S2658 Mortality Trends in Premature IHD With MASLD Among Young-Middle Aged Adults (25-54 Years): A CDC WONDER Analysis (2018-2023)

Introduction: Premature ischemic heart disease (IHD) is a leading cause of mortality in adults, with metabolic dysfunction-associated steatotic liver disease (MASLD) as a major comorbidity that affects cardiovascular outcomes. Despite the role of MASLD in adverse cardiac outcomes, national trends in premature IHD mortality with MASLD among adults aged 25–54 years have not been well characterized. This study examines mortality patterns in U.S. adults and addresses a critical knowledge gap. Methods: Retrospective analysis was conducted using data from CDC WONDER Multiple Cause of Death database (2018-2023). Deaths involving IHD and MASLD were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes I20–I25 and K76.X. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated annually and stratified by sex (men, women) and for the total population. Trends were analyzed using Joinpoint regression to estimate the annual percent change (APC), average annual percent change (AAPC), and assess statistical significance (P < 0.05). Results: From 2018 to 2023, a total of 1,346 premature IHD deaths with comorbid MASLD occurred among U.S. adults aged 25–54 years. Annual mortality peaked in 2020 (n = 246), followed by 2021 (n = 241). Overall mortality trend remained relatively stable, with a slight decline in 2023 (n = 205). AAMR for total population remained low and stable: 0.1 per 100,000 in 2018–2019, rising to 0.2 during 2020–2022, and returning to 0.1 in 2023. Joinpoint regression showed stable trend (AAPC ≈ 0%, P > 0.05). Sex-stratified analysis revealed stable AAMRs in women (0.1 per 100,000 annually), with no significant trend (APC = 0%, P = 1.0). In contrast, men had higher AAMRs, increasing from 0.2 in 2018 to 0.3 during 2019–2022 before declining to 0.2 in 2023. A trend shift was seen in 2019; +50% APC (2018–2019; P > 0.05), 0% APC (2019–2022; P > 0.05), and −33% APC (2022–2023; P > 0.05), but none were statistically significant (all P > 0.05). Statistical analysis revealed no significant temporal trends within any subgroup. Conclusion: Mortality from premature IHD with MASLD among US adults aged 25–54 years remained low and stable between 2018 and 2023. Although the mortality rate was consistently higher in men than in women, no significant temporal trends noted in either group. Given the study’s limitations and low event rates, alongside the rising burden of metabolic disease in younger populations, ongoing surveillance of cardiovascular risks remain crucial.