Demographic and Regional Trends of Heart Failure-Related Mortality in Young Adults in the US, 1999-2019.

Importance There are limited data on mortality trends in young adults with heart failure (HF). Objective To study the trends in HF-related mortality among young adults. Design, Setting, and Participants This retrospective cohort analysis used mortality data of young adults aged 15 to 44 years with HF listed as a contributing or underlying cause of death in the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from January 1999 to December 2019. Analysis took place in October 2021. Exposures Age 15 to 44 years with HF listed as a contributing or underlying cause of death. Main Outcomes and Measures HF-related age-adjusted mortality rates (AAMR) per 100 000 US population stratified by sex, race and ethnicity, and geographic areas. Results Between 1999 and 2019, a total of 61 729 HF-related deaths occurred in young adults. Of these, 38 629 (62.0%) were men and 23 460 (38.0%) were women, and 22 156 (35.9%) were Black, 6648 (10.8%) were Hispanic, and 30 145 (48.8%) were White. The overall AAMR per 100 000 persons for HF in young adults increased from 2.36 in 1999 to 3.16 in 2019. HF mortality increased in young men and women, with men having higher AAMRs throughout the study period. AAMR increased for all race and ethnicity groups, with Black adults having the highest AAMRs (6.41 in 1999 and 8.58 in 2019). AAMR for Hispanic adults and White adults increased from 1.62 to 2.04 and 1.83 to 2.45 over the same time period, respectively. Across most demographic and regional subgroups, HF-related mortality stayed stable or decreased between 1999 and 2012, followed by an increase between 2012 and 2019. There were significant regional differences in the burden of HF-related mortality, with states in the upper 90th percentile of HF-related mortality (Oklahoma, South Carolina, Louisiana, Arkansas, Alabama, and Mississippi) having a significantly higher mortality burden compared with those in the bottom tenth percentile. Conclusions and Relevance Following an initial period of stability, HF-related mortality in young adults increased from 2012 to 2019 in the United States. Black adults have a 3-fold higher AAMR compared with White adults, with significant geographic variation. Targeted health policy measures are needed to address the rising burden of HF in young adults, with a focus on prevention, early diagnosis, and reduction in disparities.

[1]  G. Fonarow,et al.  Trends in HF Hospitalizations Among Young Adults in the United States From 2004 to 2018. , 2022, JACC. Heart failure.

[2]  Sanjiv J. Shah,et al.  Age dependent associations of risk factors with heart failure: pooled population based cohort study , 2021, BMJ.

[3]  A. Nayak,et al.  Understanding the Complexity of Heart Failure Risk and Treatment in Black Patients , 2020, Circulation. Heart failure.

[4]  Y. Liu,et al.  Diagnostic Category Prevalence in 3 Classification Systems Across the Transition to the International Classification of Diseases, Tenth Revision, Clinical Modification , 2020, JAMA network open.

[5]  Yuling Hong,et al.  National Burden of Heart Failure Events in the United States, 2006 to 2014 , 2018, Circulation. Heart failure.

[6]  A. Hofman,et al.  Geographic Variation in Heart Failure Mortality and Its Association With Hypertension, Diabetes, and Behavioral-Related Risk Factors in 1,723 Counties of the United States , 2018, Front. Public Health.

[7]  G. Grunwald,et al.  African Americans Are Less Likely to Receive Care by a Cardiologist During an Intensive Care Unit Admission for Heart Failure. , 2018, JACC. Heart failure.

[8]  Deepak L. Bhatt,et al.  Association of the Hospital Readmissions Reduction Program Implementation With Readmission and Mortality Outcomes in Heart Failure , 2017, JAMA cardiology.

[9]  W. Self,et al.  The burden of acute heart failure on U.S. emergency departments. , 2014, JACC. Heart failure.

[10]  K. Swedberg,et al.  Heart failure in young adults: 20-year trends in hospitalization, aetiology, and case fatality in Sweden , 2013, European heart journal.

[11]  Xuan Cai,et al.  Lifetime risk for heart failure among white and black Americans: cardiovascular lifetime risk pooling project. , 2013, Journal of the American College of Cardiology.

[12]  Daniel Levy,et al.  Accuracy of Death Certificates for Coding Coronary Heart Disease as the Cause of Death , 1998, Annals of Internal Medicine.

[13]  H M Rosenberg,et al.  Age standardization of death rates: implementation of the year 2000 standard. , 1998, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.