Trends in Age-Adjusted Cardiovascular Mortality Rates with Hyperlipidemia among the United States Population, from 1999–2023: A CDC Wonder Database Study

Abstract

Background/Synopsis

Despite the progress made in managing hyperlipidemia in recent years, the mortality trends among the general population in the United States remain understudied. The lack of evidence in the demographic variations hampers the ability to implement evidence-based interventions on community-based levels. Our synthesis is to analyze the trends in hyperlipidemia-related mortality among United States residents by demographic characteristics such as age, gender, race or ethnicity, urbanization, and census region. Furthermore, state-wise age-adjusted mortality rates (AAMR) and county-wise data for highly prevalent states were subsequently analyzed.

Objective/Purpose

Prior studies have reported cardiovascular mortality rates in general, but they lack sufficiently updated data and trends among variable demographic groups suffering from hyperlipidemia. Furthermore, there haven't been any prior studies conducted to show specific correlations between mortality rates and certain geographically vulnerable areas.

Methods

We abstracted national mortality data from the multiple cause of death/underlying case of death files in the CDC WONDER database retrieved from death certificates nationwide. The ICD-10 codes (E78.0-E78.9) were used to identify any type of hyperlipidemia-related deaths (including familial hypercholesterolemia) among the United States population from 1999 to 2023 in the multiple causes of death section. While ICD codes for cardiovascular (circulatory) system were identified by using I00–I99 for the underlying cause of death as a sensitivity analysis to only measure cardiovascular-related mortality in the hyperlipidemic population. Trends in age-adjusted mortality rate (AAMR) were assessed using joinpoint regression analysis (version 5.0.2) and the data was reported per 100,000 population. For 10-year increment age groups, only crude mortality rates were reported. Results were expressed as annual percentage changes (APC), average annual percentage changes (AAPC), and 95% confidence intervals (CI). For urbanization, the 2013 NCHS Urban-Rural Classification Scheme for Counties was used.

Results

Between 1999 and 2023, a total of 639,786 hyperlipidemia patients died secondary to cardiovascular causes within the United States (AAMR = 7.1 per 100,000; 95% CI: 7.0–7.2). Overall mortality trends increased at an annual rate of 6.21% (95% CI: 5.41–7.01) and were much higher in females from 1999–2006 and then 2018–2023; however, in the male population, APC was evidently higher in 1999–2006 and 2018–2021, respectively. Specifically, the trends in crude mortality rate would increase with each age group in 10-year increments, with the most steep rises from 1999–2004 and then 2018 onwards (P<0.001). Hispanic race is least affected amongst all subgroups; however, both non-Hispanic whites and more recently non-Hispanic blacks were increasingly highly affected (from 2018 onwards). Both suburban and rural areas (after 2019) are increasingly prevalent across the rural-urban divide (P<0.001). States in the top 90th percentile included Vermont (crude rate = 17.12), West Virginia (crude rate = 14.07), Hawaii (crude rate = 13.67), North Dakota (crude rate = 13.61), Rhode Island (crude rate = 13.38), and Iowa (crude rate = 13.18).

Conclusions

Cardiovascular mortality among the US population with a diagnosis of hyperlipidemia has been anticipated to be increasing overall from 1999 to 2023, but with varying trends by age groups, gender, race/ethnicity, urbanization, and census region. This study will highlight the need for enhanced public health surveillance to better understand the scope of hyperlipidemia-related cardiovascular mortality and identify high-risk demographic and regional subgroups for targeted interventions.