Abstract 4141129: Temporal Trends in Substance Use and Ischemic-Heart disease related mortality in the United States: Cross-sectional Analysis of a National Database from 1999 to 2020

Background: There is a scarcity of data regarding trends in substance use (SU) and mortality related to ischemic heart disease (IHD) in the United States (US).This study aims to evaluate deaths linked to SU+IHD in the US by utilizing the CDC Wide-ranging Online Data for Epidemiologic Research database (CDC WONDER). Methods: The CDC WONDER database was used to access the mortality data of adults aged ≥25 from 1999 to 2020. Both substance use and IHD were mentioned as contributing or underlying causes of death. Results, presented as age-adjusted mortality rates (AAMR) per 100,000 population, underwent Joinpoint regression for trend analysis and annual percentage change (APC). Results: Between 1999 and 2020, a total of 236,832 deaths were attributed to IHD among patients with substance use (AAMR = 4.9, 95% CI: 4.91-4.95). The overall AAMR depicted a consistent rising trend from 3.29 in 1999 to 7.91 in 2020.Throughout the study period, males consistently exhibited higher overall AAMRs compared to females (Male: 8.3 vs Female: 1.9). Among racial/ethnic groups, non-Hispanic American Indian [NH-AI] individuals had the highest AAMRs (10.9, 95% CI: 10.6-11.3), followed by non-Hispanic blacks [NHB] (6.5, 95% CI: 6.5-6.6), non-Hispanic Whites [NHW] (5.0, 95% CI: 5.0-5.1), and Hispanics (3.5, 95% CI: 3.4-3.5). Notably, non-Hispanic Asian/Pacific Islander [NH-API] individuals had the lowest AAMR (1.2, 95% CI: 1.1-1.2). Regionally, the West reported the highest mortality rates (6.3, 95% CI: 6.3-6.4), followed by the Midwest (4.8, 95% CI: 4.8-4.9) and the South (4.6, 95% CI: 4.6-4.7), while the Northeast reported the lowest mortality rate (3.9, 95% CI: 3.9-4.0). Moreover, when comparing urbanization status, metropolitan areas had a higher AAMR value compared to metropolitan areas in 1999, however this trend sharply reversed to non-metropolitan areas having a higher AAMR in 2020 (1999 non-metro: 3.1 vs. metro: 3.3; 2020 non-metro: 9.2 vs. metro: 7.6). Conclusion: Our findings underscore a troubling rise in IHD related mortality among substance users in the US. Addressing gender, racial/ethnic, and regional disparities is crucial for targeted interventions to reduce mortality rates and improve cardiovascular health outcomes.