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

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.

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).

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.

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.