Cardiovascular Disease Mortality in Patients with Hypothyroidism: A 22-Year National Analysis of U.S. Trends and Disparities

Hypothyroidism, a common endocrine disorder, has been associated with adverse cardiovascular outcomes, yet national patterns of cardiovascular disease (CVD) mortality in this population remain poorly defined. Using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, we examined death certificate data from 1999 to 2020 to assess long-term trends and disparities in CVD mortality among U.S. adults aged 25 years and older with hypothyroidism. Cases were identified using ICD-10 codes E02–E03 and I00–I99, and age-adjusted mortality rates (AAMRs) were calculated per 100,000 population based on the 2000 U.S. standard population. Temporal changes were evaluated using Joinpoint regression. Over the 22-year period, 382,906 CVD-related deaths were linked to hypothyroidism, with an overall AAMR of 8.00 per 100,000. Mortality rates rose steadily, peaking at 10.12 per 100,000 in 2020, with the steepest increase observed between 2018 and 2020 (annual percent change 14.01%). Women accounted for nearly three times more deaths than men, although mortality rose faster in men. Non-Hispanic White individuals experienced the highest absolute mortality, while Hispanic populations had the most rapid growth. Relative increases were greatest among adults aged 35–44 and 45–54 years. Rural residents consistently showed higher mortality than their urban counterparts, and most deaths occurred in long-term care facilities. These findings demonstrate rising CVD mortality in patients with hypothyroidism and reveal disparities across demographic and geographic subgroups. Targeted screening, timely diagnosis, and integrated management strategies are urgently needed to address these inequities