Trends in rheumatic heart disease mortality in the United States of America from 1968 to 2023: a nationwide analysis

Abstract Background Rheumatic heart disease (RHD) is a preventable sequela of acute rheumatic fever causing chronic valvular damage to the heart. In the United States of America (USA), RHD persists among socioeconomically disadvantaged populations. This study examines long-term trends in RHD mortality from 1968 to 2023, identifying associated demographic and geographic factors to guide targeted public health interventions. Methods This retrospective observational study examined death certificate data from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (WONDER) database, encompassing three different International Classification of Disease periods (ICD-8, ICD-9, ICD-10). Analysis included stratification by age, gender, race, ethnicity and urbanisation level. Joinpoint analysis and multiple regression analysis were used to identify trends. Results RHD mortality declined significantly from 1968 to 2012, with falling crude mortality rates in both sexes and large reductions in absolute deaths among White individuals and adults aged 55–74 years. From 2012 to 2023, total deaths increased from 3,083 to 4,332, crude mortality rose from 0.98 to 1.29 per 100,000 and age-adjusted mortality increased from 0.88 to 1.04 per 100,000 (all p < 0.0001). Increases were observed across sex, race, ethnicity, urbanisation, and most age subgroups. Females had consistently higher RHD crude mortality rate ratios than men (1.09–2.43). The age distribution of RHD mortality shifted markedly over the study period, with deaths among individuals aged ≥ 75 years increasing from 17% in 1968 to 61% in 2023. Race- and ethnicity-specific CMR increased across all assessed groups from 2012 to 2023, with the largest relative increases among American Indian or Alaska Native individuals (+ 112.4%; β = 0.033 per 100,000/year, p = 0.002) and Hispanic individuals (+ 60.2%; β = 0.014 per 100,000/year, p < 0.001). Conclusion Following decades of decline, RHD mortality in the United States increased after 2012. Our study identified a persistent female predominance in RHD mortality and a marked shift in mortality burden from middle-aged adults towards older populations.