A 55-year nationwide analysis of rheumatic heart disease mortality from 1968 to 2023

Background Rheumatic heart disease (RHD) is a largely preventable condition with well-defined treatment options. Analysing mortality trends can help identify disparities, facilitating more targeted and effective interventions. Purpose To identify overall and sub-group RHD mortality trends in the United States of America from 1968-2023. Method The study examined death certificate data from the Center for Disease Control and Prevention’s WONDER (Wide-Ranging Online Data for Epidemiologic Research) database, encompassing three different International Classification of Disease periods (ICD-8, 9,10). Analysis included stratification by age, gender, race, urbanisation, census division, population size, geography and cause of death. Joinpoint analysis and multiple regression were used to analyse trends. Results 365,298 cases of fatal RHD from 1968-2023 were included. Independent of anticipated rate changes following transitions in ICD coding, RHD mortality decreased from 1968-2012 (16,358 annual deaths vs 3,088 annual deaths, annual percentage change -1.8%, p<0.0001) with subsequent rise from 2013 (APC +3.1%, p<0.0001). Multiple regression demonstrated that female sex (p=0.046) and White race (p=0.029) were independently associated with reducing RHD crude mortality rate (CMR) from 1968-2012. From 2013-23, both sexes (male p=0.024 and female p=0.022), Hispanic/Latino status (p=0.044) and age 35-54 years (p=0.003) were independently associated with increasing RHD CMR. Females represented 62.4% of overall cases, with consistently higher RHD CMR than men (CMR ratio range 1.09-2.43) Conclusion RHD mortality in the USA declined from 1968 to 2012, primarily due to reductions in White females, but has increased since 2013, particularly among middle-aged Hispanic/Latino populations. Future RHD management strategies should prioritise the elderly while addressing persistent gender disparities.