Intersection of substance use and cardiac arrest mortality in the United States: a 25-year CDC WONDER analysis

Background: Cardiac arrest (CA) is one of the main causes of death in the U.S., and its impact on the healthcare system may be associated with substance-use (SU) disorders through the interplay of metabolic and cardiotoxic mechanisms. Despite the extensive research on drug overdose-related mortality, the impact of drug use on mortality from CA has not been thoroughly examined. Methods: We utilized the CDC WONDER Multiple Cause of Death database (1999–2023) to extract mortality data related to CA and SU-related causes of death among individuals aged ≥25 years. Age-adjusted mortality rates (AAMRs) per 100 000 were computed. Temporal trends were assessed using Joinpoint to calculate annual percent changes (APCs) along with 95% confidence intervals. Rates were stratified by sex, race, age groups, region, and place of death. Results: A total of 163 384 deaths were identified from 1999 to 2023. The AAMR increased from 2.22 to 4.32, surging in 2021 after a period of sharp rise (APC 13.52%, 2018–2021), before dropping thereafter (APC −7.18%, 2021–2023). Compared with women, men consistently had higher mortality rates (mean AAMR men: 4.45 vs women: 1.52). The non-Hispanic (NH) American Indian/Alaskan Natives reported the highest AAMR (9.35), whereas NH Asian/Pacific Islanders had the lowest (0.93), depicting the racial disparities. Geographic variations were notable, with the West reporting the highest burden (5.13). Most fatalities (63.3%) occurred in healthcare facilities, followed by the decedents’ homes (25.78%), with lower proportions observed in other locations. Conclusion: These findings describe a growing burden of deaths with marked sex, racial/ethnic, and geographic differences that may inform targeted prevention and equitable care delivery.