What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure with respiratory comorbidity (n=353179). Primary outcome: Annual percentage change (AAPC) in mortality (AAPC +0.89%, 95% CI 0.42-1.37).

What does this research mean for the field?

Heart failure mortality with respiratory comorbidity in the US increased significantly from 1999 to 2020, with widening disparities particularly affecting Hispanic, American Indian/Alaska Native, and rural populations. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Evaluate trends in heart failure mortality associated with respiratory disease over 22 years and identify disparities.

May 20, 2026

A37-10 Widening Disparities in Heart Failure Mortality With Respiratory Comorbidity: A 22-year US Trends Analysis (1999-2020)

Key Result

Heart failure mortality with respiratory comorbidity in the US increased significantly from 1999 to 2020 (AAPC +0.89%; 95% CI 0.42-1.37%), with the greatest increases in Hispanic and rural populations.

Key Points

Evaluate trends in heart failure mortality associated with respiratory disease over 22 years and identify disparities.
Analyzed CDC Multiple Cause of Death data from 1999 to 2020 for heart failure and respiratory disease.
Calculated annual percentage change (AAPC) using log-linear regression.
Examined mortality data by demographics, age, geography, and urbanization.
Total of 353,179 deaths, with an overall AAPC of +0.89% (95% CI: 0.42-1.37%).
Highest mortality rates were in individuals aged 85+ (142.4/100k) with a declining AAPC of -1.45%.
Hispanic populations exhibited the largest mortality increase (AAPC: +2.15%), while disparities by race were prominent.

Study Design

Type

Observational (n=353,179)

Multicenter

Yes

Structured PICO

Population

353,179 deaths in the US (1999-2020) with heart failure as the underlying cause and respiratory disease (ICD-10: J00-J98) as a contributing cause, 56% female.

Outcome

Annual percentage change (AAPC) in mortalityhard clinical

Heart failure mortality with respiratory comorbidity in the US increased significantly from 1999 to 2020, with widening disparities among elderly, Hispanic, rural, and underrepresented racial/ethnic populations.

Main Result

Effect estimate: AAPC +0.89% (95% CI 0.42-1.37)

Abstract

Abstract Background Heart failure (HF) mortality trends with respiratory disease as a contributing cause remain understudied. We analyzed 22-year US mortality data to quantify HF burden and identify disparities. Methods CDC Multiple Cause of Death data (1999-2020) were analyzed for deaths with HF as underlying cause and respiratory disease (ICD-10: J00-J98) as contributing cause. Annual percentage change (AAPC) was calculated using log-linear regression. Results Of 353,179 deaths (overall rate: 5.2/100,000), 56% were female (n = 198,608; AAPC: +0.12%) and 44% male (n = 154,571; AAPC: +0.78%). Overall AAPC was +0.89% (95% CI: 0.42-1.37%), with 27% mortality increase from 1999 (15,821 deaths) to 2020 (20,137 deaths). Age 85+ showed highest rates (142.4/100k) with declining AAPC (-1.45%). Regional analysis revealed South (AAPC: +0.42%) and Midwest (AAPC: +0.37%) with steeper increases than Northeast (+0.18%) and West (+0.35%). Hispanic populations (AAPC: +2.15%) showed greatest increase versus non-Hispanic (+0.25%). Disparities persisted across demographics: Black/African American (rate: 3.4/100k, AAPC: +1.23%) versus White (5.9/100k, AAPC: +0.32%). Rural areas (NonCore rate: 8.8/100k) exceeded urban centers (Large Central Metro: 4.0/100k) by 2.2-fold. American Indian/Alaska Native populations showed highest AAPC (+2.45%). Conclusion HF mortality with respiratory comorbidity increased significantly over two decades, with notable disparities by age, geography, race, and urbanization. Elderly, Hispanic, rural, and underrepresented racial/ethnic populations warrant targeted interventions. This abstract is funded by: NA

Bookmark