Mason Klisares

Background/Objectives: Cerebrovascular disease (CVD) is the fifth leading cause of death in the U.S. and poses marked health ramifications. Improvements in CVD-related mortality rates have been observed since the 1970s, but incidence remains high. It is imperative to analyze demographic disparities and trends in CVD-related mortality to inform better efforts to reduce the burden of CVD. This study aimed to examine demographic disparities in CVD-related mortality across age groups, biological sex, race/ethnicity, and regions from 1999 to 2024. Methods: This was a retrospective population-based study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER). The CDC WONDER was used to extract crude and age-adjusted mortality rates (AAMRs) for CVD-related deaths in the US. Adults aged 25 years and older were included in the study. Joinpoint analysis software was used to calculate the annual percent change (APC) and the average annual percent change (AAPC) for mortality trends. Results: There was a total of 6,541,598 CVD-related deaths from 1999 to 2024 in adults aged 25 years and older. The trend in overall CVD-AAMR steadily declined until 2014, then gradually increased, accelerated, and eventually peaked in 2021 during the COVID-19 pandemic. Male individuals experienced a higher mortality rate and comprised 43% of crude deaths vs. 57% of female individuals across the study period. When stratified by race/ethnicity, non-Hispanic (NH) Black individuals had an AAMR that was nearly 1.5 times that of the next-highest group at 148.37 (146.89 to 149.85) per 100,000 people in 2024. The South had the highest AAMR and experienced 39.4% of deaths out of the four regions. All demographics experienced an increase in mortality during the pandemic, but the Northeast region experienced an earlier peak in 2020 as opposed to all other groups, which saw a peak in 2021. Conclusions: CVD-related mortality declined significantly in adults from 1999 to 2024. Differences across demographic and regional subgroups have narrowed; however, significant disparities persist. These disparities will require comprehensive, concerted efforts to improve cerebrovascular health, outcomes, and equity among the young and middle-aged populations in the US.

Background: Myocarditis is associated with increased mortality due to complications such as cardiogenic shock and arrhythmia. Trends of myocarditis-related mortality in the United States, along with demographic and regional disparities and changes during the COVID-19 pandemic, are unknown. Methods: We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database to extract data for myocarditis deaths from 1999 to 2023. The Joinpoint Regression Program was used to analyze long-term trends in mortality, and R Studio (version 4.4.1) was used to calculate expected and excess mortality for 2020 to 2023. Results: There were 33,016 myocarditis-related deaths from 1999 to 2023. The age-adjusted mortality rate (AAMR) of myocarditis deaths decreased by 46.08% from 7.40 (95% CI: 7.04–7.76) in 1999 to 3.99 (95% CI: 3.74–4.23) in 2019, with an APC of −2.59 (95% CI: −2.97 to −2.24). From 2019 to 2021, the AAMR increased by 46.62% to 5.85 (95% CI: 5.56–6.14) by 2021 (2019–2021 APC 22.3%*), reversing the gains of the previous two decades. By 2023, the AAMR recovered to 4.33 (95% CI: 4.09 to 4.58), though mortality was still higher than expected from pre-pandemic trends. From 2020 to 2023, there were 40.12% more deaths than expected, with 54.94% higher mortality in 2021. Briefly, 70.33% of excess myocarditis-related deaths also had COVID-19, with a peak of 76.15% of excess myocarditis deaths in 2021 being reported as involving COVID-19 infection. Significant disparities in mortality trends persisted, with males, NH Black or African Americans, and the elderly having higher mortality rates. Conclusions: Myocarditis mortality decreased in the United States from 1999 to 2019 but significantly increased during the COVID-19 pandemic years 2020 and 2021. At the height of the pandemic, COVID-19 infection contributed to almost three-quarters of excess myocarditis mortality. Significant disparities in myocarditis mortality persisted from 1999 to 2023.

Background/Objectives: Acute myocardial infarction (AMI) has been a leading cause of mortality in the US. Though AMI mortality has been decreasing in the US, significant disparities have persisted. We aim to evaluate disparities in AMI-related deaths in the US from 1999 to 2022. Methods: Data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database were used to analyze death certificates from 1999 to 2022 for AMI-related deaths among United States older adults (aged ≥ 65) for overall trend and disparities based on demographic (sex, race/ethnicity, and ten-year age groups) and regional (census regions, rural-urban status, and states) subgroups. Rural and urban status were distinguished using definitions set by the 2013 NCHS Urban-Rural Classification scheme for counties. These data come from the 2010 Census report and are updated from the 2006 NCHS Urban-Rural Classification scheme for counties. The crude mortality rate (CMR) and age-adjusted mortality rates (AAMRs) per 100,000 people were used to calculate annual percentage changes (APCs) and average annual percentage changes (AAPCs) using Joinpoint regression analysis. Results: From 1999 to 2022, there were 3,249,542 deaths due to AMI. Overall, age-adjusted mortality rates (AAMRs) decreased by 62.78% from 563.2 * (95% CI 560.3–565.7) in 1999 to a nadir at 209.6 * (208.3–210.8) in 2019, with an AAPC of −4.96 * (95% CI −5.11 to −4.81). There were a total of 355,441 deaths from AMI from 2020 to 2022; 21,216 (5.97%) of those were from AMI with COVID-19 infection. An increase of 11.4% was observed from an AAMR of 209.6 * (95% CI 208.3–210.8) in 2019 to 233.5 * (95% CI 232.2–234.8) in 2021. From 2021 to 2022, the AAMR of AMI decreased from 233.5 * (95% CI 232.2–234.8) to 209.8 * (95% CI 208.6–211), recovering to the 2019 levels. The AAMR for AMI excluding associated COVID-19 infection was 217.2 at its peak in 2021, which correlates to only a 3.63% increase from 2019. Significant disparities in AMI mortality were observed, with higher mortality rates in men, African Americans, the oldest age group (age ≥ 85), and those living in southern states and rural areas. Conclusions: AMI mortality in the older adult population of the US has significantly decreased from 1999 to 2019, with a brief increase during the pandemic from 2019 to 2021, followed by recovery back to the 2019 level in 2022. The majority of the rise observed during the pandemic was associated with COVID-19 infection. Despite remarkable improvement in mortality, significant disparities have persisted, with men, African Americans, and those living in rural areas and the southern region of the US having disproportionately higher mortality.