122.4]). The Midwest had the highest rates for NICU admissions in NH/PI (254.2 [217.2, 295.2]), assisted ventilation in AI/AN (143.8 [133.2, 155.1]), and mortality in BA (4.1 [3.7, 4.5]). The South had the highest rate of low birth weight for BA (244.4 [242.9, 246.0]). Conclusion: Significant racial and regional disparities exist in neonatal outcomes among hypertensive women in the US. BA mothers consistently experienced the poorest outcomes, while WA mothers had the best. Further research is crucial to understand the reasons behind these disparities and develop targeted interventions for high-risk populations.

Abstract 4117310: Alcohol-Related Cardiomyopathy - Exploration of Recent Mortality Trends in the United States

Introduction: Data is accumulating regarding the contemporary trends of mortality rates in patients with alcohol-related cardiomyopathy across the United States. Hypothesis: We hypothesized that with increased awareness about the adverse effects of alcohol on the cardiovascular system and the advancement of echocardiography in the early diagnosis of alcoholic cardiomyopathy, mortality rates may show a downward trend. Methods: This is a retrospective observational study that retrieved death certificates from the CDC WONDER (Center for Disease Control and Prevention’s Wide-ranging ONline Data for Epidemiological Research) database from 2001-2020. The mortality rate of alcohol-related cardiomyopathy using ICD code I42.6 (Alcoholic cardiomyopathy) was studied from 2001-2020. This study duration was further subdivided into five-year periods. We calculated the crude mortality rate and age-adjusted mortality rate per 100,000 for four U.S census regions (CR-1 Northeast, CR-2 Midwest, CR-3 South, CR-4 West). Results: The overall age-adjusted mortality rate remained at 0.1/100,000 deaths in four U.S census regions until 2015; however, in the last five years of the study period, AAMR(age-related mortality rate) increased from 0.1 to 0.2/100,000 deaths. Conclusions: The mortality trends associated with alcohol-related cardiomyopathy have not changed significantly over the past two decades. This can be explained by the larger number of people developing alcoholic cardiomyopathy due to the increase in global alcohol use in addition to the fact that more diagnosed patients are receiving earlier treatment with goal-directed medical therapy for cardiomyopathy. Limitations of this study include intrinsic weakness of the WONDER dataset (changes with ICD-9 to ICD-10 codes, and potentially miscoding) which needs further research. Discussion: This suggests that while mortality rates associated with alcohol-related cardiomyopathy remained relatively steady for most of the study period, there was a concerning uptick in the latter years. This could prompt further investigation into potential factors contributing to this increase, despite advancements in awareness and diagnostic techniques.

Abstract 4134754: Trends and Disparities in Mortality Due to Abdominal Aortic Aneurysm: Who Is at Risk?

Background: Screening studies have reported a prevalence of 3-8% for abdominal aortic aneurysms (AAA). Despite a positive trend of decline over the past two decades, mortality linked to AAA remains a significant public health concern. In the United States alone, AAA complications resulted in an estimated 13,640 deaths between 2018 and 2021. Thus, understanding trends and disparities in AAA mortality is crucial for evaluating the effectiveness of current approaches and identifying vulnerable populations. Methods: This study analyzed death certificates from 1999 to 2020 within the CDC WONDER Database. Deaths among individuals aged 25 years and older caused by AAA were identified using the International Classification of Diseases, Tenth Revision (ICD-10) codes I71.3 and I71.4. Age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and annual percent change (APC) were computed and categorized based on year, gender, race/ethnicity, and urbanization status. Results: Between 1999 and 2020, 195,117 deaths were reported in patients with AAA (both ruptured and non-ruptured). Overall, AAMRs for AAA significantly decreased from 69.0 deaths in 1999 to 27.9 deaths in 2020. This decline occurred in two phases: a steeper decrease from 1999 to 2014 (APC: -5.47; 95% CI: -5.68 to -5.29) followed by a further significant decrease from 2014 to 2020 (APC: -1.66; 95% CI: -2.46 to -0.57). Gender-based analysis revealed that men consistently had higher AAMRs than women (men: 65.6; 95% CI: 65.3 to 66.0; women: 24.5; 95% CI: 24.3 to 24.7). Similarly, AAMRs varied by race/ethnicity, with the highest rates observed among non-Hispanic Whites (45.6; 95% CI: 45.3 to 45.8), followed by non-Hispanic American Indian or Alaska Natives (30.3; 95% CI: 27.9 to 32.7), non-Hispanic African Americans (27.2; 95% CI: 26.7 to 27.8), non-Hispanic Asian or Pacific Islanders (20.7; 95% CI: 20.0 to 21.4), and Hispanics (17.5; 95% CI: 17.0 to 18.0). Additionally, individuals residing in non-metropolitan areas had significantly higher AAMRs than those in metropolitan areas (non-metropolitan: 50.7; 95% CI: 50.2 to 51.1; vs. metropolitan: 39.2; 95% CI: 39.0 to 39.4) (Figure 1). Conclusions: This analysis revealed a significant decline in mortality from AAA. However, disparities persist, with higher AAMRs observed among men, non-Hispanic Whites, and residents of non-metropolitan areas.

Abstract 4125533: Demographic Trends and Disparities in Mortality Related to Coexisting Heart Failure and Diabetes Mellitus Among Older Adults in the United States: A Large Database Analysis from 1999 to 2020

Background: In the United States, over 38 million people have diabetes mellitus (DM) and more than 6 million have heart failure (HF). DM and HF often coexist, and each condition independently increases the likelihood of developing the other. Approximately 40% of individuals with HF also have DM, and this prevalence is even higher among older adults and hospitalized patients. While there has been concern regarding the increasing burden of disease for both conditions individually over the last decade, a comprehensive examination of mortality trends associated with their coexistence has not been thoroughly explored. Methods: This study analyzed death certificates from the CDC WONDER database, specifically focusing on mortality caused by the simultaneous presence of HF and DM among individuals aged 75 years and older. The data covers the period from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 individuals and annual percent change (APC) were computed and categorized based on year, gender, and race/ethnicity. Results: Between 1999 and 2020, a total of 663,016 deaths were reported in patients with coexisting HF and DM. Overall, AAMR increased from 154.1 to 186.1 per 100,000 population between 1999 and 2020, with an initial increase from 1999 to 2005 (APC: 0.80; 95% CI: -0.17 to 2.94), a significant decline from 2005 to 2011 (APC: -2.82; 95% confidence interval (CI): -5.47 to – 1.71), a subsequent increase from 2011 to 2018 (APC: 0.61; 95% CI: -0.59 to 2.18), and finally a steep increase from 2018 to 2020 (APC: 11.30; 95% CI: 6.98 to 14.11). Gender-based analysis revealed that older men had consistently higher AAMRs than older women (Men: 185; 95% CI: 184.3 to 185.6; vs Women: 135.4; 95% CI: 135 to 135.8). Furthermore, we found that AAMRs were the highest among non-Hispanic American Indian or Alaska natives (214.4; 95% CI: 207.5 to 221.4) followed by non-Hispanic African Americans (179.9; 95% CI: 178.5 to 181.4), Hispanics (159.5; 95% CI: 158 to 161.1), non-Hispanic White (152.9; 95% CI: 152.5 to 153.3), and non-Hispanic Asian or Pacific Islander populations (104.1; 95% CI 102.4 to 105.8) (Figure 1). Conclusion: The mortality rate due to coexisting HF and DM has increased in the elderly population over the past decade. Males and non-Hispanic American Indians or Alaskan Natives had the highest AAMRs in our study.