Trends in Rheumatic Heart Disease Mortality in the United States of America from 1968 to 2023: A Nationwide Analysis

Background Rheumatic heart disease (RHD) is a preventable sequela of acute rheumatic fever causing chronic valvular damage to the heart. In the United States of America (USA), RHD persists among socioeconomically disadvantaged populations. This study examines long-term trends in RHD mortality from 1968-2023, identifying associated demographic and geographic factors to guide targeted public health interventions. Methods This retrospective observational study examined death certificate data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (WONDER) database, encompassing three different International Classification of Disease periods (ICD-8, 9, 10). Analysis included stratification by age, gender, race, ethnicity and urbanisation level. Joinpoint analysis and multiple regression analysis were used to identify trends. Results 365,298 cases of fatal RHD from 1968-2023 were included. Independent of definitional changes following transitions in ICD coding, RHD mortality decreased from 1968-2012 (16,325 annual deaths vs 3,083 annual deaths, annual percentage change -1.8%, p<0.0001) with subsequent rise from 2013 to 2023 (APC +3.1%, p<0.0001). Females represented 62.4% of overall cases, with consistently higher RHD CMR than men (CMR ratio range 1.09-2.43). Minimal differences in valvular patterns of damage between sexes were observed. Both male and female sex (p=0.024 and p=0.022 respectively), Hispanic/Latino status (p=0.044) and age 35-54 years (p=0.003) were most associated with increasing RHD CMR from 2012 to 2023. Conclusion Following decades of decline RHD mortality in the USA has increased from 2012 to 2023. Disproportionate increases in American Indian and rural populations underscore need for targeted strengthened surveillance and initiatives in these groups.