Temporal Trends in Cardiovascular Mortality in Underlying Viral Hepatitis: A Retrospective Analysis of Gender, Racial/Ethnic, and Regional Disparities

Abstract

Objective

This study aimed to investigate contemporary trends in mortality related to cardiovascular disease and viral hepatitis.

Methods

We conducted a retrospective analysis using data from the CDC-WONDER dataset. Our study cohort consisted of adults aged ≥ 15 years, where both cardiovascular disease and viral hepatitis were identified as an underlying or contributory cause of death between 1999 and 2020. Crude and age-adjusted mortality rates (AAMR) per 1 000 000 population were extracted. Joinpoint regression analysis was utilized to calculate annual percentage change (APC) of each trend.

Results

The overall AAMR exhibited a notable increase from 15.2 in 1999 to 24.9 in 2020. However, a recent decline was observed from 2013 to 2020 (APC: −2.1; 95% confidence interval [CI]: −3.4 to 0.65). African Americans experienced the highest mortality rate, surpassing that of Whites by more than twofold (AAMR: 20.3). Middle-aged adults (35–54 years) faced the greatest mortality burden among all other age groups. Urban–rural disparities were significant, with urban areas showing substantially higher AAMRs compared to rural areas. Notably, urban AAMR decreased between 2013 and 2020 (APC: −2.7).

Conclusion

The observed decrease in mortality related to cardiovascular disease and viral hepatitis over the past decade can be attributed to several factors, including heightened awareness and screening efforts, the introduction of novel and improved direct-acting antiviral therapies, and the implementation of integrated public health models.