Temporal and demographic trends in depression or anxiety along with cardiovascular diseases-related mortality among U.S. adults: A 25-year nationwide analysis (1999-2023).

BACKGROUND: Cardiovascular diseases (CVD) are strongly associated with psychiatric disorders like depression and anxiety (D/A), which can exacerbate disease burden and worsen outcomes. However, mortality trends in patients with both conditions remain underexplored. This study examines mortality trends among U.S. adults in whom both depression/anxiety (D/A) and cardiovascular diseases (CVD) were documented on the death certificate from 1999 to 2023. METHOD: Data were extracted from the CDC WONDER Multiple Cause-of-Death database for adults aged ≥25 years to identify deaths in which both D/A and CVD were listed anywhere on the death certificate (underlying or contributing causes), and to calculate age-adjusted mortality rates (AAMRs) per 100,000 population. Joinpoint Regression v5.2.0 calculated annual percent changes (APCs) and average annual percent changes (AAPCs) with 95% CIs (p ≤ 0.05), stratified by year, sex, race, region, urbanization, and 10-year age groups. RESULTS: From 1999 to 2023, 299,201 deaths were attributed to coexisting D/A and CVD, with highest rates in older adults (AAMR: 22.26). After declining between 1999 and 2015, overall AAMR increased from 4.92 in 2015 to 7.14 in 2021 (APC: 7.51; 95% CI: 1.23-12.12). Females showed consistently higher mortality than males (5.62 vs 4.66), with female AAMR rising from 5.05 (1999) to 7.44 (2023) [AAPC: 1.61; 95% CI: 1.24-1.55]. Non-Hispanic Whites had the highest AAMR (5.90), followed by American Indians/Alaska Natives (4.62). Geographically, the Midwest (6.85) and West (5.08) had highest rates, while rural areas exceeded urban areas (6.78 vs 4.79). State-level variation ranged from North Dakota (11.33) to Nevada (1.85). CONCLUSION: Rising mortality involving co-listed D/A and CVD disproportionately affects females, Non-Hispanic Whites, Midwest residents, rural populations, and older adults. These findings highlight critical demographic and geographic disparities requiring targeted interventions and further investigation into underlying mechanisms.