National mortality trends in mood affective disorders and hypertensive/ischemic heart diseases in the United States, 1999 to 2020: a CDC WONDER analysis

Objective: This study assessed demographic and geographic trends in mortality linked to mood affective disorders (MAD) and hypertensive/ischemic heart diseases (HHD/IHD) in the United States. Methods: Death certificate data from CDC WONDER (1999-2020) were analyzed to identify individuals (≥15 years) with MAD and HHD/IHD listed as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent change (APC) were calculated by year, sex, race/ethnicity, and region. Results: From 1999 to 2020, 198,332 MAD-HHD/IHD-related deaths were recorded. The overall AAMR rose from 2.53 in 1999 to 5.05 in 2020. Women had consistently higher AAMRs than men (2.65 vs 2.30 in 1999; 5.36 vs 4.53 in 2020). Non-Hispanic Whites had the highest AAMR (3.57), followed by American Indian/Alaska Natives (2.31). North Dakota (7.51) and the Midwest (4.45) recorded the highest regional rates. Nonmetropolitan areas (6.73) showed higher mortality than metropolitan ones (3.29). Conclusion: MAD-HHD/IHD mortality has steadily increased, with notable sex, racial, and geographic disparities, highlighting the need for targeted preventive strategies, such as improved mental health screening, cardiovascular risk assessment, and integrated care, as well as policy measures aimed at expanding access to mental health and cardiovascular services.