Mortality co-mentioning bronchiectasis and cardiovascular disease among U.S. adults ≥65 years declined from 1999 to 2016 (APC -1.78%, p<0.001) but increased from 2016 to 2020 (APC +6.98%, p=0.019).
Observational (n=10,232)
Yes
Mortality co-mentioning bronchiectasis and cardiovascular disease among older US adults improved until 2016 but has since rebounded, particularly driven by heart failure and hypertension in those aged ≥85 years.
Effect estimate: APC -1.78%/yr (1999-2016); APC +6.98%/yr (2016-2020)
p-value: p=<0.001 (1999-2016); 0.019 (2016-2020)
Abstract Rational Bronchiectasis often coexists with cardiovascular disease (CVD), yet population mortality patterns when both are documented on death certificates are not well described. We characterized national trends and inflection points in deaths co-mentioning bronchiectasis and CVD. Methods We used CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death (MCOD) data for 1999-2020 to examine deaths among adults ≥65 years. Bronchiectasis and CVD—ischemic heart disease (IHD), heart failure (HF), and hypertensive diseases (HTN)—were identified via ICD-10 codes. Our primary outcome was any death certificate co-mentioning bronchiectasis with ≥1 CVD category. WONDER-provided age-adjusted mortality rates (AAMRs) per 100,000 (2000 U.S. standard) were obtained overall and by sex, race/Hispanic origin, and 2013 National Center for Health Statistics (NCHS) urbanization; 10-year age groups used crude rates. For subtype analyses, HTN, HF, and IHD were queried separately (not summed). Temporal trends used Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC), following WONDER suppression rules. NS = nonsignificant. Results There were 10,232 deaths co-mentioning bronchiectasis and CVD. AAMR was 1.328 in 1999, 0.877 in 2014, then 1.232 in 2019 and 1.172 in 2020. Joinpoint showed a 2016 inflection: 1999-2016 declined (APC −1.78%/yr, p 0.001); 2016-2020 increased (APC +6.98%/yr, p = 0.019); AAPC −0.17%/yr (NS). Sex. Women: 1.228 → 1.145 (2020); APC −1.21%/yr to 2016, then +5.20%/yr (NS). Men: 1.424 → 1.121 (2020); APC −1.95%/yr to 2016, then +6.57%/yr (NS). Race/ethnicity. Whites mirrored the 2016 inflection (APC −1.73%/yr to 2016; +7.40%/yr after); others were often suppressed/unreliable. Urbanization. Highest AAMR: Medium Metro 1.431(2020); lowest: Small Metro 0.850(2020). Medium Metro had a 2016 joinpoint (−1.11%/yr to 2016; +9.71%/yr after). Ten-year age groups. 65-74y: 0.375 → 0.270 (2020) with 2008/2013 joinpoints (APC −1.16%, −10.54%, +5.57%/yr; AAPC −1.34%/yr). 75-84y declined (AAPC −1.55%/yr). ≥85y highest (4.237 → 4.836), 2016 joinpoint (APC −0.26%/yr to 2016; +7.44%/yr after); AAPC +1.16%/yr. CVD subtypes. Hypertension rose (AAPC +5.07%/yr); heart failure increased post-2016 (APC +8.22%/yr); ischemic heart disease declined overall (AAPC −1.57%/yr) with a late uptick. Conclusion Among U.S. adults ≥65, mortality with co-mentioned bronchiectasis and CVD improved through the mid-2010s but rebounded after 2016, most evident in the ≥85y group, Medium Metro areas, and in HF and HTN subtypes. Because MCOD reflects co-mentions (not underlying cause) and small strata were suppressed, causal attribution and race-specific precision are limited. Findings support integrated CVD prevention and HF/HTN management within bronchiectasis care. This abstract is funded by: None
Afzaal et al. (Fri,) conducted a observational in Bronchiectasis and Cardiovascular Disease (n=10,232). Mortality co-mentioning bronchiectasis and cardiovascular disease among U.S. adults ≥65 years declined from 1999 to 2016 (APC -1.78%, p<0.001) but increased from 2016 to 2020 (APC +6.98%, p=0.019).