Spatiotemporal Mortality Patterns and Temperature-Associated Risk of Aortic Dissection in the United States: A National CDC WONDER Database Analysis

Heng Wang,1,2,* Shule Wang,3,* Keyi Fan,4,* Yaling Li,5 Ziyan Wang,6 Mohamed Mawas,1,2 Wenyi Chu,7 Gamal Musleh,8 Guoping Zheng1,2 1Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia; 2Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; 3Neuroscience Institute, JFK University Medical Center, Edison, NJ, USA; 4Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China; 5Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China; 6Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China; 7Department of Anesthesiology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA; 8Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ, USA*These authors contributed equally to this workCorrespondence: Guoping Zheng, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia, Email [email protected]: Aortic dissection (AD) is a life-threatening aortic emergency that progresses rapidly and carries a high mortality rate. We characterised contemporary patterns and long-term trends in AD mortality in the United States and examined associations between ambient temperature and AD mortality.Patients and Methods: We obtained mortality data for AD from United States CDC WONDER for 1999– 2023 and calculated age-adjusted mortality rates (AAMR). Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Monthly air temperature data for the period 1999– 2023 were obtained from the North America Land Data Assimilation System (NLDAS). Associations between temperature and AD mortality were evaluated across census regions using correlation analyses and Poisson regression models. To explore the future burden, subgroup-specific time series models (ARIMA or ETS) were applied to generate 20-year forecasts.Results: In 2023, there were 4,418 AD deaths (AAMR 1.73 per 100,000; 95% CI 1.68– 1.78); rates were highest in the Midwest (1.96), in male (2.19 vs 1.24 in female), in non-Hispanic Black individuals (2.75), and in adults ≥ 85 years (11.67). From 1999– 2023, 86,943 deaths occurred and the overall AAMR declined (AAPC − 0.37), but reversed to sustained increases after 2013. Across the four census regions, the monthly AAMR was lowest in summer and highest in winter during 1999– 2023 (P < 0.05). A 10°F increase in temperature was associated with lower mortality risk (eg, South RR 0.889).Conclusion: AD mortality has rebounded since 2013 with marked demographic and regional disparities. Lower temperatures and greater thermal variability are linked to higher mortality, supporting seasonally and region-tailored prevention and health-system preparedness.Keywords: aortic dissection, mortality, ambient temperature, seasonality, health disparities