Trends and Disparities in Chronic Rheumatic Heart Disease Mortality in the United States (1999–2024) and Projections to 2050

Contemporary data on national mortality trends, projections, and evolving disparities remains limited. National rheumatic heart disease mortality data from 1999 to 2024 was assessed using Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database. Age adjusted mortality rates (AAMR) per 100,000 were calculated. Trends were assessed using joinpoint regression to compute the average annual percent change (AAPC), and predictive models were adopted to estimate rates through 2050. A total of 177,342 deaths were recorded from chronic rheumatic heart disease in the US between 1999 and 2024 with an AAPC of -0.46 [95% confidence interval, -1.20 to 0.26]. Mortality declined significantly between 1999 and 2010 [annual percent change (APC): 3.79: P < 0.001]; however, increased between 2017 and 2021 (APC: 6.04; P < 0.001). Females had a higher mortality burden than males (AAMR: 3.36 vs 2.65). AAMR declined across all racial groups, most prominently in Asian (AAPC: -0.82, P = 0.04) and Hispanics (AAPC: -0.87, P = 0.01). Mortality was higher in non-metropolitan areas (AAMR: 3.25) than metropolitan areas (AAMR: 2.91), though both showed significant decline (metropolitan: AAPC: -1.49, P < 0.001; non-metropolitan: AAPC: -0.54, P = 0.04). Geographically, the West had the highest AAMR (3.80), while Northeast experienced the steepest decline (AAPC: -1.06, P < 0.01). Mortality increased sharply with age, with those ≥65 years experiencing the highest mortality (AAMR: 12.57).