Mortality trends and disparities associated with aortic aneurysm and aortic dissection in the United States from 1999 to 2023: a CDC WONDER database analysis

BACKGROUND: Aortic aneurysm (AA) and aortic dissection (AD) are life-threatening cardiovascular diseases. AA includes thoracic (TAA) and abdominal (AAA) subtypes, while AD involves primary intimal tear. In the U.S., mortality trends, and demographic disparities remain unclear. This retrospective population-based study analyzed US AA/AD burden and disparities to guide targeted prevention and management. METHODS: We extracted AA/AD mortality data (1999–2023; urban-rural 1999–2020) for adults aged ≥ 25 in the continental U.S. from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research, stratified by sex, age, race/ethnicity and region. We calculated crude and age-adjusted rates (CMR/AAMR), and estimated annual and average annual percentage change (APC/AAPC) via joinpoint regression. Two-tailed t-tests were used (p < 0.05). RESULTS: Between 1999 and 2023, there were 289,971 AA/AD-related deaths in the U.S., with AAMR declining (AAPC = -3.73%, 95% CI: -4.33 to -3.14; p < 0.001). Males and non-Hispanic Black adults had higher AAMR and slower declines. Crude mortality rose with age, while the 35–44 age group showed a small increase (AAPC = 1.04%, 95% CI: 0.63 to 1.46; p < 0.001). The Midwest exhibited a higher disease burden, and between 1999 and 2020, nonmetropolitan areas consistently showed greater disease burden compared with metropolitan regions. CONCLUSIONS: From 1999 to 2023, U.S. mortality from aortic aneurysm and dissection declined overall, but burdens remained disproportionately high in non-Hispanic Black individuals, those aged 85+, and the Midwest. 1999–2020 data show greater burden in nonmetropolitan areas, highlighting persistent disparities in resources and risk management.