Trends in acute myocardial infarction mortality in the United States, 1999–2023

Background: Although mortality from acute myocardial infarction (AMI) has declined historically, the burden remains substantial. This study evaluated long-term temporal trends and population-level disparities in AMI-related mortality among US adults aged ≥ 45 years from 1999 to 2023. Methods: Mortality data were retrieved from the CDC WONDER underlying cause of death (UCD) and Multiple Cause of Death (MCD) datasets. We identified death records listing AMI (ICD-10: I21-I22) as the cause of death. Crude mortality rates and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, with standardization to the 2000 US population. Joinpoint regression models were employed to estimate the annual percent change (APC) and average annual percent change (AAPC). To ensure robustness, a sensitivity analysis was conducted using the MCD dataset, defining AMI as a contributing cause of death with cardiovascular disease (ICD-10: I00-I99) as an underlying cause of death. Results: A total of 3,255,707 AMI-related deaths were analyzed. The overall AAMR decreased from 206.12 (95% CI: 205.21-207.03) in 1999 to 60.71 (95% CI: 60.31-61.11) in 2023, with an overall AAPC of -4.94%. Joinpoint analysis identified decline during 1999-2018, followed by a plateau during 2018-2021 (APC: -0.02%) and a subsequent accelerated decline during 2021-2023 (APC: -8.74%). While male AAMRs remained consistently higher than female AAMRs (81.86 vs. 43.12 in 2023), females exhibited a faster rate of decline (AAPC: -5.30% vs. -4.87%). Racial disparities persisted, with non-Hispanic Black individuals showing higher mortality than non-Hispanic White individuals. Urban-rural analysis (1999-2020) revealed that rural areas faced the highest mortality burden and the slowest decline (AAPC: -3.92%) compared to large metropolitan areas (AAPC: -5.58%). Sensitivity analyses yielded results consistent with the primary findings. Conclusion: Despite a significant long-term reduction in AMI-related mortality in the United States, progress has been uneven, characterized by a phase-specific plateau and persistent geographic and racial disparities. Targeted public health strategies and resource allocation are essential to address the high burden in rural areas and among vulnerable populations to further reduce health inequities.