Disparities in chronic ischemic heart disease-related mortality across sex, race, and urbanization status in the United States, 1999–2019

Chronic ischemic heart disease (CIHD) is one of the leading causes of significant morbidity and mortality in the United States. While previous studies have reported an overall decline in ischemic heart disease mortality, contemporary trends in CIHD-related mortality across sex, race, and urbanization status remain inadequately explored. We examined CIHD-related mortality trends in the U.S. from 1999 to 2019.We analyzed mortality data from the CDC WONDER database using CIHD ICD-10 codes. Age-adjusted mortality rates (AAMR) were calculated per 100,000 individuals. Trends were analyzed using Joinpoint regression to determine annual percentage change (APC) and average annual percentage change (AAPC) with 95% confidence intervals. Over two decades, 5,729,619 CIHD-related deaths were recorded. AAMR declined from 185.6 (95% CI: 184.9-186.2) per 100,000 in 1999 to 94.9 (95% CI: 94.5-95.3) per 100,000 in 2019. There were, however, disparities among demographic groups. Males had consistently higher mortality than females (overall AAMR: 167.2 vs. 96.0 per 100,000), and among racial groups, non-Hispanic Black individuals had the highest AAMR (148.3 per 100,000. Initially, urban areas had higher mortality than rural areas, but by 2019, their AAMRs converged (urban: 94.7 [95% CI: 94.3-95.1]; rural: 96.1 [95% CI: 95.1-97.0] per 100,000). CIHD mortality has declined across all demographics over the last two decades; however, disparities persist, particularly among males and non-Hispanic Black individuals. While rural and urban populations had differing mortality rates initially, they showed similar AAMR by the end of the study period. Focused public health interventions are crucial to addressing these inequities.