B57-02 From Mines to Myocardium: Trends in Ischemic Heart Disease (IHD) Mortality With Pneumoconiosis Co-mention Among United States Adults ≥55 Years, 1999-2020

Rationale Pneumoconiosis—coal workers’ pneumoconiosis (CWP), asbestosis, silicosis—may promote cardiovascular injury via chronic inflammation and hypoxemia. National trends in Ischemic Heart Disease (IHD) mortality when pneumoconiosis is co-mentioned remain poorly described. Methods Using CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death (MCOD), we identified U.S. decedents aged ≥55 years (1999-2020) with IHD AND pneumoconiosis listed on the death certificate (ICD-10 underlying or contributing codes). We obtained CDC WONDER-reported age-adjusted mortality rates (AAMR) per 100,000 (2000 U.S. standard) overall and by sex, race/ethnicity, 2013 National Center for Health Statistics (NCHS) urbanization, and pneumoconiosis subtype. We use Crude Mortality Rate (CMR) for 10-year agre groups. Joinpoint log-linear models estimated annual percent change (APC) and average APC (AAPC). NS = nonsignificant. Results AAMR declined from 1.25 in 1999 to 0.49 in 2020 (nadir 0.40 in 2019); APC/AAPC −5.66%/yr (95% CI − 6.06 to − 5.25).Sex: Men accounted for most of the deaths; male AAMR 3.20→1.09, with a 2018 joinpoint (1999-2018 −6.54%/yr; 2018-2020 +3.24%/yr, NS). Female series were frequently suppressed.Age: All bands declined with 2020 upticks—AAPC −7.48%/yr (65-74 y), −6.01%/yr (75-84 y), −4.09%/yr (≥85 y). CMR remained highest in ≥ 85 y.Race/ethnicity: Only White adults supported annual modeling (AAMR 1.27→0.56; 2017 joinpoint: −5.85%/yr then +2.92%/yr, NS; AAPC −4.65%/yr). Counts for Black, Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander adults were often <20/year with suppression, limiting inference.Urbanization: All six 2013 NCHS strata declined (0 joinpoints); AAPC ranged −6.74%/yr (micropolitan) to −3.55%/yr (noncore rural). In 2020, AAMR was highest in noncore rural (1.07) and lowest in large central metro (0.21).Subtype: CWP showed two joinpoints with sustained declines (1999-2005 −8.89%/yr; 2005-2013 −14.33%/yr; 2013-2020 −6.36%/yr; AAPC −10.18%/yr). Asbestosis declined (AAPC −3.80%/yr) but rose in 2020 (0.35 vs 0.29 in 2019). Silicosis counts were sparse/unreliable annually. Conclusions From 1999-2020, IHD mortality with pneumoconiosis co-mention fell markedly, driven by sharp reductions in CWP, and improvements among men and younger-old adults. However, there is persistent rural excess and a 2020 uptick after a 2019 nadir. The predominance of White decedents likely reflects historical exposure patterns and may also indicate under-ascertainment/under-reporting of pneumoconiosis in other groups. In addition, asbestosis now accounts for the largest subtype share. Targeted prevention in high-risk rural/occupational cohorts, improved death-certificate coding and surveillance across races, and systematic cardiovascular risk management in patients with occupational lung disease are warranted. This abstract is funded by: None