Integrating the micropolitan and state-level disparities in mortality of coexisting congestive heart failure and atrial fibrillation in the United States: A 20-year-long analysis

Abstract

Congestive heart failure (CHF) and atrial fibrillation (AF) are major cardiovascular diseases, particularly among older adults. This study analyzes national mortality trends for CHF and AF in the United States from 1999 to 2020, focusing on demographic variations and addressing gaps in evidence regarding urbanization and state-level disparities. Data were extracted from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death Public Use database (1999-2020). Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated for adults aged ≥ 25 years. Mortality rates were stratified by year, gender, ethnicity, urbanization, census region, and state. Annual percent changes (APCs) were analyzed using the Joinpoint Regression Program. Between 1999 and 2020, 744,565 deaths related to CHF and AF were reported among adults aged ≥ 25 years. Overall, AAMR increased from 11.43 (95% CI: 11.27-11.58) in 1999 to 20.72 (95% CI: 20.55-20.89) in 2020, with significant APCs of 1.78% (1999-2010) and 3.38% (2010-2020). Males consistently showed higher AAMR (17.62) than females (14.13). Whites had the highest AAMR (16.42), while Asian/Pacific Islanders had the lowest (6.72). Among urbanization categories, Micropolitan areas exhibited the highest AAMR (18.61), while Large Central Metro areas exhibited the lowest (13.32). By region, the West had the highest AAMR (17.55), and the Northeast had the lowest (14.14). Mortality varied by state, with Oregon showing the highest (AAMR 25.65) and Nevada the lowest (AAMR 8.61). Rising CHF and AF-related mortality rates warrant targeted public health interventions, particularly in high-burden groups. Addressing healthcare issues, providing access, promoting early detection, and implementing evidence-based management are critical to reducing mortality.

Keywords

Congestive heart failure / Atrial fibrillation / Mortality trends / CDC WONDER / Epidemiology

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