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September 10, 2025Open Access

Stalled progress and emerging disparities in acute myocardial infarction mortality among U.S. older adults (> 65 Years) with renal failure, 1999–2023

Key Points

Mortality rates for acute myocardial infarction among older adults with renal failure fell overall from 42.1 in 1999 to 18.5 in 2023.
The age-adjusted mortality rates varied significantly, with non-Hispanic Black adults experiencing the highest burden at 35.8 per 100,000 population.
Joinpoint regression analysis was used to quantify annual percent change, revealing a concerning increase in mortality rates from 2015 to 2023.
Stalled improvements in mortality and widening disparities indicate the urgent need for enhanced cardiovascular care and prevention strategies.

Abstract

Older adults with chronic kidney disease (CKD) experience disproportionately high mortality after acute myocardial infarction (AMI). Contemporary national trends-and their variation across demographic and geographic strata remain poorly defined. Using the CDC WONDER Multiple Cause-of-Death files, we identified U.S. decedents ≥ 65 years in whom ICD-10 codes for AMI and renal failure appeared anywhere on the death certificate between 1999 and 2023. Age-adjusted mortality rates (AAMRS) per 100,000 population were standardized to the 2000 U.S. census. Joinpoint regression quantified annual per cent change (APC) and inflexion points overall and by sex, race/ethnicity, census region, state, and urban-rural status. Among 288,801 AMI-related renal-failure deaths, the AAMR fell from 42.1 in 1999 to 18.5 in 2023. Mortality declined steadily from 1999-2012 (APC - 3.39%; 95% CI - 4.25 to - 1.16) and more sharply from 2012-2015 (APC - 17.82%; 95% CI - 22.98 to - 6.99), but rose thereafter (2015-2023 APC + 3.01%; 95% CI - 0.21 to 16.30). Men carried persistently higher rates than women (overall AAMR 39.2 vs 21.2). Non-Hispanic Black adults had the greatest burden (AAMR 35.8), followed by non-Hispanic American Indian/Alaska Native (34.7) and Asian/Pacific Islander patients (34.2); non-Hispanic White adults had the lowest (26.4). From 2020-2023, AAMRs rebounded across most groups and surged 85% among Asian/Pacific Islanders. Regionally, the South recorded the highest AAMR (28.8), and state-level rates ranged three-fold (Utah 14.5 to Rhode Island 43.0). Non-metropolitan counties consistently exceeded metropolitan areas (34.5 vs 28.1). Two decades of improvement in AMI mortality among older adults with renal failure have stalled, with a worrisome upturn since 2015 and widening disparities by sex, race, geography, and rurality. These findings underscore the need for cardiovascular-kidney-metabolic-focused prevention, equitable access to acute cardiac care, and tailored post-AMI management to avert further excess deaths in this growing high-risk population.

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