Temporal trends and disparities in cardiovascular disease and sleep disorder comorbidity mortality in the United States, 1999–2023: a population-based analysis

Objective Bidirectional cardiovascular disease (CVD)-sleep disorder (SD) relationship increases mortality. This study analyzed U.S. CVD-SD mortality trends and disparities (1999–2023).Study design Population-based retrospective analysis using CDC WONDER Multiple Causes of Death Database.Methods Death certificates for adults ≥25 years with CVD (ICD-10 I00-I99) and SD (G47/F51). Age-adjusted mortality rates (AAMR/100,000) were calculated using the 2000 US standard population. Joinpoint regression assessed AAPC and APC (maximum 3 joinpoints, Monte Carlo permutation test, p < 0.05).Results 268,538 CVD-SD comorbidity deaths. AAMR increased from 1.21 (1999) to 8.67 (2023), AAPC 8.47% (95%CI:7.73–9.21, p < 0.001). Males showed higher absolute mortality (AAMR 12.24 vs 5.77), while females had a steeper relative increase (AAPC 8.73% vs 8.36 %). The highest absolute burden in non-Hispanic Blacks, rural residents, and age ≥85. Highest absolute burden in non-Hispanic Blacks, rural residents, and age ≥85. Mortality declined post-2021 (APC −4.26%, 95%CI: −7.76 to −0.64).Conclusion CVD-SD comorbidity mortality increased continuously until 2021 then declined. The highest absolute burden was observed in males, non-Hispanic Blacks, rural populations, and those aged ≥85, while females showed a steeper relative increase. These findings reflect population-level associations requiring further mechanistic investigation. Targeted sleep disorder screening in CVD patients is needed to reduce mortality disparities.