Twenty years of change: trends and challenges in ischemic heart disease mortality among older adults in Poland

Abstract Introduction Ischemic heart disease (IHD) remains the leading cause of cardiovascular mortality worldwide, particularly among older adults. Purpose The aim of the study is to analyse trends in mortality due to IHD among people aged 65 and over in Poland in the years 2000-2022. Methods The study database contained information on all deaths among Polish residents aged 65 and older (divided into two age groups: early old age (65-74 years) and late old age (75+) due to IHD between 2000 and 2022 (ICD-10, codes I20-I25). Standardized death rates (SDR) were calculated. Time trends were analysed with Joinpoint Regression Program. Annual Percentage Change (APC) for each segments of broken lines and average annual percentage change (AAPC) for the whole study period were calculated. Results By 2022, the proportion of cardiovascular-related deaths had declined compared to 2000 in both sexes and age groups. Among men, cardiovascular diseases contributed to 31.7% of deaths in the 65–74 age group and 39.7% in the 75+ group. Among women, the corresponding percentages were 26.6% and 47.4%. Within the cardiovascular disease category, IHD was the leading cause of death. The proportion of deaths due to IHD in the analysed mentioned groups was respectively: 13.1%, 16.5%, 9.5%, 18.5%. Among women aged 65–74, SDR decreased from 333.3 in 2000 to 125.7 in 2016 (APC=-5.8%; p0.05), but after 2016, it started to increase at a rate of 5.7% per year (p0.05), reaching 151.8 per 100,000 women in 2022. In the 75+ female group, IHD became the leading cause of cardiovascular-related deaths. Between 2000 and 2009, SDR for IHD declined at a rate of -3.2% per year (p0.05), which accelerated to -6.9% per year between 2009 and 2016 (p0.05). However, after 2016, SDR began to rise rapidly at a rate of 12.8% per year (p0.05). As a result, the SDR in 2021 reached 1575.0, exceeding the 2000 value of 1559.6. Among men aged 65–74, ischemic heart disease had the highest mortality rates within the cardiovascular disease category, with an unfavorable upward trend starting in 2016. From 2000 to 2016, SDR declined from 812.6 to 361.1 per 100,000 (APC=-4.9%; p0.05). However, after 2016, SDR started increasing at a rate of 5.0% per year (p0.05), reaching 459.0 in 2022. The SDR for IHD among men aged 75+ declined from 2174.9 in 2000 to 1138.4 in 2016 (APC=-4.3%; p0.05). However, since 2016, SDR began rising at a rate of 8.7% per year (p0.05), reaching 1810.9 per 100,000 in 2022. Conclusions Despite the overall reduction in mortality due to cardiovascular diseases, IHD continued to be the primary contributor to cardiovascular mortality in both men and women, particularly in the older age group. The observed trend reversal may reflect stagnation in cardiovascular risk factor control or potential gaps in secondary prevention strategies. Efforts should focus on intensifying prevention and addressing modifiable risk factors to mitigate further increases in IHD-related deaths.