Epidemiologic patterns and disparities in cardiovascular deaths associated with liver disease over two decades (1999–2020) in the U.S.

Cardiovascular disease (CVD) and liver disease (LD) frequently coexist and may jointly contribute to mortality; however, long-term national trends and disparities in CVD mortality with LD as a contributing cause remain incompletely characterized. This study aimed to characterize long-term national trends and demographic and geographic disparities in CVD mortality in the presence of LD. Using CDC WONDER mortality data from 1999 to 2020, we analyzed U.S. mortality data among adults aged ≥ 25 years. Age-adjusted mortality rates (AAMRs) were calculated, and temporal trends were evaluated using joinpoint regression to estimate average annual percent change (AAPC) and annual percent change (APC). Analyses were stratified by sex, ethnicity, census region, urbanization status, age group, and state. A total of 172,970 deaths from CVD with LD as a contributing cause were identified among U.S. adults aged ≥ 25 years between 1999 and 2020. Overall, AAMR increased from 3.96 (95% CI, 3.87–4.05) in 1999 to 4.38 (95% CI, 4.30–4.46) in 2020. Although the overall trend was not statistically significant (AAPC, 0.39; 95% CI, − 0.42 to 1.21), a significant increase was observed during 2016–2020 (APC, 5.22; 95% CI, 3.73–6.74). Mortality rates remained consistently higher in men; however, increases were observed in both sexes, with relatively steeper rises among women. Marked ethnic disparities were evident: Hispanic individuals experienced persistently high mortality, while non-Hispanic White individuals showed a significant upward trend (AAPC, 0.62; 95% CI, 0.10–1.14). Regionally, the South and Midwest exhibited unfavorable trends, whereas mortality declined in the Northeast and remained relatively stable in the West. Mortality increased more sharply in nonmetropolitan areas (AAPC, 1.62; 95% CI, 1.01–2.23), surpassing metropolitan areas by 2020. Although older adults bore the greatest absolute burden, the most pronounced relative increases were observed among younger adults, particularly those aged 25–34 years. Substantial geographic heterogeneity was observed at the state level, with most states demonstrating increasing trends over time. Mortality from CVD with LD recorded as a contributing cause increased most notably after 2015. Higher mortality rates were observed among males, Hispanic individuals, adults aged ≥ 85 years, and nonmetropolitan populations, while unfavorable increasing trends were most evident in the South and Midwest. These findings highlight a growing national burden of CVD mortality among decedents with LD recorded as a contributing cause and underscore the need for continued surveillance.