Mortality Trends in Heart Disease and COPD 1999–2020: A CDC Wonder Analysis

Abstract Background Heart failure (HF) and Chronic Obstructive Pulmonary Disease (COPD) are leading causes of morbidity and mortality in older adults. Their coexistence poses major clinical challenges and complicates management. This study quantified and analyzed mortality trends highlighting disparities by sex, race/ethnicity, age, region, state, and urban-rural status. Methods The CDC WONDER multiple-cause mortality database was used (1999–2020), including deaths in which both HF and COPD were recorded on death certificates. Age-adjusted mortality rates (AAMRs) per 100,000, with 95% confidence intervals (CIs), were calculated across demographic, geographic, and temporal variables using ICD-10 codes. Joinpoint regression identified statistically significant ( p < 0.05) trend changes and annual percent changes (APCs). Results A total o f 1,054,847 deaths occurred in adults ≥ 15 years with both HF and COPD. In males, AAMR declined from 24.01 in 1999 to 21.22 in 2012, followed by an increase to 26.23 in 2020; in females, from 13.91 in 1999 to 14.68 in 2012 and to 18.59 in 2020. White individuals had the highest racial AAMR (19.18). The Midwest reported the highest regional AAMR (20.75), while West Virginia ranked highest among states (32.40). Noncore and micropolitan areas showed higher AAMRs compared with metropolitan areas. Conclusions Mortality associated with the coexistence of heart failure and chronic obstructive pulmonary disease in the United States has increased substantially over the past decade Persistent disparities were observed across sex, race/ethnicity, geography, and urban-rural status. These findings underscore the need for targeted public health strategies to reduce mortality and narrow disparities in high risk groups.