Trends and racial-geographic disparities in mortality among US older adults with peripheral artery disease, 1999 to 2020

Background Peripheral arterial disease (PAD) is a progressive vascular disorder among older adults that is associated with significant disability and elevated cardiovascular mortality. However, national mortality trends and disparities among US adults aged ≥65 years with PAD listed on death certificates have not been fully characterized.Methods This study evaluated national mortality trends and demographic disparities among US adults aged ≥65 years with PAD or selected peripheral vascular/arterial conditions. Using the CDC WONDER Multiple Cause of Death database (1999–2020), we conducted a retrospective population-based analysis. ICD-10 codes for peripheral vascular and arterial diseases were used to identify deaths in which PAD or associated peripheral arterial/vascular conditions were listed as an underlying or contributing cause of death. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated using the 2000 US standard population. We used joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC), with P values < 0.05 considered statistically significant.Results A total of 1,738,432 PAD-related deaths occurred among adults aged ≥65 years. The overall AAMR declined from 245.14 in 1999 to 145.82 in 2020. Mortality was higher among males than females (282.70 vs 215.26 in 1999; 173.84 vs 117.10 in 2020). Non-Hispanic Black individuals had the highest mortality burden (319.28; 179.12), whereas non-Hispanic Asian or Pacific Islander individuals had the lowest (116.56; 77.52). Adults aged ≥85 years exhibited the highest mortality (836.30; 473.61). Nonmetropolitan areas demonstrated higher mortality than metropolitan areas (268.35 vs 239.55 in 1999; 160.15 vs 142.88 in 2020). Regionally, the Midwest had the highest AAMR (265.61; 148.99), while the Northeast had the lowest (203.99; 127.07). State-level variation ranged from 281.89 in Ohio to 114.82 in Hawaii. Most deaths occurred in medical facilities (39.1%).Conclusions Mortality among older adults with PAD or selected peripheral vascular/arterial conditions listed on death certificates declined overall. However, demographic and geographic disparities persisted, with recent increases observed after 2018. Targeted prevention, early detection, and modification of risk factors are needed for high-risk older populations.