Mortality trends in Ischemic heart diseases and new infectious triggers (Influenza & Pneumonia), A CDC Wonder Analysis (1999-2020)

Abstract Background : The risk for ischemic heart disease increases after contracting pneumonia and influenza. This association poses major clinical challenges and complicates management. This study quantified and analyzed mortality trends in ischemic heart disease and infectious triggers (pneumonia+influenza) with attention to disparities by sex, race/ethnicity, region, state, and urban-rural status. Methods : We used the CDC WONDER multiple-cause mortality database (1999-2020) to find Age-adjusted mortality rates (AAMRs) per 100,000 among individuals aged 15 and older, with 95% confidence intervals (CIs), calculated across demographic, geographic, and temporal variables using ICD-10 codes. Joinpoint regression identified statistically significant (p < 0.05) trend changes and annual percent changes (APCs). Results : A total of 567,770 deaths occurred between 1999 and 2020, primarily in inpatient medical facilities and nursing homes. The overall age-adjusted mortality rate (AAMR) declined from 17.58 in 1999 to 10.35 in 2020, with significant reductions through 2018 followed by a sharp increase thereafter. Males consistently had higher AAMRs than females, while White and non-Hispanic populations and nonmetropolitan areas exhibited the highest mortality rates. West Virginia and Rhode Island had the highest state-level AAMR. At the regional level, the Northeast exhibited the highest AAMR. Across all demographic and geographic subgroups, mortality trends reversed after 2018, indicating worsening outcomes in recent years. Conclusions: From 1999 to 2018, mortality rates declined but increased sharply after 2018. Persistent disparities were observed across sex, race/ethnicity, geography, and urban-rural status. These findings underscore the need for targeted public health strategies to reduce mortality and narrow disparities among at risk populations.