Infant mortality related to congenital heart disease in the United States, 1999–2025: trends, disparities, and projections to 2040

Introduction Congenital heart disease remains a leading congenital cause of infant mortality in the United States despite major advances in diagnosis and neonatal care. This study evaluated national mortality trends from 1999 to 2025, examined sex and racial disparities, and projected future burden through 2040 using time-series forecasting. Methods A retrospective CDC WONDER analysis examined U.S. infant (< 1 year) CHD mortality from 1999 to 2025 using ICD-10 codes Q20–Q26. Deaths listing CHD as underlying or contributing cause were included. Crude mortality rates (CMRs) per 100,000 with 95% CIs were calculated. Trends were evaluated using Joinpoint regression analysis to estimate annual percent change (APC) and average annual percent change (AAPC). Forecasts to 2040 used ARIMA and ETS models, stratified by sex and race/ethnicity. Results From 1999 to 2025, 55,719 infant deaths related to CHD were recorded in the United States, 92.16% in medical facilities. The CMRs declined from 69.66 in 1999 to 46.44 in 2025 (AAPC − 1.32%) and is projected at 37.51 by 2040. Male mortality remained higher than female (54.86 vs. 52.04). NH Black infants had the highest mean mortality (71.87), while NH Asian/Pacific Islander infants showed the steepest decline (AAPC − 2.30%). Recent increases appeared in NH White infants after 2018 (APC 1.56%) and Hispanic infants after 2020 (APC 3.48%) overall. Conclusion Infant CHD related mortality declined substantially from 1999 to 2025 and is projected to continue decreasing through 2040; however, persistent excess mortality in male, NH Black, and Hispanic infants underscores enduring demographic disparities in outcomes.