Trends and predictors of pediatric cardiovascular mortality: a 2014–2024 multicenter retrospective cohort study in Hawassa, Ethiopia

Cardiovascular diseases remain an important cause of mortality among children and adolescents, particularly in low-resource settings, yet evidence on temporal trends and determinants is limited. This retrospective multicenter cohort study assessed trends, patterns, and predictors of cardiovascular mortality among 2132 patients under 18 years of age followed in four hospitals in Hawassa, Ethiopia, between 2014 and 2024. Medical records were reviewed, and mortality trends were analyzed using joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC), while independent predictors were identified using a two-level multilevel logistic regression model accounting for clustering by hospital. Over a median follow-up of 6.5 years (IQR 4.0–8.6), 514 patients (24.1%) died. Mortality showed a significant decline after 2020, decreasing by 27.5% (95% CI − 42.2 to − 17.7; p < 0.001), with an overall AAPC of − 9.99% (95% CI − 13.4 to − 6.2; p < 0.001). The leading causes of death were congenital heart disease and rheumatic valvular heart disease. Independent predictors of mortality included severe acute malnutrition (AOR 5.2; 95% CI 3.2–8.5), New York Heart Association (NYHA)/Ross class III–IV heart failure (AOR 3.4; 95% CI 2.7–4.5), and dysmorphic features (AOR 3.8; 95% CI 2.9–4.4), while later year of presentation was associated with reduced mortality risk (AOR 0.94; 95% CI 0.89–0.98). Despite an overall decline in mortality, substantial variability was observed across hospitals, reflecting differences in case severity and referral patterns. These findings highlight the importance of early detection, nutritional support, and strengthened referral systems to further reduce preventable cardiovascular deaths in children in resource-limited settings.