Demographics and disparities in cardiomyopathy and ischemic heart disease mortality among U.S. adults >65 years: CDC WONDER 1999–2024 analysis

Background: Ischemic heart disease (IHD) and, at its progression, ischemic cardiomyopathy are leading causes of cardiovascular mortality globally. Despite progress in prevention and treatment, large disparities still exist by age, gender, race, and geography, especially among older adults. Methods: We analyzed deaths related to cardiomyopathy in older adults with IHD in the United States (1999–2024), focusing on demographic and regional differences. Centers for Disease Control and Prevention WONDER Multiple Cause of Death data were used, including individuals aged ≥65 years with IHD listed as a primary or contributing cause of death. Age-adjusted mortality rates (AAMRs) were calculated, and Joinpoint regression was used to calculate annual percent changes (APCs) across demographic and geographic strata. Results: From 1999 to 2024, AAMRs have fallen from 39.3 to 14.1 per 100 000. A significant drop was recorded between 2002 and 2018 (APC: −4.94%; P = 0.004), with a plateau observed from 2018 to 2024. Male mortality was twice as high as that of females (18.7 vs. 10.0 in 2024). NH Black populations had the highest mortality rate in 1999 (42.7), which narrowed by 2024 (17.4); however, disparities continued. Geographically, the South and non-metropolitan areas exhibited the greatest mortality, with slower reductions. One significant shift in trends was in the type of place of death, with a decrease in hospital deaths and an increase in deaths at home and in hospices. Conclusion: Persistent disparities between sexes, races, geographic regions, and levels of urbanization underscore the need for specific and targeted public health interventions, equal access to care, and refocusing cardiovascular health initiatives on high-risk participants. Graphical abstract available at: https://links.lww.com/MS9/B434