Trends in cardiovascular mortality (1999–2023) in the United States: an analysis of underlying causes of death using the CDC WONDER database

OBJECTIVES: National statistics on mortality due to cardiovascular disease (CVD) in the United States remain insufficiently characterized. This study aimed to analyze the long-term trends and subgroup disparities in CVD-related mortality across the US from 1999 to 2023. METHODS: We utilized the CDC WONDER database to identify all US residents with CVD recorded as the only underlying cause of death from 1999 to 2023 (ICD-10 codes: I00-I99). Age-adjusted mortality rates (AAMRs) per 100,000 population and average annual percent changes (AAPCs) with 95% confidence intervals (CIs) were calculated via Joinpoint regression analysis (version 5.3.0). RESULTS: In the United States, the number of cardiovascular-related deaths decreased from 954,339 in 1999 to 915,973 in 2023. Concurrently, the overall AAMR fell from 350.76 (95% CI: 350.06 to 351.47) in 1999 to 218.32 (95% CI: 217.87 to 218.77) in 2023, reflecting an AAPC of -1.95 (95% CI: -2.36 to -1.55). Notably, AAMR was consistently higher in men compared to women (2023: 263.04 vs. 180.16). An analysis by race indicated that non-Hispanic blacks experienced the highest mortality in 2023 (290.03 (95% CI: 288.35 to 291.72)), followed by whites (223.73 (95% CI: 223.19 to 224.27)), Hispanics (156.65 (95% CI: 155.42 to 157.88)), and individuals from other racial backgrounds (124.21 (95% CI: 122.92 to 125.49)). Regionally, the South exhibited the highest AAMR in 2023 (234.53 (95% CI: 233.77 to 235.30)), succeeded by the Midwest (231.41 (95% CI: 230.39 to 232.42)), the West (197.25 (95% CI: 196.35 to 198.16)), and the Northeast (194.97 (95% CI: 193.99 to 195.96)). Furthermore, the AAMR was most pronounced among individuals aged over 85 years. Between 1999 and 2020, AAMR was notably higher in rural regions compared to urban areas, with a widening gap after 2011. CONCLUSION: The age-adjusted mortality rate of CVD in the United States continued to decrease from 1999 to 2023, with the highest burden among men, non-Hispanic black, rural areas, and individuals over 85 years of age.