Nationwide spatiotemporal patterns of aortic aneurysm mortality and temperature-related risk in the United States (1999–2023)

BACKGROUND: Although aortic aneurysm (AA) mortality has declined in recent decades, contemporary nationwide evidence in the United States and the potential impact of ambient temperature on AA mortality remain limited. METHODS: We analyzed AA mortality among individuals aged ≥25 years in the United States from 1999 to 2023 using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database. Age-adjusted mortality rates (AAMRs) were calculated by direct standardization to the 2000 United States standard population. Temporal trends were evaluated using joinpoint regression to estimate average annual percent change (AAPC). Mortality patterns were examined by Census region, state, sex, race/ethnicity, urbanization, and age group. Ambient temperature data were obtained from the North American Land Data Assimilation System. Seasonal patterns, month-to-month temperature changes, and nonlinear temperature–mortality associations were assessed using seasonal analyses, correlation analyses, and generalized additive models (GAMs). RESULTS: From 1999 to 2023, 203028 AA-related deaths occurred in the United States, with a sustained decline in AAMRs (AAPC − 5.51 [−5.86, −5.17]). In 2023, 5664 AA deaths were recorded, corresponding to an AAMR of 2.06 (2.01, 2.12). AA mortality was higher in males, non-Hispanic (NH) White individuals, older age groups, nonmetropolitan areas, and the South region. Clear seasonal variation was observed, with the lowest mortality in summer and the highest in winter ( P < 0.001). Month-to-month temperature declines were associated with increases in AA mortality, particularly during winter. GAM analyses demonstrated a nonlinear inverse association between ambient temperature and AA mortality across all Census regions. CONCLUSIONS: Despite substantial declines in AA mortality, marked regional, demographic, and seasonal disparities persist. Winter seasonality and abrupt temperature decreases are significantly associated with increased AA mortality risk, highlighting the need for cold weather-specific prevention and healthcare preparedness strategies.