Temporal and regional trends in Ischemic Heart Disease mortality associated with Anxiety - A nationwide analysis from 1999 to 2023 in the United States
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Background: The interplay of ischemic heart disease (IHD) and anxiety represents an emerging public health challenge. However, long-term mortality trends and disparities related to this interplay remain underexplored. This study investigates IHD and anxiety-related mortality in the United States (USA) from 1999 to 2023. Methods: We used the CDC WONDER Multiple Cause of Death database to analyze age-adjusted mortality rates (AAMRs) per 100,000 population for adults aged 25 and older from 1999 to 2023 for IHD alone and then IHD with underlying anxiety. Joinpoint regression identified trend segments. We assessed disparities by gender, race/ethnicity (White, Black, Hispanic, and Non-Hispanic Others, including American Indians/Alaska Natives and Asian/Pacific Islanders), census regions, states, and urbanization levels. Results: IHD and anxiety-related AAMRs nearly doubled from 0.14 (95% CI: 0.12–0.16) in 1999 to 0.26 (95% CI: 0.24–0.28) in 2023 (AAPC: 2.54%, P = 0.000003). There was a decline from 1999 to 2007 (APC: -2.2%, P = 0.02), a sharp rise from 2007 to 2021 (APC: 5.47%, P < 0.000001), and stabilization from 2021 to 2023. Whites dominated mortality (94.35% of 8,287 deaths, AAMR: 0.21). Blacks (AAMR: 0.06), Hispanics (AAMR: 0.14), and Non-Hispanic Others (AAMR: 0.07) followed. Females had higher AAMRs (0.2758 in 2023), but males showed a steeper rise (AAPC: 4.14% vs. 2.26%). The Midwest had the highest regional AAMR (0.38, 2023; APC: 11.94%). West Virginia (AAMR: 0.46) and Ohio (AAMR: 0.38) led in state-level burdens, in contrast to Utah (AAMR: 0.06). Noncore areas exhibited the highest AAMR (0.4 in 2020, AAPC: 4.08%). Conclusions: IHD and anxiety-related mortality are rising, driven by a post-2007 surge that may relate to the 2008 financial crisis and increased anxiety screening. Whites, males, the Midwest, and rural areas bear the heaviest burden. Underdiagnosis in minority groups may mask their true mortality. Further research should further elucidate the reasons for these differences, as these findings showcase the urgent need for integrated mental health and cardiovascular care.
