What is the clinical evidence from this study?

Study design: Observational. Population: Alzheimer's disease and heart failure (n=192459). Primary outcome: Age-adjusted mortality rate (AAMR) per 100,000 people.

November 19, 2025Open Access

Trends in Alzheimer's disease and heart failure-related mortality among older American adults: Insights from the CDC WONDER database

Key Result

Alzheimer's disease mortality with coexisting heart failure in older US adults showed significant temporal variation, ultimately rising by an annual percentage change of 4.16% from 2013 to reach an age-adjusted mortality rate of 22.21 per 100,000 in 2020.

Study Design

Type

Observational (n=192,459)

Structured PICO

Population

Adults aged ≥65 years in the United States with Alzheimer's disease and coexisting heart failure recorded as either the underlying or contributing cause of death on death certificates between 1999 and 2020 (n=192,459).

Outcome

Age-adjusted mortality rates (AAMRs) per 100,000 people and Annual Percentage Change (APCs)hard clinical

Mortality related to Alzheimer's disease and coexisting heart failure in older US adults showed a U-shaped trend from 1999 to 2020, with recent increases and significant disparities by sex, race, and geography.

Limitations

Reliance on ICD-10 codes and death certificate data introduces risk of misclassification or underreporting
Lack of validation data for ICD-10 codes in CDC WONDER
Database lacks detailed clinical variables such as disease severity, comorbid conditions, treatment history, or cognitive and functional status
Lacks data on left ventricular ejection fraction to classify HF subtypes
Key socioeconomic factors like income, education, healthcare access, and insurance status are not captured
Absence of information on diagnostic methods
Unreliable data for certain races, especially NH American Indian/Alaskan Natives
Use of aggregate data prevents exploration of causal relationships

Abstract

Introduction: Alzheimer's disease is one of the leading causes of death among the elderly in the United States with heart failure sharing similar risk factors. This study investigated trends and disparities in Alzheimer's disease mortality among older adults with heart failure from 1999 to 2020 in the United States. Methods: Making use of ICD-10 codes death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research database was retrieved for patients aged ≥65 years between 1999 and 2020. Age-adjusted mortality rates (AAMRs), per 100,000 people, and Annual Percentage Change (APCs) with their respective 95 % Confidence Intervals (CI) were also calculated. Data was stratified by year, gender, race and geographical distribution. Results: Alzheimer's disease with coexisting heart failure was responsible for 192,459 deaths between 1999 and 2020. Overall the AAMR increased from 21.32 in 1999 to 24.56 in 2005 (APC: 1.9760*; 95 % CI: 0.6001 to 3.9507) after which a significant decrease to 16.52 by 2013 was observed (APC: -4.9301*; 95 % CI: -6.5209 to -4.0119). AAMRs decreased from this point forward reaching 22.21 in 2020 (APC: 4.1573*; 95 % CI: 3.0373 to 5.7232). Women had higher AAMRs than men (21.57 vs 18.41). Among racial groups, the Non-Hispanic (NH) White (21.62) population had the highest AAMRs followed by NH Black/African American (17.87), Hispanic/Latino (14.3) and NH Asian/Pacific Islander (8.96). Furthermore, AAMRs also varied by census region (West: 24.05; Midwest: 22.83; South: 21.1; Northeast: 13.38). Moreover, nonmetropolitan areas had higher AAMRs compared to metropolitan areas (27.23 vs 19.09). States in the top 90th percentile such as Kentucky, Oklahoma, Washington, North Dakota and Mississippi had AAMRs that were three times higher relative to states in the lower 10th percentile including Nevada, Florida, New York, District of Columbia and Hawaii. Conclusion: Alzheimer's disease mortality with associated heart failure has shown considerable variation in adults ≥65 years. AAMRs were highest in women, NH Whites, residents of the West and nonmetropolitan patient populations. Targeted interventions and a more holistic approach to patient management are essential in achieving favorable outcomes for vulnerable groups moving forward.

Ask AI

Helpful

Bookmark

View Full Paper