Trends and Projected Inequalities in Ischemic Heart Disease Mortality in the United States, 1999–2050: A Retrospective Analysis

Ischemic heart disease (IHD) remains a leading cause of cardiovascular mortality in the United States despite decades of advances in prevention, diagnosis, and treatment. This retrospective analysis evaluated long-term trends, demographic and geographic disparities, and future projections of IHD-related mortality using national death-certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) for 1999 to 2025. Age-adjusted mortality rates (AAMRs) were examined with Joinpoint regression, and an optimized ensemble model was used to project mortality through 2050. More than 15.5 million IHD-related deaths were recorded, and the overall AAMR declined from 384.15 to 193.23 per 100,000 population (average annual percentage change, − 2.77), although rates rose modestly during 2018–2021 before declining again. The burden remained consistently higher among men, older adults, Black or African American individuals, non-metropolitan residents, and several high-burden states, particularly West Virginia, and most deaths occurred at home. Projections suggested continued overall decline through 2050; however, implausible negative values for some subgroups and rising urbanization-specific forecasts represent modeling artifacts that warrant cautious interpretation. Persistent disparities across sex, age, race and ethnicity, geography, and urbanization indicate that aggregate progress has not been shared equally, and sustained reductions will require equitable prevention, improved rural cardiovascular care, and targeted interventions for high-burden populations.