Abstract 4357915: How Thoracic Aortic Aneurysm Deaths Turned Upward After Two Decades of Progress in Older Americans: A 25-Year Mortality Analysis (1999-2023)

Background: Thoracic aortic aneurysms (TAA) are life-threatening conditions that often remain asymptomatic until rupture, resulting in >90% mortality. Despite their clinical significance, comprehensive epidemiologic data on TAA mortality trends and demographic disparities remain limited. Objective: To investigate mortality trends and demographic disparities in TAA-related deaths among adults aged 75 or older from 1999 to 2023. Method: In this retrospective study death certificate data were retrieved from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research database. Mortality for TAA using ICD-10 codes I71.1 and I71.2 from 1999-2023. Age-adjusted mortality rate (AAMR) per 100,000 were calculated. The data was stratified by sex, race, ethnicity and geographic locations. Using Joinpoint regression analysis, annual percentage changes (APC) in AAMR were calculated. Results: From 1999-2023, TAA accounted for 36,502 deaths with an overall declining trend (AAPC: -2.08%), with AAMR decreasing from 11.5 to 6.9 in 2023. However, mortality trends showed a significant inflection point, rates declined substantially from till 2016 (APC: -4.27%) but increase from 2016-2023 (APC: 3.42%, 95% CI: 1.08-5.82). Men demonstrated higher overall mortality than women (AAMR: 7.93 vs 7.16) despite both sexes showing declining trends (men: AAPC -1.93%, women: AAPC -2.57%, both p<0.001). Patients ≥85 years consistently had the highest mortality rates and mirrored the overall trend with declining mortality from 1999-2015 (APC: -3.16%) followed by increasing rates from 2015-2023 (APC: 3.17%). Racial disparities were evident, with Asians having the highest AAMR (7.91), followed by Whites (7.72), Blacks (7.26), and Hispanics (4.08). Non-Hispanic Blacks showed the greatest improvement (AAPC: -2.85%, p<0.001). Regionally, the Midwest had the highest mortality rates (8.22), followed by Northeast (7.76), West (7.51), and South (6.73). Most deaths occurred in medical facilities (59.1%, predominantly inpatient 44.6%), followed by home (26.9%) and nursing facilities (12.8%). Conclusion: While TAA mortality rates declined overall, the significant trend reversal after 2016 represents critical public health concern. Persistent demographic and geographic disparities, combined with recent mortality increases, highlight the urgent need for targeted interventions and improved clinical management strategies.