Temporal trends and demographic and geographic patterns in U.S. mortality involving cardiac arrhythmias, conduction disorders, cardiac arrest, and tobacco-use disorders: a CDC WONDER analysis, 1999–2024

Cardiac arrhythmias, conduction disorders, cardiac arrest, and tobacco use contribute to cardiovascular mortality, but patterns in deaths recording these cardiac conditions with tobacco-use disorders remain incompletely characterized. We analyzed CDC WONDER Multiple Cause of Death data for adults aged ≥25 years with a cardiac arrhythmia, conduction disorder, or cardiac arrest and a tobacco-use disorder listed anywhere on the death certificate, regardless of underlying cause. AAMRs per 100,000 were described by sex, race/ethnicity, census region, and urbanization; age-specific crude rates were calculated. Joinpoint models characterized historical trends. Additional analyses evaluated the 2003 certificate revision, 2020–2021 database transition, condition composition, and definitions omitting cardiac arrest from the qualifying set or restricted to atrial fibrillation/flutter. Subgroup comparisons were descriptive. Overall AAMR rose from 2.20 in 1999 to 26.96 in 2021, then declined to 23.13 in 2024 (historical AAPC +10.69%; 95% CI 8.59–12.82). Cardiac arrest was recorded on 58.4% of included deaths, so this composite trend should not be interpreted as a single arrhythmia phenotype. Males had numerically higher rates than females; American Indian/Alaska Native individuals had the highest observed peak racial/ethnic AAMR; the Midwest had the highest 2024 regional AAMR; and nonmetropolitan categories had higher observed 2020 AAMRs than large metropolitan categories. These between-group patterns were not formally tested. A 2003 level shift fit better than a continuous trend (+4.56 per 100,000; 95% CI 2.48–6.63), and revised-certificate adoption was associated with higher AAMRs after state and calendar-year adjustment (rate ratio 2.24; 95% CI 1.44–3.50). During 2018–2024, APCs were statistically uncertain for the primary, cardiac-arrest-omitted qualifying, and atrial fibrillation/flutter definitions. Mortality involving cardiac arrhythmias, conduction disorders, or cardiac arrest together with tobacco-use disorders increased substantially from 1999 to 2024, despite recent moderation. Because the full-period estimate reflects early ascertainment change, greater weight should go to 2018–2024, when APCs were uncertain across primary and sensitivity definitions. The observed temporal and demographic/geographic patterns support continued multiple-cause-of-death surveillance, but full-period trends were affected by changing ascertainment and the broad outcome was strongly influenced by cardiac arrest. The findings do not estimate tobacco-attributable mortality or establish causal effects.