What is the clinical evidence from this study?

Study design: Observational. Population: Cardiovascular disease mortality. Intervention: Calendar year (1999-2023) vs. 1999 (baseline). Primary outcome: Age-adjusted mortality rate (AAMR) per 100,000 population (AAPC -1.95, 95% CI -2.36 to -1.55, p=<0.05).

What question did this study set out to answer?

This analysis aims to characterize long-term trends and disparities in cardiovascular disease-related mortality in the United States from 1999 to 2023.

June 14, 2026Open Access

Trends in cardiovascular mortality (1999–2023) in the United States: an analysis of underlying causes of death using the CDC WONDER database

Q: What are the key findings of this study?

The overall age-adjusted cardiovascular mortality rate in the United States declined from 350.76 in 1999 to 218.32 per 100,000 population in 2023, reflecting an average annual percent change of -1.95.

Q: What question did this study set out to answer?

This analysis aims to characterize long-term trends and disparities in cardiovascular disease-related mortality in the United States from 1999 to 2023.

Key Result

The overall age-adjusted cardiovascular mortality rate in the United States declined from 350.76 in 1999 to 218.32 per 100,000 population in 2023, reflecting an average annual percent change of -1.95.

Key Points

This analysis aims to characterize long-term trends and disparities in cardiovascular disease-related mortality in the United States from 1999 to 2023.
Utilized the CDC WONDER database to identify CVD-related deaths from 1999 to 2023
Calculated age-adjusted mortality rates and average annual percent changes via Joinpoint regression analysis
Analyzed mortality data across different demographics, including gender, race, and geographic regions.
Cardiovascular-related deaths decreased from 954,339 in 1999 to 915,973 in 2023
The overall age-adjusted mortality rate fell from 350.76 in 1999 to 218.32 in 2023 (AAPC: -1.95)
Non-Hispanic blacks had the highest mortality rate in 2023 at 290.03 per 100,000.

Study Design

Type

Observational

Structured PICO

Population

U.S. resident decedents of all ages with cardiovascular disease recorded as the only underlying cause of death between 1999 and 2023, analyzed using the CDC WONDER database.

Outcome

Age-adjusted mortality rates (AAMRs) per 100,000 population and average annual percent changes (AAPCs)hard clinical

Between 1999 and 2023, U.S. cardiovascular mortality significantly declined overall, though substantial disparities persist with higher burdens in men, non-Hispanic Black individuals, rural areas, and older adults.

Main Result

Effect estimate: AAPC -1.95 (95% CI -2.36 to -1.55)

Absolute Event Rate: 218.32% vs 350.76%

p-value: p=<0.05

Limitations

CVD misclassification on death certificates
Demographic/geographic reporting variability across U.S. states
Age adjustment via the 2000 U.S. standard population underrepresents the contemporary U.S. older adult population
Subject to the ecological fallacy as group-level trends cannot be extrapolated to individual CVD risk
Urban-rural analyses are restricted to 2020
Pandemic-era coding variability

Abstract

National statistics on mortality due to cardiovascular disease (CVD) in the United States remain insufficiently characterized. This study aimed to analyze the long-term trends and subgroup disparities in CVD-related mortality across the US from 1999 to 2023. We utilized the CDC WONDER database to identify all US residents with CVD recorded as the only underlying cause of death from 1999 to 2023 (ICD-10 codes: I00-I99). Age-adjusted mortality rates (AAMRs) per 100,000 population and average annual percent changes (AAPCs) with 95% confidence intervals (CIs) were calculated via Joinpoint regression analysis (version 5.3.0). In the United States, the number of cardiovascular-related deaths decreased from 954,339 in 1999 to 915,973 in 2023. Concurrently, the overall AAMR fell from 350.76 (95% CI: 350.06 to 351.47) in 1999 to 218.32 (95% CI: 217.87 to 218.77) in 2023, reflecting an AAPC of -1.95 (95% CI: -2.36 to -1.55). Notably, AAMR was consistently higher in men compared to women (2023: 263.04 vs. 180.16). An analysis by race indicated that non-Hispanic blacks experienced the highest mortality in 2023 (290.03 (95% CI: 288.35 to 291.72)), followed by whites (223.73 (95% CI: 223.19 to 224.27)), Hispanics (156.65 (95% CI: 155.42 to 157.88)), and individuals from other racial backgrounds (124.21 (95% CI: 122.92 to 125.49)). Regionally, the South exhibited the highest AAMR in 2023 (234.53 (95% CI: 233.77 to 235.30)), succeeded by the Midwest (231.41 (95% CI: 230.39 to 232.42)), the West (197.25 (95% CI: 196.35 to 198.16)), and the Northeast (194.97 (95% CI: 193.99 to 195.96)). Furthermore, the AAMR was most pronounced among individuals aged over 85 years. Between 1999 and 2020, AAMR was notably higher in rural regions compared to urban areas, with a widening gap after 2011. The age-adjusted mortality rate of CVD in the United States continued to decrease from 1999 to 2023, with the highest burden among men, non-Hispanic black, rural areas, and individuals over 85 years of age.

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Cite This Study

Jiang et al. (Fri,) conducted a observational in Cardiovascular disease mortality. Calendar year (1999-2023) vs. 1999 (baseline) was evaluated on Age-adjusted mortality rate (AAMR) per 100,000 population (AAPC -1.95, 95% CI -2.36 to -1.55, p=<0.05). The overall age-adjusted cardiovascular mortality rate in the United States declined from 350.76 in 1999 to 218.32 per 100,000 population in 2023, reflecting an average annual percent change of -1.95.

synapsesocial.com/papers/6a2e4704b1cc60ccdea8b9b7 https://doi.org/https://doi.org/10.1186/s12872-026-06118-8

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