Trends in Acute Myocardial Infarction–Related Mortality Among US Adults with Respiratory Diseases from 1999 to 2023: A Cross-Sectional Analysis of the CDC WONDER Database

Background: Acute myocardial infarction (AMI) is a leading cause of death in the United States. However, the long-term trends in AMI-related mortality among adults with respiratory diseases have not been thoroughly investigated. This study aimed to analyze these trends from 1999 to 2023 and to identify high-risk subgroups. Method: Data were obtained from the CDC WONDER database for a retrospective cohort study. The age-adjusted mortality rate (AAMR per 100,000) of acute myocardial infarction (ICD-10 I21) was analyzed among adults aged ≥25 years diagnosed with respiratory diseases (ICD-10 J00-J98). Joinpoint regression modeled temporal trends, generating the average annual percentage change (AAPC) and annual percentage change (APC). To model future trends, the best-fitting autoregressive integrated moving average (ARIMA) model was used to project mortality rates for the coming decade. Result: A total of 775,365 deaths from acute myocardial infarction (AMI) were recorded among US adults with respiratory diseases during the study period (1999-2023). The overall age-adjusted mortality rate (AAMR) fell from 20.20 (95% CI: 19.99–20.41) to 10.58 per 100,000, corresponding to an average annual percentage change (AAPC) of -2.77% (95% CI: -3.18 to -2.51). This downward trend was interrupted by a sharp, transient rise coinciding with the COVID-19 pandemic (APC 2018–2021 = 8.63%; 95% CI: 4.81–11.00). Furthermore, stark disparities were evident, as mortality rates consistently remained elevated for males, non-Hispanic American Indian/Alaska Native persons, individuals aged 85 and above, and inhabitants of the Southern US and rural communities. Conclusion: The decline in AMI mortality among adults with respiratory diseases notwithstanding, this issue continues to pose a major public health challenge in the United States—a challenge that was severely intensified by the exacerbation of pre-existing disparities during the COVID-19 pandemic. Our study reveals that patients with respiratory diseases constitute a distinct high-risk population for AMI, whose gains in survival are precarious and inequitably distributed. These findings mandate a paradigm shift towards integrated cardiopulmonary care and equity-focused public health interventions to reduce the burden of coronary artery disease in this vulnerable group.