National Trends and Geographic Disparities in Ischemic Heart Disease Mortality in the United States, 1968–2023
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Background
Ischemic heart disease (IHD) is a leading cause of mortality in the United States, with significant variations across demographic and geographic factors. This study analyzes trends in IHD-related mortality among adults (> 25 years) from 1968 to 2023 using the CDC WONDER database.
Methods
We analyzed death certificates of adults aged >25 years from the CDC-WONDER database with IHD (ICD-8 codes: 410-413, ICD-9 codes: 410-414 and ICD-10 codes: I20-I25) from 1968-2023. Age-adjusted mortality rates (AAMR) per 100,000 population were stratified by gender, race, census region, and year. Join-Point analysis was performed to estimate annual percent change (APC) and average annual percent change (AAPC), complemented by spatiotemporal modeling to capture the geographic variations and evolving patterns of IHD mortality over time.
Results
Between 1968 and 2023, IHD caused 27,685,173 deaths in adults aged >25 years. Throughout the study period, the overall AAMR demonstrated a sustained and significant decline, falling from 746.29 in 1968 to 127.07 in 2023 with an AAPC (-3.12; 95% CI: -3.51 to -2.73; p<0.001). Additionally, the overall AAMR for males (452.99) was higher than that of females (260.08). Non-Hispanic (NH) Black or African American displayed slightly higher AAMR (346.75) as compared to NH white (345.38). The Northeast had the highest overall AAMR (379.61), followed by the Midwest (351.31), the South (329.15), and the West (303.15). Older adults (≥65 years) had the highest overall crude mortality rate (CMR) (1312.66), followed by middle-aged adults (45–64 years) (171.67). Younger adults (25–44 years) had the lowest rate (12.18).
Conclusion
Mortality rates due to IHD have decreased in the United States over the last few decades. However, the rate of decline has decreased in the past decade. In addition, significant disparities still exist across different sexes, age, race/ethnicity, and geographic regions. These disparities highlight the need for targeted interventions and improvement of clinical care facilities in high-risk populations.
