Trends in aortic dissection–related mortality among adults with tobacco use: a retrospective analysis

Background Aortic dissection (AD) is a catastrophic vascular emergency characterized by high morbidity and mortality. Tobacco use is a well-established, modifiable risk factor that promotes chronic inflammation, oxidative stress, and structural degeneration of the aortic wall, thereby increasing susceptibility to dissection. Despite ongoing public health efforts to reduce smoking prevalence, the long-term national burden of tobacco-associated AD mortality in the United States, along with its demographic and geographic disparities, remains insufficiently characterized. Purpose To evaluate national trends in aortic dissection–related mortality among U.S. adults with tobacco use from 2003 to 2023 and to assess demographic and geographic disparities in mortality rates. Methods We conducted a retrospective population-based analysis using the CDC WONDER database from 2003 to 2023. Adults aged ≥25 years with both AD (ICD-10: I71.0) and tobacco use (ICD-10: F17) listed as underlying or contributing causes of death were included. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Temporal trends were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Results From 2003 to 2023, a total of 10,169 AD-related deaths among tobacco users were identified. The national AAMR increased nearly fourfold from 0.08 in 2003 to 0.31 in 2023 (AAPC: 5.60%, p<0.01). Men consistently exhibited higher mortality than women (AAMR increased from 0.13 to 0.45 vs. 0.04 to 0.21, respectively). By race/ethnicity, Non-Hispanic Blacks demonstrated the highest overall AAMR (0.28). Regionally, the Midwest had the highest mortality (overall AAMR 0.27), and non-metropolitan areas experienced significantly higher mortality compared with metropolitan areas (0.23 vs. 0.18). The majority of deaths occurred among older adults, with the highest crude mortality rate observed in this age group (CMR 0.57). Conclusions AD-related mortality among tobacco users increased substantially between 2003 and 2023, with pronounced disparities across sex, race, age, and geographic regions. The disproportionately higher burden observed in men, Non-Hispanic Blacks, rural populations, and the Midwest underscores the urgent need for strengthened tobacco cessation initiatives and improved access to equitable cardiovascular and vascular care nationwide.