Mortality trends and disparities associated with aortic aneurysm and aortic dissection in the United States from 1999 to 2023: a CDC WONDER database analysis

Aortic aneurysm (AA) and aortic dissection (AD) are life-threatening cardiovascular diseases. AA includes thoracic (TAA) and abdominal (AAA) subtypes, while AD involves primary intimal tear. In the U.S., mortality trends, and demographic disparities remain unclear. This retrospective population-based study analyzed US AA/AD burden and disparities to guide targeted prevention and management. We extracted AA/AD mortality data (1999–2023; urban-rural 1999–2020) for adults aged ≥ 25 in the continental U.S. from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research, stratified by sex, age, race/ethnicity and region. We calculated crude and age-adjusted rates (CMR/AAMR), and estimated annual and average annual percentage change (APC/AAPC) via joinpoint regression. Two-tailed t-tests were used (p < 0.05). Between 1999 and 2023, there were 289,971 AA/AD-related deaths in the U.S., with AAMR declining (AAPC = -3.73%, 95% CI: -4.33 to -3.14; p < 0.001). Males and non-Hispanic Black adults had higher AAMR and slower declines. Crude mortality rose with age, while the 35–44 age group showed a small increase (AAPC = 1.04%, 95% CI: 0.63 to 1.46; p < 0.001). The Midwest exhibited a higher disease burden, and between 1999 and 2020, nonmetropolitan areas consistently showed greater disease burden compared with metropolitan regions. From 1999 to 2023, U.S. mortality from aortic aneurysm and dissection declined overall, but burdens remained disproportionately high in non-Hispanic Black individuals, those aged 85+, and the Midwest. 1999–2020 data show greater burden in nonmetropolitan areas, highlighting persistent disparities in resources and risk management.