Trends in Mortality Due to Coexisting Chronic Obstructive Pulmonary Disease and Ischemic Heart Disease in the United States,1999–2020: A Retrospective Observational Study

Abstract

Objectives

To describe trends in chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD)-related mortality in the United States from 1999 to 2020 using data from CDC WONDER.

Methods

This study analyzed mortality data from CDC WONDER, identifying decedents aged 25 years and above using ICD-10 codes. A total of 1,459,562 deaths occurred between 1999 and 2020. Annual crude and age-adjusted mortality rates (AAMRs) per 100,000 were calculated and stratified by age, sex, race, and region. Annual percentage changes (APC) were determined using Joinpoint regression.

Results

The overall AAMR declined from 24.78 in 1999 to 18.5 in 2020, with a gradual decrease from 1999 to 2018 (APC = −2.06 [95% CI: −2.27, −1.90]) and a subsequent rise through 2020 (APC = 4.53 [95% CI: 0.56,6.41]). Males had higher AAMRs (28.2) than females (13.95). Non-Hispanic Whites had the highest AAMRs (21.93). Mortality among adults aged 45–64 was stable until 2008, then increased through 2020. For adults ≥ 65 years, AAMRs declined until 2018 but rose sharply thereafter. Non-metropolitan areas (AAMR: 26.29) had higher mortality than metropolitan areas (AAMR: 18.42). States in the 90th percentile, such as Tennessee and Kentucky, had AAMRs approximately three times higher than those in the 10th percentile, including Arizona and Hawaii.

Conclusions

Substantial demographic and regional disparities persist in COPD and IHD-related mortality, necessitating targeted interventions in high-risk populations.

Graphical abstract

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Keywords

COPD disparities epidemiology IHD mortality

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