July 1, 2025Clinical CardiologyOpen Access

Trends in Sudden Cardiac Death Related Mortality in Adults in the United States: A CDC WONDER Database Analysis, 1999–2020

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Why the study?

Sudden cardiac death is a leading cause of mortality in the United States, with significant variations across demographic and geographic factors.

Structured PICO

Population

Adults (> 25 years) in the United States with sudden cardiac death (SCD)-related mortality (ICD-10 code I46.1) from 1999 to 2020 (n=279,599 deaths).

Outcome

Age-adjusted mortality rates (AAMR) per 100,000 population for SCD-related deathshard clinical

Sudden cardiac death mortality in the US declined from 1999 to 2018 but experienced a concerning sharp increase from 2018 to 2020, particularly among Hispanic and Asian/Pacific Islander populations and in urban areas.

Implication

Reversing post-2018 SCD trends, especially in Hispanics and urban areas, warrant monitoring; leaves open drivers and targeted prevention strategies.

Abstract

BACKGROUND: Sudden cardiac death (SCD) is a leading cause of mortality in the United States, with significant variations across demographic and geographic factors. This study analyzes trends in SCD-related mortality among adults (> 25 years) from 1999 to 2020 using the CDC WONDER database. METHODS: We extracted data on SCD-related deaths (ICD-10 code I46.1) and calculated age-adjusted mortality rates (AAMR) per 100 000 population, stratified by sex, race/ethnicity, urbanization, and census region. Joinpoint regression was performed to estimate the annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CI). RESULTS: A total of 279 599 SCD-related deaths were recorded from 1999 to 2020. Overall AAMR declined significantly (AAPC: -1.20%; 95% CI: -1.58% to -0.82%) until 2018, followed by a sharp increase from 2018 to 2020 (APC: +6.93%; 95% CI: +3.04% to +10.96%). Declines were most pronounced in American Indian/Alaska Native populations (-3.67%), while the highest increases post-2018 were observed in Hispanic (+13.1%) and Asian/Pacific Islander groups (+12.3%). Urban areas experienced greater post-2018 increases compared to rural areas. Regional disparities were evident, with the West showing the steepest rise in mortality. CONCLUSION: While SCD mortality declined from 1999 to 2018, a concerning reversal has emerged since 2018, particularly in specific racial/ethnic groups and urban areas. Further research is needed to investigate underlying causes, including the potential impact of COVID-19, healthcare disparities, and lifestyle factors.