National Trends in Heart Failure–Associated Cerebrovascular Disease Mortality Among U.S. Adults, 1999–2023: A 25-Year Analysis of Rates and Disparities
Mahmoud Tablawy1, Mohamed Hemida Saleh2, Alyaa Ahmed Ibrahim2, Chintha Sriram3, Maryam Saghir4, Sahil Jairamani5, Eshal Saghir6, Pakeezah Tabasum7, Mohamed Elgendy1, Ahmed Ebrahim1, Amro Ali8
1Faculty of Medicine, Al-azhar University, Cairo, Egypt, 2Alexandria Faculty of Medicine, Alexandria, Egypt, 3Jayabharath Hospital, Nellore, India, 4Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan, 5Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan, 6Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan, 7Peoples University of Medical and Health Sciences for Women, Nawabshah, Pakistan, 8Community Regional Medical Center, Department of Medicine, Fresno, California, USA.
Objective:
This study aims to examine the mortality trends in Heart failure and associated cerebrovascular disease among adults in the United States.
Background:
Cerebrovascular diseases and heart failure (HF) can coexist as contributors in adults morbidity and mortality in the United States with potential for serious complications.
Design/Methods:
Data from CDC WONDER (1999–2023) identified U.S mortality rates in adults aged (+25) with cerebrovascular diseases (ICD-10: I60-I69) and heart failure (ICD-10: I50 heart failure) as leading causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Trends were analyzed using Joinpoint regression to estimate annual percent change (APC) and Average annual percent change (AAPC).
Results:
Between 1999 and 2023, a total of 541,325 deaths among adults (+25) were attributed to cerebrovascular disease and heart failure. The AAMR significantly declined from 14.74 to 10.76 (AAPC: -1.34%, 95% CI: -2.11 to -0.56; p = 0.008). Gender-stratified trends showed higher mortality in women (312,995) than men (228,330) with higher AAMR in men (15.47 in 1999 to 12.16 in 2023 vs 14.11 to 9.58). Urbanization differences revealed higher deaths in metropolitan areas (350,860 vs.104,571), with nonmetropolitan regions experiencing a higher overall AAMR (12.32 vs 8.96). Racially, the highest number of deaths was observed in the NH White (432,894). However, NH Black had the highest AAMR (17.29). Geographically, the Northeast had the sharpest decline (AAPC: -1.99%, p < 0.001). Regarding age, the highest number of deaths occurred in the +65 age group (501,870) with a significant decline in AAMR from 72.35 in 1999 to 49.21 in 2023 (AAPC: -1.63; p = 0.004). Regarding the place of death, the majority occurred in nursing homes with 181,896 deaths (33.60%).
Conclusions:
Mortality from heart failure–associated cerebrovascular disease declined significantly from 1999–2023, with the steepest reductions in older adults and Northeastern states, yet persistent sex and racial disparities remain.
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