Disparities in aortic stenosis and heart failure related mortality trends by sex, race, and geography in United States: A two-decade perspective

Objective: This study aimed to evaluate two decades of U.S. mortality patterns in patients with aortic stenosis (AS) and heart failure (HF), focusing on disparities by sex, race, and geography. Design: Retrospective Study. Setting: Using the CDC WONDER database, we examined national mortality data from 1999 to 2023. Participants: Individuals aged ≥45 years with AS and HF were included. Main outcome measure: Trends in age-adjusted mortality rates (AAMRs) across age, sex, race, geography, and urbanization using Joinpoint regression analysis. Results: A total of 236,504 deaths were recorded. Overall AAMR increased until 2011 (APC: 0.78, AAMR 9.42), then stabilized through 2023 (APC: 0.07, AAMR 9.45). Mortality rates were consistently higher among males, older adults >65 years, non-Hispanic Whites, rural populations, and the Midwest region. AAMR in older adults was approximately 80 times higher than in middle-aged groups. Conclusions: Although national mortality rates for AS and HF have stabilized in recent years, they are still on the rise and significant disparities persist across demographic and geographic groups. These findings highlight the need for equitable healthcare access and targeted interventions to reduce preventable cardiovascular deaths.