Abstract 4370954: Trends and Disparities in Nicotine Dependence and Acute Myocardial Infarction–Related Mortality in the United States (1999–2020) Among Adults Aged ≥ 25: A CDC Wonder Perspective

Background: Nicotine use remains a major modifiable risk factor for acute myocardial infarction (AMI), contributing significantly to cardiovascular mortality in adults. Despite public health efforts, nicotine-dependent individuals continue to face disproportionately high AMI-related death rates, underscoring the ongoing need for targeted prevention strategies. Methods: Using CDC WONDER data (1999–2020), we analyzed AMI (ICD-10: I21–I22.9) mortality among U.S. adults ≥25 years with nicotine dependence (F17.0). Age-adjusted mortality rates (AAMR) per 100,000 were calculated using the 2000 U.S. standard population. Trends were assessed via Joinpoint regression, stratified by sex, race/ethnicity, region, and urbanicity. Results: From 1999–2020, there were 357,167 AMI deaths among nicotine-dependent adults. Most deaths occurred in medical facilities (37.01%) or at home (32.88%). AAMR rose from 1.64 in 1999 to 9.46 in 2020 (AAPC: 10.27; p <0.000001). Males had higher AAMRs (11.3) than females (4.27), with both showing significant declines over time. The highest mortality was among those aged ≥85 years (33.55/100,000); the lowest was in ages 35–45 (0.83/100,000). Racial disparities showed NH American Indians/Alaska Natives with the highest AAMR (10.3). Regionally, the Midwest (9.05) and South (6.94) had higher rates, and nonmetropolitan areas (11.71) exceeded metropolitan ones (6.13). States with the highest AAMRs included Wyoming and Nebraska; the lowest were Massachusetts and Hawaii. Conclusion: Although AMI mortality among nicotine users declined earlier, recent increases are concerning. These trends emphasize the need for renewed tobacco control efforts and vigilance amid the rising use of alternative nicotine products.